Diffusion tensor imaging evaluation and long-term prognosis of patients with brain motor area low-grade gliomas_West China Medical Journal

Authors：

WANG Xijie ^1,2,3 , YU Songlin ^1,2,3 , LIN Song ^1,2,3 , ZUO Zhentao ⁴ ,  YU Tao ^1,2,3

1. Beijing Neurosurgical Institute, Beijing 100070, P. R. China;
2. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, P. R. China;
3. National Clinical Research Center for Neurological Diseases, Beijing 100070, P. R. China;
4. State Key Laboratory of Brain and Cognitive Sciences, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, P. R. China;

Corresponding?author：

YU Tao, Email: frankpumc@aliyun.com

Keywords：

Cerebral glioma; functional magnetic resonance imaging; diffusion tensor imaging; motor area

DOI：

10.7507/1002-0179.202511176

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Objective To analyze the diffusion tensor imaging (DTI) characteristics and long-term prognosis of low-grade gliomas located in motor functional areas, and to evaluate the clinical significance of DTI findings and their corresponding surgical strategies. Methods A total of 71 patients with low-grade gliomas in motor functional areas who underwent surgical treatment at Beijing Tiantan Hospital, Capital Medical University between January 2014 and January 2019 were retrospectively collected. All the patients received preoperative DTI, and the minimum distance between the corticospinal tract (CST) and the lesion was less than 10 mm. Morphological changes in the CST caused by tumor invasion were evaluated. The extent of resection (EOR), postoperative paralysis rates, and long-term follow-up hemiplegia rates were reviewed. Logistic regression was used to analyze the relationship between these outcomes and DTI groupings. Patients were followed up for progression-free survival and overall survival, and Cox regression was used to analyze factors affecting prognosis. Results Based on DTI findings, patients were divided into two groups: CST Intact Group (n=49, 69.0%) and the CST Disrupt Group (n=22, 31.0%). The mean tumor volume in the CST Intact Group was significantly smaller than that in the CST Disrupt Group [(35.2±5.0) vs. (56.1±11.2) cm³, P=0.006]. Gross total or subtotal resection was achieved in 47 patients (66.2%), while 24 patients (33.8%) underwent partial resection. Univariate logistic regression showed that the EOR was associated with tumor volume [odds ratio=1.019, 95% confidence interval (CI) (1.005, 1.033), P=0.002] but not with the preoperative neurological function (P=0.702), age (P=0.216), or the integrity of CST (P=0.215). Postoperatively, 23 patients experienced hemiplegia, and 7 patients still had mild hemiplegia after six months. The CST Disrupt Group was more likely to develop postoperative hemiplegia compared to the CST Intact Group (63.6% vs. 18.4%, P<0.001). Among the 71 patients, 17 experienced tumor recurrence within 8 to 84 months. Multivariate Cox regression analysis indicated that partial resection [hazard ratio (HR)=2.115, 95%CI (1.253, 3.570), P=0.008], CST disruption [HR=2.709, 95%CI (0.999, 7.349), P=0.050], and absence of 1p19q codeletion [HR=0.258, 95%CI (0.072, 0.926), P=0.038] independently increased the risk of recurrence. Conclusions Patients with low-grade gliomas involving CST disruption have a higher risk of postoperative hemiplegia and tumor recurrence. Preoperative DTI can accurately identify the degree of motor fiber bundle involvement. Precise surgical resection is conducive to improving the total resection rate, reducing postoperative hemiplegia, and extending progression-free survival.

Citation： WANG Xijie, YU Songlin, LIN Song, ZUO Zhentao, YU Tao. Diffusion tensor imaging evaluation and long-term prognosis of patients with brain motor area low-grade gliomas. West China Medical Journal, 2026, 41(5): 742-747. doi: 10.7507/1002-0179.202511176 Copy

