Diffusion-tensor Imaging and Tractography Application in Pre-operative Planning of Intra-axial Brain Lesions

Gliomas are the most common brain tumors that diffusely infiltrate the surrounding white matter (WM) tracts. Conventional MRI is commonly used for tumor localization and characterization. However, this does not give precise information about the WM infiltration surrounding the tumor. Diffusion-tensor imaging (DTI) is a non-invasive magnetic resonance (MR) technique that measures WM tissue integrity and tractography (fiber tracking) used to investigate the preferential directionality of diffusion. DTI allows visualization of WM tracts in the immediate vicinity of brain tumors that permit maximum tumor resection while also preserving the eloquent brain areas. The relation of tumors with the white matter tracts (deviation, infiltration, and disruption) has been one the most important initial applications of DTI. The fibers can be infiltrated in normal-appearing areas, and abnormal-appearing areas of the brain can show anatomically intact fibers. In the surgical planning of brain tumors, surgery is aided by knowing the proximity and relative position of the tumor to the adjacent WM tracts. The aim of the present study is to assess the role of DT tractography (DTT) in preoperative mapping of major WM tracts in relation to brain tumors.