Tractography is one way to predict the distribution of cortical functional domains preoperatively. Diffusion tensor tractography (DTT) is commonly used in clinical practice but is known to have limitations in delineating crossed fibers, which can be overcome by q-ball imaging tractography (QBT). In this study, we aimed to compare the reliability of these two methods, based on the spatial correlation between the arcuate fasciculus depicted by tractography and direct cortical stimulation (DCS) during awake surgery.
Fifteen patients with glioma underwent awake surgery with DCS. Tractography was depicted in a 3D computer graphic model preoperatively, which was integrated with the photograph of the actual brain cortex using our novel mixed-reality technology. The termination of the arcuate fasciculus depicted by either DTT or QBT and the results of DCS were compared, and sensitivity and specificity were calculated in speech-associated brain gyri: pars triangularis, pars opercularis, ventral precentral gyrus, and middle frontal gyrus.
QBT had significantly better sensitivity and lower false positive rate than DTT in the pars orpercularis. The same trend was noted for the other gyri.
QBT is more reliable than DTT in identification of the motor speech area and may be clinically useful in brain tumor surgery.
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Accurate Preoperative Identification of Motor Speech Area as Termination of Arcuate Fasciculus Depicted by Q-ball Imaging Tractography.
