The scientific value of tractography: accuracy vs usefulness

Tractography has emerged as a central tool for mapping the cerebral white matter architecture. However, its scientific value continues to be a subject of debate, given its inherent limitations in anatomical accuracy. This concise communication showcases key points of a debate held at the 2024 Tract-Anat Retreat, addressing the trade-offs between the accuracy and utility of tractography. While tractography remains constrained by limitations related to resolution, sensitivity, and validation, its usefulness and utility in areas such as surgical planning, disorder prediction, and the elucidation of brain development are emphasized. These perspectives highlight the necessity of context-specific interpretation, anatomically informed algorithms, and the continuous refinement of tractography workflows to achieve an optimal balance between accuracy and utility.