Diffusion tensor imaging--arcuate fasciculus and the importance for the neurosurgeon

Area of Science:

• Neuroimaging
• Neuroanatomy
• Neurosurgery

Background:

• Tumors in eloquent brain areas (e.g., Broca, Wernicke) pose significant risks.
• Understanding white matter tract relationships is crucial for surgical planning.

Purpose of the Study:

• To visualize the arcuate fasciculus (AF) using diffusion tensor imaging (DTI).
• To demonstrate the AF's relationship with the corticospinal tract and visual pathway.
• To assess DTI's utility in eloquent brain areas.

Main Methods:

• DTI sequences were performed on 71 patients (2012-2014).
• 3-Tesla MRI with 32 gradient directions and Echo-Planar Imaging (EPI) was utilized.
• Parameters included a 2mm slice thickness and nearly isotropic 2x2x2 mm voxels.

Main Results:

• The arcuate fasciculus (AF) was successfully visualized bilaterally in 63 patients.
• Lesions disrupted or displaced AF fibers in affected patients.
• Visualization was challenging in cases with glioblastoma affecting specific AF sides.

Conclusions:

• DTI is a valuable, time-saving tool for visualizing the arcuate fasciculus (AF).
• This technique can help preserve patient morbidity in eloquent brain areas.
• DTI offers insights into white matter organization and postoperative fiber reorganization.