DTT should be taken cautiously before drawing conclusions in brain stem cavernomas.
Clinically relevant damage of white matter tracts might not be detected by DTT.
DTT may over-estimate damage to the brain stem white matter tracts.
Diffusion tensor tractography (DTT) might reflect the postoperative clinical outcome of the patients with brain stem (BS) tumors correlating well with the neurological symptoms, but cavernous malformation (CM) is a hemorrhagic tumor prone to artifacts that may limit DTT. We set out to determine the correlation of DTT findings with the neurological examination before and after surgical resection in patients with BSCMs.
Materials and methods
DTT findings were evaluated bilaterally for fiber tract displacement or deviation, deformation and interruption in every patient before and after the surgery. Neurological examination was performed at admission, discharge and outpatient follow-up visit. The sensitivity, specificity, positive and negative predictive values of DTT were calculated both pre- and post-operatively.
There were 25 patients (9 men 16 women) with a mean age of 39.5±13.9 years. The mean size of the CMs was 6909±8374mm3 (range: 180–38,220mm3) The mean follow-up time was 42.7±23.2 months (range: 8 to 112 months). Preoperatively, the sensitivity, specificity, positive and negative predictive values of DTT for corticospinal tracts (CST) and medial lemnisci (ML) were 100%, 60%, 38.4%, 100% and 87.5%, 11.7%, 31.8%, 66.6%, respectively. Postoperatively, the sensitivity, specificity, positive and negative predictive values of DTT for CSTs and ML were 100%, 64.7%, 40%, 100% and 100%, 0%, 33.3%, 66.6%, respectively.
Positive findings on DTT such as fiber tract deviation, deformation, disruption or interruption should be taken cautiously before drawing conclusions of a clinically relevant damage of white matter tracts.Le texte complet de cet article est disponible en PDF.
Keywords : Brain stem, Cavernoma, Cavernous malformation, Diffusion tensor imaging, Diffusion tensor tractography
|☆|| Name of Institutional Review Board (IRB)/Ethics Committee: Yeditepe University Ethical Committee. IRB Approval Number: 758.
|☆☆|| All coauthors meet the criteria for authorship of the manuscript.