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Twenty major white matter tracts were reconstructed and each divided into 100 equidistant nodes. Direct tumor involvement was quantified across enhancing tumor, necrotic core, and edema regions. Remote white matter tissue properties were assessed through hemispheric asymmetry analysis of free water-corrected fractional anisotropy (FW-FA), mean diffusivity (FW-MD), and free water fraction (FWF) in non-tumor involved regions at standardized distances from radiological tumor margins.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      459 patients with unilateral glioma were included (361 glioblastoma, 87 astrocytoma, 11 oligodendroglioma). Glioblastoma demonstrated greater direct white matter involvement in enhancing tumor and necrotic core compared to astrocytoma and oligodendroglioma (\n                      <jats:italic>q<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>q<\/jats:italic>\n                      \u2009=\u20090.01, respectively). Beyond radiological tumor margins, glioblastoma and astrocytoma exhibited decreased FW-FA, while oligodendroglioma showed increased FW-FA (\n                      <jats:italic>q<\/jats:italic>\n                      \u2009=\u20090.008,\n                      <jats:italic>q<\/jats:italic>\n                      \u2009=\u20090.04, respectively). Distance-based analysis revealed that this effect was most prominent in the proximal peritumoral region and diminished with increasing distance from tumor margins.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Using FWE tractometry on a large clinical repository, we identified distinct pathology-specific patterns of white matter alteration. Glioblastoma showed extensive direct involvement and peritumoral microstructural changes, while oligodendroglioma demonstrated relatively preserved white matter architecture near tumor margins. These patterns reflect expected biological differences and provide a reproducible framework for characterizing extent of white matter involvement, with potential applications in presurgical planning and understanding recurrence patterns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-025-05370-w","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:13:05Z","timestamp":1765383185000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Free water elimination tractometry reveals local and remote white matter alterations in diffuse gliomas"],"prefix":"10.1007","volume":"176","author":[{"given":"Daniel J.","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Jaskir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A.","family":"Davis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel M.","family":"Stein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishant","family":"Sinha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard E.","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Manuel","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Grabowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Rokem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"5370_CR1","doi-asserted-by":"publisher","first-page":"v1","DOI":"10.1093\/neuonc\/noz150","volume":"21","author":"QT Ostrom","year":"2019","unstructured":"Ostrom QT, Cioffi G, Gittleman H et al (2019) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the united States in 2012\u20132016. 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All methods were carried out in accordance with relevant guidelines and regulations. The original data collection, including all experimental protocols, was performed in accordance with the Declaration of Helsinki and was approved by the University of California San Francisco Institutional Review Board. As a secondary analysis of publicly available de-identified data, this study was granted exemption from requiring additional institutional review board approval.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent to participate in the study was obtained from all participants (or their legal guardian) at the time of original data collection. As this study involved secondary analysis of publicly available de-identified data, additional consent was not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"115"}}