Diffusion tensor imaging and white matter tractography in patients with brainstem lesions

Acta Neurochir (Wien). 2007 Nov;149(11):1117-31; discussion 1131. doi: 10.1007/s00701-007-1282-2. Epub 2007 Aug 23.


Background: Diffusion tensor imaging (DTI) and white matter tractography (WMT) are promising techniques for estimating the course, extent, and connectivity patterns of the white matter (WM) structures in the human brain. In this study, we investigated the ability of DTI and WMT to visualize white matter tract involvement for the preoperative surgical planning and postoperative assessment of brainstem lesions.

Methods: Preoperative and postoperative DTI data (echo-planar, 1.5T) were retrospectively analyzed in 10 patients with brainstem lesions (3 diffuse, 7 focal). WMT applying a tensor deflection algorithm was used to reconstruct WM tracts adjacent to the lesions. Reconstructed tracts included corticospinal tracts and medial lemnisci. The clinical and imaging follow-up data were also compared and analyzed.

Findings: WMT revealed a series of tract alteration patterns including deviation, deformation, infiltration, and apparent tract interruption. WMT reconstructions showed that the major WM tracts were preserved during surgery and improved in position and appearance postoperatively. These findings correlated with the improvement or preservation of neurological function as determined by clinical assessment.

Conclusions: Compared with the information provided by conventional MR imaging, DTI and WMT provided superior quantification and visualization of lesion involvement in eloquent fibre tracts of the brainstem. Moreover, DTI and WMT were found to be beneficial for white matter recognition in the neurosurgical planning and postoperative assessment of brainstem lesions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Astrocytoma / diagnosis*
  • Astrocytoma / pathology
  • Astrocytoma / surgery
  • Brain Damage, Chronic / diagnosis
  • Brain Damage, Chronic / pathology
  • Brain Damage, Chronic / surgery
  • Brain Mapping*
  • Brain Stem Neoplasms / diagnosis*
  • Brain Stem Neoplasms / pathology
  • Brain Stem Neoplasms / surgery
  • Cranial Nerve Diseases / diagnosis
  • Cranial Nerve Diseases / pathology
  • Diffusion Magnetic Resonance Imaging*
  • Dominance, Cerebral / physiology
  • Female
  • Hemangioma, Cavernous, Central Nervous System / diagnosis*
  • Hemangioma, Cavernous, Central Nervous System / pathology
  • Hemangioma, Cavernous, Central Nervous System / surgery
  • Humans
  • Image Processing, Computer-Assisted*
  • Imaging, Three-Dimensional*
  • Male
  • Middle Aged
  • Nerve Fibers, Myelinated / pathology*
  • Nerve Net / pathology*
  • Nerve Net / surgery
  • Neurologic Examination
  • Neuronavigation*
  • Pons / pathology*
  • Pons / surgery
  • Postoperative Complications / diagnosis
  • Postoperative Complications / pathology
  • Pyramidal Tracts / pathology
  • Pyramidal Tracts / surgery