BACKGROUND: High-definition fiber tractography (HDFT), an advanced white matter (WM) imaging technique, was evaluated in the management of supratentorial cavernous malformations.
OBJECTIVE: To investigate the relationship of cavernous malformations to the relevant perilesional WM tracts with HDFT and to characterize associated changes first qualitatively and then quantitatively with our novel imaging measure, quantitative anisotropy (QA).
METHODS: Imaging analysis was carried out by researchers blinded to the clinical details. Contralateral WM tracts were used for comparison. Mean QA values were obtained for whole WM tracts. Qualitatively affected superior longitudinal fasciculus/arcuate fibers and corticospinal tracts were further analyzed with the use of mean QA values for the perilesional segments.
RESULTS: Of 10 patients, HDFT assisted with the decision-making process and the offer of surgical resection in 2 patients, lesion approach and removal in 7 patients, and conservative management in 1 patient. Of 17 analyzed WM tracts, HDFT demonstrated partial disruption in 2 tracts, complete disruption in 2 tracts, a combination of displacement and partial disruption in 1 tract, displacement only in 7 tracts, and no change in 5 tracts. Qualitative changes correlated with clinical symptoms. Mean QA values for the whole WM tracts were similar, with the exception of 1 case demonstrating complete disruption of 2 WM tracts. QA-based perilesional segment analysis was consistent with qualitative data in 5 assessed WM tracts.
CONCLUSION: HDFT illustrated the precise spatial relationship of cavernous malformations to multiple WM tracts in a 3-dimensional fashion, optimizing surgical planning, and demonstrated associated disruption and/or displacement, with both occurring perilesionally. These changes were supported by our quantitative marker, which needs further validation.
ABBREVIATIONS: AF, arcuate fasciculus
CM, cavernous malformation
CMU, Carnegie Mellon University
CST, corticospinal tract
DSI, diffusion spectrum imaging
DTI, diffusion tensor imaging
FA, fractional anisotropy
HDFT, high-definition fiber tractography
QA, quantitative anisotropy
SLF, superior longitudinal fasciculus
UF, uncinate fasciculus
WM, white matter
*Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
‡Learning and Research Development Center, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania;
§Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania
Correspondence: Juan C. Fernandez-Miranda, MD, Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, 200 Lothrop St, PUH B-400, Pittsburgh, PA 15213. E-mail: email@example.com
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Received November 01, 2013
Accepted February 07, 2014