Diffusion Tensor Imaging of the Corticospinal Tract in Preoperative Planning for Motor Area Gliomas
DOI:
https://doi.org/10.5281/zenodo.22310457Keywords:
Diffusion tensor imaging, Corticospinal tract, Tractography, Glioma, Preoperative planningAbstract
Background: Gliomas near the rolandic cortex threaten the corticospinal tract (CST), the pathway chiefly responsible for
voluntary motor function. Diffusion tensor imaging (DTI) tractography offers a noninvasive way to visualise this tract before
surgery. Objective: To review published evidence on DTI-CST tractography for preoperative planning of motor-area gliomas.
Methods: Narrative review of validation studies, neuronavigation series, comparative imaging studies and outcome cohorts.
Findings: Tractography integrated into neuronavigation increases extent of resection and reduces new motor deficits versus
anatomical navigation alone. Validation against direct subcortical stimulation shows tractography approximates, but does not
exactly localise, the functional tract, with discordance growing near tumour and oedema. Classifying tumour-tract interaction as
displaced, infiltrated or disrupted correlates with resectability and motor outcome. Crossing-fibre regions remain a persistent
tensor-model weakness that probabilistic tracking, Q-ball and constrained spherical deconvolution partly address.
Conclusions: DTI-CST tractography is a valuable, imperfect adjunct that should inform, not replace, intraoperative functional
mapping.
References
Essayed, W.I., Zhang, F., Unadkat, P., Cosgrove, G.R., Golby, A.J., O'Donnell, L.J. (2017) White matter tractography for neurosurgical planning: a topography-based review of the current state of the art. NeuroImage: Clinical, 15: 659-672.
Berman, J.I., Berger, M.S., Mukherjee, P., Henry, R.G. (2004) Diffusion-tensor imaging-guided tracking of fibers of the pyramidal tract combined with intraoperative cortical stimulation mapping in patients with gliomas. Journal of Neurosurgery, 101(1): 66-72.
Costabile, J.D., Alaswad, E., D'Souza, S., Thompson, J.A., Ormond, D.R. (2019) Current applications of diffusion tensor imaging and tractography in intracranial tumor resection. Frontiers in Oncology, 9: 426.
Farshidfar, Z., Faeghi, F., Mohseni, M., Seddighi, A., Hadizadeh Kharrazi, H., Abdolmohammadi, J. (2014) Diffusion tensor tractography in the presurgical assessment of cerebral gliomas. The Neuroradiology Journal, 27(1): 75-84.
Nimsky, C., Ganslandt, O., Hastreiter, P., Wang, R., Benner, T., Sorensen, A.G., Fahlbusch, R. (2005) Preoperative and intraoperative diffusion tensor imaging-based fiber tracking in glioma surgery. Neurosurgery, 56(1): 130-138.
Nimsky, C., Ganslandt, O., Merhof, D., Sorensen, A.G., Fahlbusch, R. (2006) Intraoperative visualization of the pyramidal tract by diffusion-tensor-imaging-based fiber tracking. NeuroImage, 30(4): 1219-1229.
Ohue, S., Kohno, S., Inoue, A., Yamashita, D., Matsumoto, S., Suehiro, S., Kumon, Y., Kikuchi, K., Ohnishi, T. (2014) Surgical results of tumor resection using tractography-integrated navigation-guided fence-post catheter techniques and motor-evoked potentials for preservation of motor function in patients with glioblastomas near the pyramidal tracts. Neurosurgical Review, 38(2): 293-307.
Wu, J.S., Zhou, L.F., Tang, W.J., Mao, Y., Hu, J., Song, Y.Y., Hong, X.N., Du, G.H. (2007) Clinical evaluation and follow-up outcome of diffusion tensor imaging-based functional neuronavigation: a prospective, controlled study in patients with gliomas involving pyramidal tracts. Neurosurgery, 61(5): 935-949.
Berman, J.I., Berger, M.S., Chung, S., Nagarajan, S.S., Henry, R.G. (2007) Accuracy of diffusion tensor magnetic resonance imaging tractography assessed using intraoperative subcortical stimulation mapping and magnetic source imaging. Journal of Neurosurgery, 107(3): 488-494.
Zolal, A., Hejčl, A., Vachata, P., Bartoš, R., Humhej, I., Malucelli, A., Nováková, M., Hrach, K., Derner, M., Sameš, M. (2012) The use of diffusion tensor images of the corticospinal tract in intrinsic brain tumor surgery: a comparison with direct subcortical stimulation. Neurosurgery, 71(2): 331-340.
Javadi, S.A., Nabavi, A., Giordano, M., Samii, A. (2017) Evaluation of diffusion tensor imaging-based tractography of the corticospinal tract: a correlative study with intraoperative magnetic resonance imaging and direct electrical subcortical stimulation. Neurosurgery, 80(2): 287.
Zhu, F.P., Wu, J.S., Song, Y.Y., Yao, C.J., Zhuang, D.X., Xu, G., Tang, W.J., Qin, Z.Y., Mao, Y., Zhou, L.F. (2012) Clinical application of motor pathway mapping using diffusion tensor imaging tractography and intraoperative direct subcortical stimulation in cerebral glioma surgery. Neurosurgery, 71(6): 1170-1184.
