Glioma-white matter tract interactions: A diffusion magnetic resonance imaging-based 3-tier classification and its clinical relevance
Jia Hu, Hongbo Bao, Xing Liu, Shengyu Fang, Zeya Yan, Zihan Wang, Renwu Zhang, Ruiyang Wang, Tianjie Pu, Chao Li, Zaixu Cui, Tao Jiang, Yinyan Wang
Abstract
BACKGROUND: This study proposed a classification system for the interaction between gliomas and white matter tracts, exploring its potential associations with clinical characteristics, tumor pathological subtypes, and patient outcomes. METHODS: Clinical data and diffusion magnetic resonance imageing (dMRI) from 360 glioma patients who underwent craniotomy were analyzed. Using automatic fiber tractography, glioma-tract relationships were categorized into 3 types: displacement, infiltration, and disruption. Double immunohistochemical staining for isocitrate dehydrogenase (IDH) and myelin basic protein was performed on neuronavigation-guided tissue samples to validate the imaging-based classifications. The clinical implications of these classifications on the extent of tumor resection, postoperative motor function, and survival outcomes were evaluated. RESULTS: Among the patients, 35 (9.7%) were categorized as displacement type, 283 (78.6%) as infiltration type, and 42 (11.7%) as disruption type. Disruption-type tracts were predominantly associated with IDH wild-type gliomas (87.2%), significantly higher than infiltration (28.5%) and displacement types (23.5%) (P < .001). Displacement and infiltration types were more common in IDH-mutant gliomas (P < .001). Displacement-type tracts were significantly associated with higher rates of gross tumor resection compared to infiltration types (P = .015). In corticospinal tract involved cases, displacement-type tumors demonstrated no significant postoperative motor strength changes, whereas infiltration (P < .001) and disruption types (P = .013) were highly associated with postoperative motor deficits. Histological results aligned with dMRI-based classifications. CONCLUSIONS: This dMRI-based classification of glioma-tract interactions is significantly associated with tumor pathology, resection outcomes, functional prognosis, and survival, providing a valuable tool for personalized and precise surgical planning.