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DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions
Published on: August 26, 2014
The Value of White Matter Tractography by Diffusion Tensor Imaging in Altering a Neurosurgeon's Operative Plan
Georgios Alexopoulos1, Ulas Cikla2, Najib El Tecle1
1Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA.
World Neurosurgery
|September 9, 2019
Summary
Diffusion tensor imaging (DTI) tractography helps neurosurgeons identify interrupted white matter tracts near brain tumors. While it aids in aggressive tumor resection, DTI did not change the planned surgical approach in this study.
Area of Science:
- Neurosurgery
- Neuroradiology
- Neuroimaging
Background:
- Presurgical planning for supratentorial tumors near eloquent white matter (WM) tracts is critical.
- Diffusion tensor imaging (DTI) tractography offers detailed visualization of WM pathways.
Purpose of the Study:
- To determine if DTI tractography in presurgical planning alters neurosurgeons' operative strategies for supratentorial tumors adjacent to eloquent WM tracts.
Main Methods:
- Retrospective review of patients with supratentorial tumors and eloquent WM tracts who underwent DTI tractography.
- Classification of patients into 3 DTI groups based on WM tract integrity (intact, displaced, injured).
- Prospective blinded study where neurosurgeons reviewed MRI with and without DTI to assess impact on surgical approach.
Main Results:
- Neurosurgeons correctly estimated DTI group in 53-60% of motor, optic, and language tracts.
- DTI group 3 (injured tracts) was underestimated in 75% of motor and optic cases.
- DTI tractography did not alter the neurosurgeons' planned surgical approach.
Conclusions:
- DTI WM tractography aids in identifying interrupted motor and optic pathways.
- This identification allows for more aggressive tumor resection.
- Despite improved identification, DTI did not change the overall operative strategy.
