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Updated: May 9, 2026
DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions
Published on: August 26, 2014
Is intraoperative diffusion tensor imaging at 3.0T comparable to subcortical corticospinal tract mapping?
Svatopluk Ostrý1, Tomáš Belšan, Jakub Otáhal
1*Department of Neurosurgery, First Medical Faculty, Charles University in Prague, Central Military Hospital-Military University Hospital Prague, Czech Republic; ‡Department of Radiology, Central Military Hospital-Military University Hospital Prague, Czech Republic; and §Department of Developmental Epileptology, Institute of Physiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic.
Intraoperative MRI with diffusion tensor tractography (DTT) showed a correlation with neurophysiological mapping for corticospinal tract (CST) tumors. However, neurophysiological mapping remains superior for safe tumor resection near the CST.
Area of Science:
- Neurosurgery
- Neuroradiology
- Neurophysiology
Background:
- Surgery for brain tumors near the motor cortex carries a high risk of permanent motor deficits.
- Intraoperative primary motor cortex mapping and corticospinal tract (CST) monitoring are established techniques.
- Diffusion tensor tractography (DTT) for CST imaging is also feasible.
Purpose of the Study:
- To assess the utility of 3.0T intraoperative MRI (iMRI) with intraoperative DTT (iDTT) for surgeries near the CST.
- To compare iDTT with intraoperative neurophysiological CST mapping in glioma and metastasis resection.
Main Methods:
- Prospective study of 25 patients with supratentorial lesions near the CST.
- Subcortical CST mapping via monopolar stimulation.
- Preoperative and intraoperative 3.0T CST DTT.
- Recording motor-evoked potential threshold current and probe-CST distance.
Main Results:
- A significant linear correlation was found between current and distance for CST mapping both pre- and post-iMRI (R=0.470 and R=0.338, respectively).
- Radical resection was achieved in 68% of patients.
- Postoperative paresis occurred in 32%, with permanent deficits in 4%.
Conclusions:
- While iDTT shows correlation, neurophysiological mapping is superior for guiding tumor resection near the CST.
- Intraoperative image distortion occurred in 36% of cases.
- Combining iDTT and neurophysiological mapping can enhance surgical safety for select cases.
