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Related Experiment Video

Updated: Mar 20, 2026

DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions
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Language pathway tracking: comparing nTMS-based DTI fiber tracking with a cubic ROIs-based protocol.

Chiara Negwer1,2, Nico Sollmann1,2, Sebastian Ille1,2

  • 1Department of Neurosurgery.

Journal of Neurosurgery
|May 28, 2016
PubMed
Summary

Navigated transcranial magnetic stimulation (nTMS)-based diffusion tensor imaging (DTI) fiber tracking (FT) better visualizes language pathways than cubic region-based protocols. However, the cubic ROI method remains effective for arcuate fascicle tracking.

Keywords:
AF = arcuate fascicleArF = arcuate fibersCST = corticospinal tractDCS = direct cortical stimulationDTI = diffusion tensor imagingFA = fractional anisotropyFT = fiber trackingMFL = minimum fiber lengthRMT = resting motor thresholdROI = region of interestSLF = superior longitudinal fascicleTMS = transcranial magnetic stimulationUF = uncinate fasciclecortical mappingfMRI = functional MRIfiber trackinglanguagenTMS = navigated transcranial magnetic stimulationnavigated transcranial magnetic stimulationrTMS = repetitive navigated transcranial magnetic stimulationspace-occupying lesionssubcorticalsurgical technique

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Area of Science:

  • Neurosurgery
  • Neuroimaging
  • Brain Mapping

Background:

  • Diffusion tensor imaging (DTI) fiber tracking (FT) is crucial for glioma surgery, especially for eloquent lesions.
  • Accurate visualization of language pathways aids surgical planning and patient outcomes.
  • Current methods for language pathway tractography have varying degrees of reproducibility.

Purpose of the Study:

  • To compare a novel navigated transcranial magnetic stimulation (nTMS)-based DTI FT approach for language pathways with a standard cubic regions of interest (ROIs) protocol.
  • To evaluate the efficacy of both methods in visualizing various language-related fiber tracts in patients with brain lesions.

Main Methods:

  • Thirty-seven patients with left-sided perisylvian lesions underwent language mapping using repetitive nTMS.
  • DTI FT was performed using both a cubic ROIs-based protocol and an nTMS-based DTI FT approach.
  • Standardized parameters (minimal fiber length: 50 mm, fractional anisotropy: 0.2) and clinical tractography software were used.

Main Results:

  • Both methods successfully visualized language-related fiber tracts in all patients.
  • The nTMS-based DTI FT detected 76.0% of language-related fiber tracts, significantly higher than the 39.9% detected by the cubic ROIs protocol.
  • The cubic ROIs protocol showed superior results for arcuate fascicle tracking (97.3% vs. 75.7% for nTMS-based DTI FT).

Conclusions:

  • The cubic ROIs-based protocol is effective for arcuate fascicle tractography.
  • The nTMS-based DTI FT approach offers superior visualization of broader language-related fiber tracts compared to the cubic ROIs method.
  • nTMS-based DTI FT represents an advancement in mapping language pathways during neurosurgical planning.