Diffusion tensor tractograghy can affect treatment strategy to remove brain occupying mass lesions

Radical resection of a pathological lesion along with the preservation of eloquent cerebral tissue is the principle goal of neurosurgery. Brain lesions are usually diagnosed by conventional magnetic resonance imaging (MRI), but this method is unable to describe the relationship between lesions and neighboring specific white matter (WM) tracts. Diffusion tensor tractograghy (DTT) is a new sophisticated imaging modality to reveal the neural fibers and their relationships with lesions. In the current study we assess that how diffusion tensor tractograghy can affect on treatment planning in patients afflicted by different types of brain lesions. In this prospective observational study, eight patients with brain mass lesion underwent conventional brain MRI pulse sequences and DTT imaging with 1.5 Tesla system using 64 independent diffusion encoding directions between December 2011 to January 2013.Acquired images were assessed by the neuroradiologist and neurosurgeon. Finally, the treatment strategies were compared using data before and after the tractograghy. The treatment strategy in six patients changed from radiotherapy into the craniotomy by using tractograghy data, in one patient changed from radio surgery to craniotomy and in one patient, neurosurgeon preferred to avoid operation. As we can infer from this study, based on the tractograghy results, the treatment technique may be changed, and the treatment plan could be devised with more accuracy and in case of surgery, may lead to less post-operative neurological deficits and better outcome results.