Korean J Radiol.  2017 Oct;18(5):844-851. 10.3348/kjr.2017.18.5.844.

Optimal Factors of Diffusion Tensor Imaging Predicting Corticospinal Tract Injury in Patients with Brain Tumors

• Min ZG
• Niu C
• Zhang QL
• Zhang M
• Qian YC

• KMID: 2427221
• DOI: http://doi.org/10.3348/kjr.2017.18.5.844

Abstract

OBJECTIVE
To identify the optimal factors in diffusion tensor imaging for predicting corticospinal tract (CST) injury caused by brain tumors.
MATERIALS AND METHODS
This prospective study included 33 patients with motor weakness and 64 patients with normal motor function. The movement of the CST, minimum distance between the CST and the tumor, and relative fractional anisotropy (rFA) of the CST on diffusion tensor imaging, were compared between patients with motor weakness and normal function. Logistic regression analysis was used to obtain the optimal factor predicting motor weakness.
RESULTS
In patients with motor weakness, the displacement (8.44 ± 6.64 mm) of the CST (p = 0.009), minimum distance (3.98 ± 7.49 mm) between the CST and tumor (p < 0.001), and rFA (0.83 ± 0.11) of the CST (p < 0.001) were significantly different from those of the normal group (4.64 ± 6.65 mm, 14.87 ± 12.04 mm, and 0.98 ± 0.05, respectively) (p = 0.009, p < 0.001, and p < 0.001). The frequencies of patients with the CST passing through the tumor (6%, p = 0.002), CST close to the tumor (23%, p < 0.001), CST close to a malignant tumor (high grade glioma, metastasis, or lymphoma) (19%, p < 0.001), and CST passing through infiltrating edema (19%, p < 0.001) in the motor weakness group, were significantly different from those of the patients with normal motor function (0, 8, 1, and 10%, respectively). Logistic regression analysis showed that decreased rFA and CST close to a malignant tumor were effective variables related to motor weakness.
CONCLUSION
Decreased fractional anisotropy, combined with closeness of a malignant tumor to the CST, is the optimal factor in predicting CST injury caused by a brain tumor.

Keyword

Brain tumor; Diffusion tensor imaging; DTI; MRI; Corticospinal tract; Motor function

MeSH Terms

Adolescent
Adult
Aged
Area Under Curve
Brain Neoplasms/*pathology
*Diffusion Tensor Imaging
Female
Glioma/pathology
Humans
Logistic Models
Male
Meningioma/pathology
Middle Aged
Prospective Studies
Pyramidal Tracts/*diagnostic imaging/injuries
ROC Curve
Young Adult

Figure

• 

  Fig. 1 Measuring displacement of affected CST.Displacement of affected CST was determined according to distance (m) between symmetrical position of contralateral CST and actual CST position. Vertical distance between contralateral CST and its symmetrical position to center line is same (a). CST = corticospinal tract

• 

  Fig. 2 ROC curves for predicting motor weakness.ROC curves of rFA, minimum distance, displacement and predicted probabilities from logistic regression model. Areas under curves were 0.92, 0.81, 0.69, and 0.96, respectively. rFA = relative fractional anisotropy, ROC = receiver operating characteristic

• 

  Fig. 3 Predictable value of CST passing through tumor.A, B. Affected CST (red) passes through low-grade glioma (WHO grade II) in left basal ganglia region. C. Some fiber tracts are interrupted. rFA of affected side is 0.54. Logistic regression result was positive. Right upper and lower extremity muscle strength were both level 4. WHO = World Health Organization

• 

  Fig. 4 Predictable value of CST close to malignant tumor.Affected CST (red) close to metastatic tumor is mildly displaced, and FA (A) is slightly decreased (rFA = 0.98) compared to contralateral CST (blue). Fibers passing through peritumoral edema (B) show integration (C). Logistic regression result was positive. Right upper and lower extremity muscle strength were both level 3. FA = fractional anisotropy

• 

  Fig. 5 Predictable value of decreased rFA.Affected CST (red) close to anaplastic astrocytoma (WHO grade III) is slightly displaced posteriorly, and FA (A) is decreased (rFA = 0.79) compared to contralateral CST (blue). Fibers passing through peritumoral edema (B) show integration (C). Logistic regression result was positive. Right upper and lower extremity muscle strength were both level 3.

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