Deterministic or probabilistic tractography? Choosing the appropriate approach in clinical neurosurgery and...

Diffusion tensor-based tractography enables non-invasive reconstruction of white matter pathways in the human brain using two main algorithms: deterministic and probabilistic. Deterministic tractography generates white matter filaments that follow the dominant diffusion direction in individual voxels, providing fast but imprecise reconstruction; however, it is limited in areas with crossed filaments. Probabilistic tractography, on the other hand, models uncertainty and allows for more accurate mapping of complex neural connections, although it is computationally demanding and more difficult to interpret. This article discusses the theoretical foundations, strengths and weaknesses, and clinical applications of both approaches, with particular emphasis on their application in neurosurgery and neuroradiology.