[Application of diffusion tensor imaging in neurosurgery]

Knowledge about integrity and location of fibre tracts arising from eloquent cortical areas is important to plan neurosurgical interventions and to allow maximization of resection of pathological tissue while preserving vital white matter tracts. Diffusion Tensor Imaging (DTI) is so far the only method to get preoperatively an impression of the individual complexity of nerve bundles. Thereby nerve fibres are not mapped directly. They are derived indirectly by analysis of the directional distribution of diffusion of water molecules which is influenced mainly by large fibre tracts. From acquisition to reconstruction and visualisation of the fibre tracts many representational stages and working steps have to be passed. Exact knowledge about problems of Diffusion Imaging is important for interpretation of the results. Particularly, brain tumor edema, intraoperative brain shift, MR-artefacts and limitations of the mathematical models and algorithms challenge DTI-developers and applicants.