Automated vs. conventional tractography in multiple sclerosis: Variability and correlation with disability

Diffusion-tensor-imaging fiber tractography enables interrogation of brain white matter tracts that subserve different functions. However, tract reconstruction can be labor and time intensive and can yield variable results that may reduce the power to link imaging abnormalities with disability. Automated segmentation of these tracts would help make tract-specific imaging clinically useful, but implementation of such segmentation is problematic in the presence of diseases that alter brain structure. In this work, we investigated an automated tract-probability-mapping scheme and applied it to multiple sclerosis, comparing the results to those derived from conventional tractography. We found that the automated method has consistently lower scan-rescan variability (typically 0.7-1.5% vs. up to 3% for conventional tractography) and avoids problems related to tractography failures within and around lesions. In the corpus callosum, optic radiation, and corticospinal tract, tract-specific MRI indices calculated by the two methods were moderately to strongly correlated, though systematic, tract-specific differences were present. In these tracts, the two methods also yielded similar correlation coefficients relating tract-specific MRI indices to clinical disability scores. In the optic tract, the automated method failed. With judicious application, therefore, the automated method may be useful for studies that investigate the relationship between imaging findings and clinical outcomes in disease.