Neurosurgery 92:1234–1242, 2023
Glioblastoma (GBM) preferred to inﬁltrate into white matter (WM) beyond the recognizable tumor margin.
OBJECTIVE: To investigate whether ﬁber density (FD) and structural brain connectome can provide meaningful information about WM destruction and glioma cell inﬁltration.
METHODS: GBM cases were collected based on inclusion criteria, and baseline information and preoperative MRI results were obtained. GBM lesions were automatically segmented into necrosis, contrast-enhanced tumor, and edema areas. We obtained the FD map to compute the FD and lnFD values in each subarea and reconstructed the structural brain connectome to obtain the topological metrics in each subarea. We also divided the edema area into a nonenhanced tumor (NET) area and a normal WM area based on the contralesional lnFD value in the edema area, and computed the NET ratio.
RESULTS: Twenty-ﬁve GBM cases were included in this retrospective study. The FD/lnFD value and topological metrics (aCp, aLp, aEg, aEloc, and ar) were signiﬁcantly correlated with GBM subareas, which represented the extent of WM destruction and glioma cell inﬁltration. The FD/lnFD values and topological parameters were correlated with the NET ratio. In particular, the lnFD value in the edema area was correlated with the NET ratio (coefﬁcient, 0.92). Therefore, a larger lnFD value indicates more severe glioma inﬁltration in the edema area and suggests an extended resection for better clinical outcomes.
CONCLUSION: The FD and structural brain connectome in this study provide a new insight into glioma inﬁltration and a different consideration of their clinical application in neurooncology.