Ostrý, S., Bělšan, T., Otáhal, J., Beneš, V., Netuka, D. (2013) Is intraoperative diffusion tensor imaging at 3.0T comparable to subcortical corticospinal tract mapping? Neurosurgery, 73(5): 797-807.
Bozzao, A., Romano, A., Angelini, A., D'Andrea, G., Calabria, L.F., Coppola, V., Mastronardi, L., Fantozzi, L.M., Ferrante, L. (2010) Identification of the pyramidal tract by neuronavigation based on intraoperative magnetic resonance tractography: correlation with subcortical stimulation. European Radiology, 20(10): 2475-2481.
Münnich, T., Klein, J., Hattingen, E., Noack, A., Herrmann, E., Seifert, V., Senft, C., Forster, M.T. (2019) Tractography verified by intraoperative magnetic resonance imaging and subcortical stimulation during tumor resection near the corticospinal tract. Operative Neurosurgery, 16(2): 197-210.
Li, Y., Guo, J., Zhang, K., Wei, H., Fan, J., Yu, S., Li, T., Yang, X. (2023) Diffusion tensor imaging versus intraoperative subcortical mapping for glioma resection: a systematic review and meta-analysis. Neurosurgical Review, 46(1): 154.
Stadlbauer, A., Nimsky, C., Buslei, R., Salomonowitz, E., Hammen, T., Buchfelder, M., Moser, E., Ernst-Stecken, A., Ganslandt, O. (2007) Diffusion tensor imaging and optimized fiber tracking in glioma patients: histopathologic evaluation of tumor-invaded white matter structures. NeuroImage, 34(3): 949-956.
Hu, J., Bao, H., Liu, X., Fang, S., Yan, Z., Wang, Z., Zhang, R., Wang, R., Pu, T., Li, C., Cui, Z., Jiang, T., Wang, Y. (2025) Glioma-white matter tract interactions: a diffusion magnetic resonance imaging-based 3-tier classification and its clinical relevance. Neuro-Oncology, 27(7): 1888-1898.
Smits, M., Vernooij, M.W., Wielopolski, P.A., Vincent, A.J., Houston, G.C., van der Lugt, A. (2007) Incorporating functional MR imaging into diffusion tensor tractography in the preoperative assessment of the corticospinal tract in patients with brain tumors. American Journal of Neuroradiology, 28(7): 1354-1361.
Muir, M., Gadot, R., Prinsloo, S., Michener, H., Traylor, J., Athukuri, P., Tummala, S., Kumar, V.A., Prabhu, S.S. (2023) Comparative study of preoperative functional imaging combined with tractography for prediction of iatrogenic motor deficits. Journal of Neurosurgery, 139(1): 65-72.
Yang, J.Y., Yeh, C.H., Poupon, C., Calamante, F. (2021) Diffusion MRI tractography for neurosurgery: the basics, current state, technical reliability and challenges. Physics in Medicine and Biology, 66(15): 15TR01.
Duffau, H. (2014) Diffusion tensor imaging is a research and educational tool, but not yet a clinical tool. World Neurosurgery, 82(1-2): e43-e45.
Vergani, F., Sarubbo, S., Yang, J.Y. (2025) DEBATE: is tractography accurate enough to be used to inform surgery? Brain Structure and Function, 230(5): 81.
Mandelli, M.L., Berger, M.S., Bucci, M., Berman, J.I., Amirbekian, B., Henry, R.G. (2014) Quantifying accuracy and precision of diffusion MR tractography of the corticospinal tract in brain tumors. Journal of Neurosurgery, 121(2): 349-358.
Bucci, M., Mandelli, M.L., Berman, J.I., Amirbekian, B., Nguyen, C., Berger, M.S., Henry, R.G. (2013) Quantifying diffusion MRI tractography of the corticospinal tract in brain tumors with deterministic and probabilistic methods. NeuroImage: Clinical, 3: 361-368.
Becker, D., Scherer, M., Neher, P., Jungk, C., Jesser, J., Pflüger, I., Brinster, R., Bendszus, M., Bruckner, T., Maier-Hein, K., Unterberg, A. (2020) Going beyond diffusion tensor imaging tractography in eloquent glioma surgery-high-resolution fiber tractography: Q-ball or constrained spherical deconvolution? World Neurosurgery, 134: e596-e609.
Sheng, Z., Yu, J., Chen, Z., Sun, Y., Bu, X., Wang, M., Sarica, C., Hernesniemi, J., Nelson, B.J., Zemmar, A., Avecillas-Chasin, J.M. (2021) Constrained-spherical deconvolution tractography in the evaluation of the corticospinal tract in glioma surgery. Frontiers in Surgery, 8: 646465.
Almairac, F., Parker, D., Mondot, L., Isan, P., Onno, M., Papadopoulo, T., Fontaine, D., Verma, R. (2024) Improvement of diffusion tensor imaging-based tractography by free-water correction in nonedematous gliomas: assessment with brain mapping. Journal of Neurosurgery, 141(3): 684-694.
