Artikel
Comparison of nTMS-based DTI fibertracking of language pathways with the Stieglitz protocol
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Autoren
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Chiara Negwer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München; TUM-Neuroimaging Center
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Sebastian Ille
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München; TUM-Neuroimaging Center
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Nico Sollmann
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München; TUM-Neuroimaging Center
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Theresa Hauck
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München; TUM-Neuroimaging Center
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Bernhard Meyer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München
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Sandro M. Krieg
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München; TUM-Neuroimaging Center
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Diffusion tensor imaging fiber tracking (DTI-FT) is widely used in modern glioma surgery within the last years. Yet, only a limited number of studies investigated the tracking of language-related fiber tracts. Since proved for nTMS-based motor mapping, this study compares the newly developed nTMS-based DTI fibertracking of language pathways with the most reproducible protocol for language pathway tractography published by Stieglitz et al. for the arcuate fascicle.
Method: 38 patients with left-sided perisylvian lesions underwent language mapping by repetitive navigated transcranial magnetic stimulation (rTMS). First, DTI FT was performed with the protocol created by Stieglitz et. al in 2011: Three seed voxels were placed along the opercular part of the IFG, the inferior part of precentral gyrus, supramarginal gyrus, superior and medial temporal gyrus. Minimal fiber length was set to 50 mm, and fractional anisotropy (FA) to 0.2 (in case of poor results due to brain edema it was changed to 0.15). Afterwards, we performed DTI-FT by using language positive stimulation spots as seed regions, which were identified by rTMS. Minimal fiber length and FA were chosen equally (50 mm; 0.2). Both methods were performed with standard deterministic clinical tractography software (Brainlab, iPlanNet 3.0).
Results: Both methods visualized language-related fiber tracts (corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, frontooccipital fascicle) in all 38 patients. By using the Stieglitz protocol we detected 40.4% oft the above-named language related fiber tracts in the examined patients, as opposed to 76.3% by performing rTMS-based DTI-FT. For specifically tracking the arcuate fascicle, however, the Stieglitz protocol showed better results (97.4% vs. 76.3%).
Conclusions: The Stieglitz protocol was designed for arcuate fascicle fiber tracking, and we could show that it is still useful for this intention. However, concerning the visualization of other language related fiber tracts the rTMS-based DTI-FT showed superior results.
