Clinical application of diffusion tensor tractography in classification of pediatric optic chiasmatic gliomas: a retrospective cohort study

Background The classification based on diffusion tensor tractography (DTT) has already been applied to the assessment of the optic chiasmatic glioma (OCGs), but the value of clinical application remains controversial. This study aimed to evaluate the predictive value of DTT classification for clinical phenotypes and to investigate the prognostic factors in children with OCGs. Methods A total of 53 patients with OCGs diagnosed and admitted between July 2015 and November 2022 were included. Clinical parameters were collected from medical records. The prognosis analysis comprised clinical, endocrinologic, ophthalmologic and pathologic during different time spans. On DTT images, the tumors were divided into the inflating endophytic type, the inflating exogenous type, and the infiltrative endophytic type based on DTT features. Regression analysis detected the evaluation of classifications which was assessed by determining age, gender, weight, diencephalic syndrome diagnosis record, vision-related data, endocrine-related indicators, surgery related indicators, survival data, chemotherapy, and radiotherapy. Results We observed that the proportion of males in the inflating exogenous type patients (10%) was significantly lower than other two types. The inflating endophytic type patients (median 9.5 kg, 4.2∼25.4 kg) had lower body weight at surgery than other two types, as well as higher prevalence of diencephalic syndrome (DS). Postoperative chemotherapy demonstrated a statistically significant protective effect on OS and EFS ( p = 0.032 and 0.017, respectively). Conclusion The DTT-based classification effectively identifies the inflating endophytic subtype, which is associated with a high incidence of diencephalic syndrome, and serves as a valuable tool for preoperative surgical guidance. Combined adjuvant chemotherapy represents a decisive therapeutic strategy that significantly prolongs long-term prognosis in pediatric OCG patients.