Objective There are a large number of prospective studies that use diffusion tensor imaging (DTI) to show the relationship between intracranial
tumors and white matter (WM) fibers. We studied the role of DTI in supratentorial intra-axial (ST-IA)
tumors of the brain in deciding the surgical approach with maximal resection and minimal or no deficit and in predicting the histological characterization of the
tumor and the neurological outcome. Methods A total of 91 cases of ST-IA
tumors were included in our study. The neurological status of the patients was assessed preoperatively, and the
tumor volume and DTI pattern were noted radiologically. Surgical plan was decided by the senior consultants of the neurosurgery department taking into consideration the findings of tractography and magnetic resonance imaging. The neurological status and the extent of resection were evaluated postoperatively, and the correlation between histopathology with DTI was studied. Results Of the 91 patients, 25 had high-grade
glioma (HGG), 60 had low-grade
glioma (LGG), and 6 were metastatic lesions. Gross total excisions were done mostly in patients with DTI showing displaced fibers and subtotal/partial resections were done mostly in disrupted/infiltrated tracts, which was statistically significant. The correlation between histopathology and tractography revealed that intact/displaced tracts were seen mostly in LGG (79%), whereas 86% of HGG showed disrupted/infiltrated fibers; both were statistically significant. Conclusion Preoperative DTI in ST-IA
brain tumors is an important tool for deciding the appropriate surgical approach for maximal safe resection, thus improving the post-op neurological outcome in patients. It also helps in predicting the
tumor histology while also serving as an important prognostication
indicator.