Oliver Ganslandt

Differences in metabolism of fiber tract alterations in gliomas: a combined fiber density mapping and magnetic resonance spectroscopic imaging study.

BACKGROUNDnGliomas propagate diffusely throughout and along white matter structures. Glioma-related changes in structural integrity and metabolism are not detectable by standard magnetic resonance (MR) imaging.nnnOBJECTIVEnTo investigate differences in the metabolism of fiber tract alterations between gliomas grade II to IV by correlation of fiber density values with metabolite concentrations measured by fiber density mapping and MR spectroscopic imaging.nnnMETHODSnFiber density mapping and MR spectroscopic imaging were performed in 48 patients with gliomas WHO grade II to IV. Fiber density mapping data were used to define fiber tracts in tumoral and peritumoral areas. Structural integrity of fiber tracts was assessed as fiber density ipsilateral-to-contralateral ratio (FD ICR). Metabolite concentrations for choline-containing compounds and N-acetyl-aspartate were computed and correlated to FD ICR values after coregistration with anatomic MR imaging.nnnRESULTSnIn tumoral areas, choline-containing compound concentrations of altered fiber tracts were significantly different between low- and high-grade glioma and showed different courses for the correlations of FD ICR and choline-containing czeompounds. In high-grade glioma, increasing fiber destruction was associated with a massive progression in cell membrane proliferation. Peritumoral fiber structures showed significantly decreased N-acetyl-aspartate concentrations for all patients, but only patients with glioblastoma multiforme had significantly decreased fiber density compared with the contralateral side. Glioma grades II and III had significantly higher peritumoral FD ICR than glioblastoma multiforme.nnnCONCLUSIONnA multiparametric MR imaging strategy providing information about both structural integrity and metabolism of the tumor is required for detailed assessment of glioma-related fiber tract alterations, which in turn is essential for treatment planning.

Multimodal functional neuronavigation and intraoperative imaging

Neurosurgical resection techniques in glioma surgery have evolved from simple tumor debulking to a holistic concept which includes anatomy, function and metabolism both of tumor and adjacent brain parenchyma. Driven by the dichotomic aim not to induce neurological deterioration while attempting to achieve gross tumor resection, neurosurgeons have sought to improve surgical outcome with the help of modern image guided techniques. In this chapter the implementation of multimodal functional neuronavigation and intraoperative imaging in glioma surgery is described.