1.	Yan JL, van der Hoorn A, Larkin TJ, et al. Extent of resection of peritumoral diffusion tensor imaging-detected abnormality as a predictor of survival in adult glioblastoma patients. J Neurosurg, 2017, 126(1): 234-241.
2.	D’Amico RS, Englander ZK, Canoll P, et al. Extent of resection in glioma–A review of the cutting edge. World Neurosurg, 2017, 103: 538-549.
3.	Hervey-Jumper SL, Berger MS. Maximizing safe resection of low- and high-grade glioma. J Neurooncol, 2016, 130(2): 269-282.
4.	Magill ST, Han SJ, Li J, et al. Resection of primary motor cortex tumors: feasibility and surgical outcomes. J Neurosurg, 2018, 129(4): 961-972.
5.	Bailey PD, Zacà D, Basha MM, et al. Presurgical fMRI and DTI for the prediction of perioperative motor and language deficits in primary or metastatic brain lesions. J Neuroimaging, 2015, 25(5): 776-784.
6.	D’Andrea G, Trillo’ G, Picotti V, et al. Functional magnetic resonance imaging (fMRI), pre-intraoperative tractography in neurosurgery: the experience of Sant’ Andrea Rome University Hospital. Acta Neurochir Suppl, 2017, 124: 241-250.
7.	Khan KA, Jain SK, Sinha VD, et al. Preoperative diffusion tensor imaging: a landmark modality for predicting the outcome and characterization of supratentorial intra-axial brain tumors. World Neurosurg, 2019, 124: e540-e551.
8.	Mandelli ML, Berger MS, Bucci M, et al. Quantifying accuracy and precision of diffusion MR tractography of the corticospinal tract in brain tumors. J Neurosurg, 2014, 121(2): 349-358.
9.	Metwali H, Raemaekers M, Kniese K, et al. Reliability of functional magnetic resonance imaging in patients with brain tumors: a critical review and meta-analysis. World Neurosurg, 2019, 125: 183-190.
10.	Ohue S, Kohno S, Inoue A, et al. Accuracy of diffusion tensor magnetic resonance imaging-based tractography for surgery of gliomas near the pyramidal tract: a significant correlation between subcortical electrical stimulation and postoperative tractography. Neurosurgery, 2012, 70(2): 283-294.
11.	Castellano A, Bello L, Michelozzi C, et al. Role of diffusion tensor magnetic resonance tractography in predicting the extent of resection in glioma surgery. Neuro Oncol, 2011, 14(2): 192-202.
12.	Wang X, Zuo Z, Yu S, et al. Long-term clinical prognosis of patients with gliomas infiltrating corticospinal tract on DTI tractography. Chin Neurosurg J, 2025, 11(1): 26.
13.	Louis D N, Perry A, Reifenberger G, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol, 2016, 131(6): 803-820.
14.	National Comprehensive Cancer Network (U. S. ). The complete library of NCCN oncology practice guidelines. U. S. : National Comprehensive Cancer Network, 2000.
15.	D’Andrea G, Angelini A, Romano A, et al. Intraoperative DTI and brain mapping for surgery of neoplasm of the motor cortex and the corticospinal tract: our protocol and series in BrainSUITE. Neurosurg Rev, 2012, 35(3): 401-412.
16.	Duffau H. Functional mapping before and after low-grade glioma surgery: a new way to decipher various spatiotemporal patterns of individual neuroplastic potential in brain tumor patients. Cancers (Basel), 2020, 12(9): 2611.
17.	Southwell DG, Birk HS, Han SJ, et al. Resection of gliomas deemed inoperable by neurosurgeons based on preoperative imaging studies. J Neurosurg, 2018, 129(3): 567-575.
18.	Sollmann N, Zhang H, Fratini A, et al. Risk assessment by presurgical tractography using navigated TMS maps in patients with highly motor- or language-eloquent brain tumors. Cancers (Basel), 2020, 12(5): 1264.
19.	Desmurget M, Bonnetblanc F, Duffau H. Contrasting acute and slow-growing lesions: a new door to brain plasticity. Brain, 2007, 130(Pt 4): 898-914.
20.	Pujol S, Wells W, Pierpaoli C, et al. The DTI challenge: toward standardized evaluation of diffusion tensor imaging tractography for neurosurgery. J Neuroimaging, 2015, 25(6): 875-882.

