Glioma-White Matter Tract Interactions: A dMRI-Based Three-Tier Classification and Its Clinical Relevance

Abstract 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 MRI from 360 glioma patients who underwent craniotomy were analyzed. Using automatic fiber tractography, glioma-tract relationships were categorized into three types: displacement, infiltration, and disruption. Double immunohistochemical staining for IDH and MBP 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 < 0.001). Displacement and infiltration types were more common in IDH-mutant gliomas (P < 0.001). Displacement-type tracts were significantly associated with higher rates of complete tumor resection compared to infiltration types (P = 0.015). In corticospinal tract involved cases, displacement-type tumors demonstrated no significant postoperative motor strength changes, whereas infiltration (P < 0.001) and disruption types (P = 0.013) 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.