Historical Evolutions and Emerging Applications of Diffusion Tensor Imaging in Peripheral Nerve Assessment

Diffusion tensor imaging (DTI) has revolutionized neuroimaging by enabling a noninvasive visualization of tissue microstructure through the analysis of the apparent diffusion of water molecules. Originating from the foundational principles of Brownian motion and Fick's law, DTI evolved from early diffusion magnetic resonance imaging into an advanced diagnostic tool for in vivo characterization of axonal pathways. This review traces the historical development of DTI and evaluates its expanding clinical applications, particularly in assessing peripheral nerve pathologies. In this review, we conducted an extensive literature review focusing on key aspects of DTI, including its mathematical framework, image acquisition protocols, core parameters, and clinical applications. The review highlighted DTI's advancements, technical challenges, and diagnostic potential with a focus on peripheral nerve imaging. While DTI has been widely adopted for central nervous system disorders, it has recently demonstrated utility in peripheral nerve imaging. Peripheral nerve-specific protocols yield higher resolution and improved accuracy; however, motion artifacts, small nerve size, non-Gaussian diffusion behavior, and lack of standardization continue to limit DTI's implementation in this area. Overall, DTI offers a robust, noninvasive method for assessing peripheral nerve integrity and pathology, with growing clinical value in early detection and diagnosis.