1. Yan JL, van der Hoorn A, Larkin TJ, et al. Extent of resection of peritumoral diffusion tensor imaging-detected abnormality as a predictor of survival in adult glioblastoma patients. J Neurosurg, 2017, 126(1): 234-241.
2. D’Amico RS, Englander ZK, Canoll P, et al. Extent of resection in glioma–A review of the cutting edge. World Neurosurg, 2017, 103: 538-549.
3. Hervey-Jumper SL, Berger MS. Maximizing safe resection of low- and high-grade glioma. J Neurooncol, 2016, 130(2): 269-282.
4. Magill ST, Han SJ, Li J, et al. Resection of primary motor cortex tumors: feasibility and surgical outcomes. J Neurosurg, 2018, 129(4): 961-972.
5. Bailey PD, Zacà D, Basha MM, et al. Presurgical fMRI and DTI for the prediction of perioperative motor and language deficits in primary or metastatic brain lesions. J Neuroimaging, 2015, 25(5): 776-784.
6. D’Andrea G, Trillo’ G, Picotti V, et al. Functional magnetic resonance imaging (fMRI), pre-intraoperative tractography in neurosurgery: the experience of Sant’ Andrea Rome University Hospital. Acta Neurochir Suppl, 2017, 124: 241-250.
7. Khan KA, Jain SK, Sinha VD, et al. Preoperative diffusion tensor imaging: a landmark modality for predicting the outcome and characterization of supratentorial intra-axial brain tumors. World Neurosurg, 2019, 124: e540-e551.
8. Mandelli ML, Berger MS, Bucci M, et al. Quantifying accuracy and precision of diffusion MR tractography of the corticospinal tract in brain tumors. J Neurosurg, 2014, 121(2): 349-358.
9. Metwali H, Raemaekers M, Kniese K, et al. Reliability of functional magnetic resonance imaging in patients with brain tumors: a critical review and meta-analysis. World Neurosurg, 2019, 125: 183-190.
10. Ohue S, Kohno S, Inoue A, et al. Accuracy of diffusion tensor magnetic resonance imaging-based tractography for surgery of gliomas near the pyramidal tract: a significant correlation between subcortical electrical stimulation and postoperative tractography. Neurosurgery, 2012, 70(2): 283-294.
11. Castellano A, Bello L, Michelozzi C, et al. Role of diffusion tensor magnetic resonance tractography in predicting the extent of resection in glioma surgery. Neuro Oncol, 2011, 14(2): 192-202.
12. Wang X, Zuo Z, Yu S, et al. Long-term clinical prognosis of patients with gliomas infiltrating corticospinal tract on DTI tractography. Chin Neurosurg J, 2025, 11(1): 26.
13. Louis D N, Perry A, Reifenberger G, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol, 2016, 131(6): 803-820.
14. National Comprehensive Cancer Network (U. S. ). The complete library of NCCN oncology practice guidelines. U. S. : National Comprehensive Cancer Network, 2000.
15. D’Andrea G, Angelini A, Romano A, et al. Intraoperative DTI and brain mapping for surgery of neoplasm of the motor cortex and the corticospinal tract: our protocol and series in BrainSUITE. Neurosurg Rev, 2012, 35(3): 401-412.
16. Duffau H. Functional mapping before and after low-grade glioma surgery: a new way to decipher various spatiotemporal patterns of individual neuroplastic potential in brain tumor patients. Cancers (Basel), 2020, 12(9): 2611.
17. Southwell DG, Birk HS, Han SJ, et al. Resection of gliomas deemed inoperable by neurosurgeons based on preoperative imaging studies. J Neurosurg, 2018, 129(3): 567-575.
18. Sollmann N, Zhang H, Fratini A, et al. Risk assessment by presurgical tractography using navigated TMS maps in patients with highly motor- or language-eloquent brain tumors. Cancers (Basel), 2020, 12(5): 1264.
19. Desmurget M, Bonnetblanc F, Duffau H. Contrasting acute and slow-growing lesions: a new door to brain plasticity. Brain, 2007, 130(Pt 4): 898-914.
20. Pujol S, Wells W, Pierpaoli C, et al. The DTI challenge: toward standardized evaluation of diffusion tensor imaging tractography for neurosurgery. J Neuroimaging, 2015, 25(6): 875-882.

West China Medical Journal

Diffusion tensor imaging evaluation and long-term prognosis of patients with brain motor area low-grade gliomas

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