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@ARTICLE{Jtten:901975,
      author       = {Jütten, Kerstin and Mainz, Verena and Gauggel, Siegfried
                      and Patel, Harshal Jayeshkumar and Binkofski, Ferdinand and
                      Wiesmann, Martin and Clusmann, Hans and Na, Chuh-Hyoun},
      title        = {{D}iffusion {T}ensor {I}maging {R}eveals {M}icrostructural
                      {H}eterogeneity of {N}ormal-{A}ppearing {W}hite {M}atter and
                      {R}elated {C}ognitive {D}ysfunction in {G}lioma {P}atients},
      journal      = {Frontiers in oncology},
      volume       = {9},
      issn         = {2234-943X},
      address      = {Lausanne},
      publisher    = {Frontiers Media},
      reportid     = {FZJ-2021-03949},
      pages        = {536},
      year         = {2019},
      abstract     = {Immunohistochemical data based on
                      isocitrate–dehydrogenase (IDH) mutation status have
                      redefined glioma as a whole-brain disease, while occult
                      tumor cell invasion along white matter fibers is inapparent
                      in conventional magnetic resonance imaging (MRI). The
                      functional and prognostic impact of focal glioma may however
                      relate to the extent of white matter involvement. We used
                      diffusion tensor imaging (DTI) to investigate
                      microstructural characteristics of whole-brain
                      normal-appearing white matter (NAWM) in relation to
                      cognitive functions as potential surrogates for occult white
                      matter involvement in glioma. Twenty patients (12
                      IDH-mutated) and 20 individually matched controls were
                      preoperatively examined using DTI combined with a
                      standardized neuropsychological examination. Tumor lesions
                      including perifocal edema were masked, and fractional
                      anisotropy (FA) as well as mean, radial, and axial
                      diffusivity (MD, RD, and AD, respectively) of the remaining
                      whole-brain NAWM were determined by using Tract-Based
                      Spatial Statistics and histogram analyses. The relationship
                      between extratumoral white matter integrity and cognitive
                      performance was examined using partial correlation analyses
                      controlling for age, education, and lesion volumes. In
                      patients, mean FA and AD were decreased as compared to
                      controls, which agrees with the notion of microstructural
                      impairment of NAWM in glioma patients. Patients performed
                      worse in all cognitive domains tested, and higher anisotropy
                      and lower MD and RD values of NAWM were associated with
                      better cognitive performance. In additional analyses,
                      IDH-mutated and IDH-wildtype patients were compared.
                      Patients with IDH-mutation showed higher FA, but lower MD,
                      AD, and RD values as compared to IDH-wildtype patients,
                      suggesting a better preserved microstructural integrity of
                      NAWM, which may relate to a less infiltrative nature of
                      IDH-mutated gliomas. Diffusion-based phenotyping and
                      monitoring microstructural integrity of extratumoral
                      whole-brain NAWM may aid in estimating occult white matter
                      involvement and should be considered as a complementary
                      biomarker in glioma.},
      cin          = {INM-4},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-4-20090406},
      pnm          = {5253 - Neuroimaging (POF4-525)},
      pid          = {G:(DE-HGF)POF4-5253},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {31293974},
      UT           = {WOS:000473055800002},
      doi          = {10.3389/fonc.2019.00536},
      url          = {https://juser.fz-juelich.de/record/901975},
}