Development of a Probabilistic Atlas of Resection Rates of Supratentorial Eloquent Diffuse Gliomas in Adults

Introduction: In diffuse gliomas it is still difficult to predict the extent of surgical resection quantitatively or the clinical course of the disease based only on preoperative MRI. Our main objective was to develop a probabilistic 3D cerebral atlas for eloquent supratentorial diffuse gliomas in adults.

Methods: To develop the atlas we based on a clinical-radiological database organized according to the Brain Imaging Data Structure. Performing MRI spatial normalization on a reference space (MNI152) via the SPM12 software and semi-automatic tumor segmentation on preoperative MRI, of any postoperative residue, and possible diffusion restrictions. Normalized volumes were extracted from the segmented regions of interest with direct quality control by the first author and random sampling by the senior author. Creation of spatial frequency maps and statistical probabilistic maps of eloquent diffuse gliomas correlated with relevant clinical data, using a Voxel-wise Lesion Symptom Mapping technology.

Results: A total of 320 patients were included, 1600 normalized MRI sequences and 954 normalized volumes were exported for analysis, including 212 treated with addiction or voxel subtraction scripts. Probability maps (p < 0.05) showed a correlation between the infiltration of the tumor in regions normally occupied by the deep white matter tracts (corticospinal tracts on both sides, arcuate fasciculus, and inferior fronto-occipital fasciculus on the left), and the probability of presenting a degraded neurological state both preoperatively and postoperatively, as well as an increased risk of incomplete resection, with a significant distribution of tumor residues in these corresponding areas.

Conclusion : The creation of an atlas capable of predicting the risks associated with preoperative surgery was possible. Further development could make it possible to estimate the risks associated with the location of the tumor even more precisely, helping the surgeon in the decision-making process. Patients could also benefit from such a tool during presurgical counseling.