Language pathway tracking: comparing nTMS-based DTI fiber tracking with a cubic ROIs-based protocol

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OBJECTIVE

Diffusion tensor imaging (DTI) fiber tracking (FT) has been widely used in glioma surgery in recent years. It can provide helpful information about subcortical structures, especially in patients with eloquent space-occupying lesions. This study compared the newly developed navigated transcranial magnetic stimulation (nTMS)-based DTI FT of language pathways with the most reproducible protocol for language pathway tractography, using cubic regions of interest (ROIs) for the arcuate fascicle.

METHODS

Thirty-seven patients with left-sided perisylvian lesions underwent language mapping by repetitive nTMS. DTI FT was performed using the cubic ROIs–based protocol and the authors' nTMS-based DTI FT approach. The same minimal fiber length and fractional anisotropy were chosen (50 mm and 0.2, respectively). Both protocols were performed with standard clinical tractography software.

RESULTS

Both methods visualized language-related fiber tracts (i.e., corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and frontooccipital fascicle) in all 37 patients. Using the cubic ROIs-based protocol, 39.9% of these language-related fiber tracts were detected in the examined patients, as opposed to 76.0% when performing nTMS-based DTI FT. For specifically tracking the arcuate fascicle, however, the cubic ROIs-based approach showed better results (97.3% vs 75.7% with nTMS-based DTI FT).

CONCLUSIONS

The cubic ROIs-based protocol was designed for arcuate fascicle tractography, and this study shows that it is still useful for this intention. However, superior results were obtained using the nTMS-based DTI FT for visualization of other language-related fiber tracts.

ABBREVIATIONSAF = arcuate fascicle; ArF = arcuate fibers; CST = corticospinal tract; DCS = direct cortical stimulation; DTI = diffusion tensor imaging; FA = fractional anisotropy; fMRI = functional MRI; FT = fiber tracking; MFL = minimum fiber length; nTMS = navigated transcranial magnetic stimulation; RMT = resting motor threshold; ROI = region of interest; rTMS = repetitive navigated transcranial magnetic stimulation; SLF = superior longitudinal fascicle; TMS = transcranial magnetic stimulation; UF = uncinate fascicle.
Article Information

Contributor Notes

INCLUDE WHEN CITING Published online May 27, 2016; DOI: 10.3171/2016.2.JNS152382.Correspondence Sandro M. Krieg, Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, Munich 81675, Germany. email: sandro.krieg@tum.de.

© AANS, except where prohibited by US copyright law.

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