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. 2019 Jun;161(6):1125-1137.
doi: 10.1007/s00701-019-03899-0. Epub 2019 Apr 19.

Manual for clinical language tractography

Lucius Fekonja  1   2 , Ziqian Wang  3 , Ina Bährend  3 , Tizian Rosenstock  3 , Judith Rösler  3 , Lara Wallmeroth  3 , Peter Vajkoczy  3 , Thomas Picht  3   4
Affiliations

Manual for clinical language tractography

Lucius Fekonja et al. Acta Neurochir (Wien). 2019 Jun.

Abstract

Background: We introduce a user-friendly, standardized protocol for tractography of the major language fiber bundles.

Method: The introduced method uses dMRI images for tractography whereas the ROI definition is based on structural T1 MPRAGE MRI templates, without normalization to MNI space. ROIs for five language-relevant fiber bundles were visualized on an axial, coronal, or sagittal view of T1 MPRAGE images. The ROIs were defined based upon the tracts' obligatory pathways, derived from literature and own experiences in peritumoral tractography.

Results: The resulting guideline was evaluated for each fiber bundle in ten healthy subjects and ten patients by one expert and three raters. Overall, 300 ROIs were evaluated and compared. The targeted language fiber bundles could be tracked in 88% of the ROI pairs, based on the raters' result blinded ROI placements. The evaluation indicated that the precision of the ROIs did not relate to the varying experience of the raters.

Conclusions: Our guideline introduces a standardized language tractography method for routine preoperative workup and for research contexts. The ROI placement guideline based on easy-to-identify anatomical landmarks proved to be user-friendly and accurate, also in inexperienced test persons.

Keywords: Brain tumor surgery; Diffusion tensor imaging; Language; Neuroanatomy; Tractography.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Visualizations for ROI placements for AF. Coronal, sagittal, or axial views of ROI placements with tractogram result. Top left shows target region with fiber tractography, top right shows target region without fiber tractography, and bottom left shows anatomical key structures for guidance
Fig. 2
Fig. 2
Visualizations for ROI placements for FAT. Coronal, sagittal, or axial views of ROI placements with tractogram result. Top left shows target region with fiber tractography, top right shows target region without fiber tractography, and bottom left shows anatomical key structures for guidance
Fig. 3
Fig. 3
Visualizations for ROI placements for IFOF. Coronal, sagittal, or axial views of ROI placements with tractogram result. Top left shows target region with fiber tractography, top right shows target region without fiber tractography, and bottom left shows anatomical key structures for guidance
Fig. 4
Fig. 4
Visualizations for ROI placements for ILF. Coronal, sagittal, or axial views of ROI placements with tractogram result. Top left shows target region with fiber tractography, top right shows target region without fiber tractography, and bottom left shows anatomical key structures for guidance
Fig. 5
Fig. 5
Visualizations for ROI placements for UF. Coronal, sagittal or axial views of ROI placements with tractogram result. Top left shows target region with fiber tractography, top right shows target region without fiber tractography, and bottom left shows anatomical key structures for guidance
Fig. 6
Fig. 6
MRI-based lightbox overview with probabilistic fiber tractography results of the five major language fiber bundles. a Axial view. b Sagittal view. c Coronal view
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