Application of diffusion tensor imaging combined with fluorescein sodium dyeing in surgery of high-grade gliomas in functional brain areas

Abstract

Objective To investigate the clinical application of magnetic resonance diffusion tensor imaging (DTI) combined with fluorescein sodium dyeing (FLS) in surgery of high-grade gliomas (HGG) in functional brain areas. Methods From October 2014 to December 2016, a total of 95 cases of HGG in functional brain areas were admitted to Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University and their data were retrospectively analyzed. In the observation group, 49 patients underwent preoperative MRI scanning, enhancement and DTI, and FLS was applied to guide the removal of tumor; in the control group, 46 patients received MRI scanning and enhancement preoperatively, and the tumor was removed by conventional operation. Postoperatively, all patients underwent MRI scanning and enhancement within 72 hours for assessment of the resection extent. The changes of muscle strength and Karnofsky performance scale (KPS) scores were evaluated at 1 month post surgery. Results The rate of total resection was significantly higher in the observation group (83.7%) than in control group (45.7%) (P<0.001). The rate of muscle strength reduction post surgery was significantly lower in observation group than in control (20.4% vs. 47.8%, P=0.005). KPS scores in the observation group were significantly higher than those in control (73.5% vs. 47.8%, P=0.029). In the observation group, the sensitivity of FLS in identifying tumor tissue was 91.7% (44/48) and the specificity was 90.0% (45/50). Conclusion The application of DTI combined with FLS could facilitate maximal resection of HGG in functional brain areas with a minimal loss of fiber bundles, reduce the disability rate and improve the quality of postoperative life, which is of great clinical significance. Key words: Glioma; Diffusion tensor imaging; Neurosurgical procedures; Fluorescein sodium; Brain functional areas