Current Applications of Diffusion Tensor Imaging and Tractography in Intracranial Tumor Resection

Abstract

In the treatment of brain tumors, surgical intervention remains a common and effective therapeutic option. Recent advances in neuroimaging have provided neurosurgeons with new tools to overcome the challenge of differentiating healthy tissue from tumor-infiltrated tissue, with the aim of increasing the likelihood of maximizing the extent of resection volume while minimizing injury to functionally important regions. Novel applications of diffusion tensor imaging (DTI), and DTI-derived tractography (DDT) have demonstrated that preoperative, non-invasive mapping of eloquent cortical regions and functionally relevant white matter tracts (WMT) is critical during surgical planning to reduce postoperative deficits, which can decrease quality of life and overall survival. In this review, we summarize the latest developments of applying DTI and tractography in the context of resective surgery and highlight its utility within each stage of the neurosurgical workflow: preoperative planning and intraoperative management to improve postoperative outcomes.

Keywords: diffusion tensor imaging; glioma; intracranial electrical stimulation; resection; tractography.

Figure 1

Comparison of DES current to distancefrom DDTfrom imaging performed intraoperatively (black) or pre/postoperatively (gray). Averages weighted by number of stimulation points divided by number of patients per study for both imaging methodologies (dash-lines). One publication studied the optic radiation (small arrow), all others studied the CST.