Comparative validation of automated presurgical tractography based on constrained spherical deconvolution and diffusion tensor imaging with direct electrical stimulation

• Published in: Human brain mapping Vol. 45; no. 6; pp. e26662 - n/a
• Main Authors: Radwan, Ahmed Mohamed, Emsell, Louise, Vansteelandt, Kristof, Cleeren, Evy, Peeters, Ronald, De Vleeschouwer, Steven, Theys, Tom, Dupont, Patrick, Sunaert, Stefan
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 15-04-2024
• Subjects: Adult; Aged; Brain Mapping - methods; Brain Mapping - standards; constrained spherical deconvolution; Cross-Sectional Studies; diffusion tensor imaging; Diffusion Tensor Imaging - methods; Diffusion Tensor Imaging - standards; direct electrical stimulation; Electric Stimulation - methods; Female; Humans; Male; Middle Aged; neurosurgery; Preoperative Care - methods; Preoperative Care - standards; presurgical planning; Pyramidal Tracts - diagnostic imaging; white matter; White Matter - diagnostic imaging; Young Adult; white matter; diffusion tensor imaging; presurgical planning; neurosurgery; direct electrical stimulation; constrained spherical deconvolution
• ISSN: 1065-9471; 1097-0193
• DOI: 10.1002/hbm.26662

Objectives
Accurate presurgical brain mapping enables preoperative risk assessment and intraoperative guidance. This cross‐sectional study investigated whether constrained spherical deconvolution (CSD) methods were more accurate than diffusion tensor imaging (DTI)‐based methods for presurgical white matter mapping using intraoperative direct electrical stimulation (DES) as the ground truth.
Methods
Five different tractography methods were compared (three DTI‐based and two CSD‐based) in 22 preoperative neurosurgical patients undergoing surgery with DES mapping. The corticospinal tract (CST, N = 20) and arcuate fasciculus (AF, N = 7) bundles were reconstructed, then minimum distances between tractograms and DES coordinates were compared between tractography methods. Receiver‐operating characteristic (ROC) curves were used for both bundles. For the CST, binary agreement, linear modeling, and posthoc testing were used to compare tractography methods while correcting for relative lesion and bundle volumes.
Results
Distance measures between 154 positive (functional response, pDES) and negative (no response, nDES) coordinates, and 134 tractograms resulted in 860 data points. Higher agreement was found between pDES coordinates and CSD‐based compared to DTI‐based tractograms. ROC curves showed overall higher sensitivity at shorter distance cutoffs for CSD (8.5 mm) compared to DTI (14.5 mm). CSD‐based CST tractograms showed significantly higher agreement with pDES, which was confirmed by linear modeling and posthoc tests (PFWE < .05).
Conclusions
CSD‐based CST tractograms were more accurate than DTI‐based ones when validated using DES‐based assessment of motor and sensory function. This demonstrates the potential benefits of structural mapping using CSD in clinical practice.
Presurgical white matter mapping using probabilistic CSD tractography is more accurate and sensitive than manual DTI FACT or automated probabilistic DTI tractography. This study included 22 patients with DES data, which was used as the ground truth. Distance in mm between tractograms and DES data resulted in 860 datapoints, 685 of which belonged to the CST and were used for linear modeling; AUC, area under the curve; CSD, constrained spherical deconvolution; DTI, diffusion tensor imaging; FWE, family‐wise error rate; TCK, tractogram/tractography.