Application of diffusion tensor tractography in pediatric optic pathway glioma

Clinical article

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  • 1 Departments of Neurosurgery, Division of Pediatric Neurosurgery;
  • 2 Ophthalmology; and
  • 3 Radiology, Division of Pediatric Radiology, Stanford University School of Medicine, Stanford, California
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Object

Magnetic resonance imaging is commonly used in diagnosis and surveillance for optic pathway glioma (OPG). The authors investigated the role of diffusion tensor (DT) tractography in assessing the location of visual pathway fibers in the presence of tumor.

Methods

Data in 10 children with OPG were acquired using a 3T MRI generalized autocalibrating parallel acquisitions DT–echo planar imaging sequence (25 isotropic directions with a b value of 1000 seconds/mm2, slice thickness 3 mm). Fiber tractography was performed, with seed regions placed within the optic chiasm and bilateral nerves on the coronal plane, including the tumor and surrounding normal-appearing tissue. Tracking was performed with a curvature threshold of 30°.

Results

For prechiasmatic lesions, fibers either stopped abruptly at the tumor or traversed abnormally dilated nerve segments. Similar findings were seen with chiasmatic lesions, with an additional arrangement in which fibers diverged around the tumor. For each patient, DT tractography provided additional information about visual fiber arrangement in relation to the tumor that was not evident by using conventional MRI methods. Retrospective reconstruction of visual fibers in 1 patient with new postoperative hemianopia revealed an unexpected superior displacement of the optic tract that might have been helpful information had it been applied to preoperative planning or surgical navigation.

Conclusions

Optic pathway DT tractography is feasible in patients with OPG and provides new information about the arrangement of visual fibers in relation to tumors that could be incorporated into surgical navigation for tumor biopsy or debulking procedures.

Abbreviations used in this paper:DT = diffusion tensor; EP = echo planar; GRAPPA = generalized autocalibrating parallel acquisitions; NF1 = neurofibromatosis Type 1; ON = optic nerve; OPG = optic pathway glioma; ROI = region of interest.

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Contributor Notes

Address correspondence to: Robert M. Lober, M.D., Ph.D., Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, MC 5327, Stanford, California 94305-5327. email: roblober@stanford.edu.

Please include this information when citing this paper: published online August 17, 2012; DOI: 10.3171/2012.7.PEDS1270.

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