Artikel
Evaluation of brain tumor regrowth in relation to motor areas – a multimodal approach
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Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Glioma cells spread towards blood-supply-sufficient microenvironments. Since neuronal activity in response to movement, for instance, induces a higher regional blood flow and oxygenation level in the respective area of activation, we examined whether glioma recurrences show a grow pattern towards motor-eloquent areas.
Methods: 60 patients with motor-eloquent high-grade gliomas (HGGs) were enrolled. All patients underwent magnetic resonance imaging (MRI) and navigated transcranial magnetic stimulation (nTMS) for motor mapping prior to surgery and suffered a relapse during long-term follow-up. Motor-eloquent areas were defined via nTMS and nTMS-based tractography. According to postoperative MRI, patients were separated into three groups: patients without a residual tumor (group 1), patients with a residual tumor moving away from motor areas (group 2), and patients with a residual tumor moving towards motor areas (group 3).
Results: Average growth towards motor areas mapped by nTMS was 2.1 ± 4.5 mm/month in the FLAIR sequences and 2.2 ± 6.1 mm/month in the contrast-enhanced T1-weighted sequences. The major growth direction was towards motor eloquent areas as defined by nTMS in all groups. Moreover, there was no significant difference in growth speed between the three groups for contrast-enhanced T1-weighted (group 1: 1.1 ± 2.0 mm/month, group 2: 1.4 ± 3.5 mm/month, group 3: 4.5 ± 7.7 mm/month) as well as FLAIR sequences (group 1: 1.5 ± 1.3 mm/month, group 2: 0.8 ± 3.4 mm/month, group 3: 3.8 ± 5.7 mm/month). Positive values mean growth towards the tumor.
Conclusion: This study suggests a new strategy to predict tumor regrowth patterns, which could improve the surgical but also radiotherapy planning.