Diffusion Tensor Tractography Around Brain Tumors: Concepts and Applications

Standard clinical MR images, however anatomically detailed, generally do not allow the assessment of specific white matter (WM) fiber tracts. Diffusion tensor imaging (DTI) and DTIbased fiber tracking (“tractography”) have enabled unprecedented, in vivo visualization of individual WM tracts and their relationships with cerebral pathology. While much of the work in this field remains experimental, DTI is currently making its way into the clinical realm. It is no longer necessary to have a team of physicists and image processing specialists on hand in order to obtain DTI with tractography in a clinical setting. As tractography makes further inroads into clinical practice, an understanding of basic principles and applications will become increasingly important to neuroimaging specialists. This presentation begins with a brief summary of the basic principles underlying tractography, followed by a review of practical clinical applications including potential pitfalls. Time and space limitations prohibit a review of normal WM fiber tract anatomy but several references to DTI-specific anatomical reviews are provided.