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Diffusion Tensor Imaging Biomarkers to Predict Neurological Outcomes in Brain Surgery: A Systematic Review.

Noa Ben Dor1,2, Giovanni Sighinolfi3, Vittoria Rosetti2

  • 1Department of Neurosurgery, IRCCS Institute of Neurological Sciences of Bologna, 40139 Bologna, Italy.

Life (Basel, Switzerland)
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Quantitative diffusion tensor imaging (DTI) metrics show promise for predicting motor and language recovery after brain surgery. However, more research is needed to establish universal prognostic thresholds for these advanced imaging techniques.

Keywords:
corticospinal tract (CST)diffusion tensor imaging (DTI)fiber trackingfractional anisotropy (FA)neurosurgerysurgical outcome

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Area of Science:

  • Neurosurgery
  • Radiology
  • Neurology

Background:

  • Diffusion tensor imaging (DTI) tractography is vital for neurosurgical planning.
  • The prognostic value of quantitative DTI metrics for postoperative functional outcomes is not well-established.

Purpose of the Study:

  • To systematically review evidence linking quantitative DTI measures to postoperative motor, language, and cognitive outcomes after intracranial surgery.
  • To synthesize findings on DTI's prognostic significance in neurosurgery.

Main Methods:

  • A PRISMA-informed systematic review of PubMed and other indexed sources (January 2005-December 2025).
  • Inclusion of 37 studies, predominantly single-center and focused on glioma surgery.

Main Results:

  • Reduced corticospinal tract integrity and adverse diffusion changes correlate with motor deficits.
  • Dorsal language pathway integrity predicts milder aphasia; ventral pathway alterations link to lexico-semantic deficits.
  • Limited evidence exists for cognition and gait outcomes, involving association, limbic, and callosal pathways.

Conclusions:

  • Quantitative DTI offers clinically relevant markers for tract disruption and network remodeling post-surgery.
  • Methodological heterogeneity and limited validation hinder the establishment of universal prognostic thresholds for DTI metrics.