Glioma-white matter tract interactions: A diffusion magnetic resonance imaging-based 3-tier classification and its clinical relevance.

Background: This study proposed a classification system for the interaction between gliomas and white matter tracts, exploring its potential associations with clinical characteristics, tumor pathological subtypes, and patient outcomes.

Methods: Clinical data and diffusion magnetic resonance imageing (dMRI) from 360 glioma patients who underwent craniotomy were analyzed. Using automatic fiber tractography, glioma-tract relationships were categorized into 3 types: displacement, infiltration, and disruption. Double immunohistochemical staining for isocitrate dehydrogenase (IDH) and myelin basic protein was performed on neuronavigation-guided tissue samples to validate the imaging-based classifications. The clinical implications of these classifications on the extent of tumor resection, postoperative motor function, and survival outcomes were evaluated.

Results: Among the patients, 35 (9.7%) were categorized as displacement type, 283 (78.6%) as infiltration type, and 42 (11.7%) as disruption type. Disruption-type tracts were predominantly associated with IDH wild-type gliomas (87.2%), significantly higher than infiltration (28.5%) and displacement types (23.5%) (P < .001). Displacement and infiltration types were more common in IDH-mutant gliomas (P < .001). Displacement-type tracts were significantly associated with higher rates of gross tumor resection compared to infiltration types (P = .015). In corticospinal tract involved cases, displacement-type tumors demonstrated no significant postoperative motor strength changes, whereas infiltration (P < .001) and disruption types (P = .013) were highly associated with postoperative motor deficits. Histological results aligned with dMRI-based classifications.

Conclusions: This dMRI-based classification of glioma-tract interactions is significantly associated with tumor pathology, resection outcomes, functional prognosis, and survival, providing a valuable tool for personalized and precise surgical planning.