Use of Diffusion Tensor Imaging in the Resection of Gliomas

Standard magnetic resonance imaging techniques provide only anatomic information without information regarding central nervous system connectivity. Overcoming this limitation, diffusion tensor imaging (DTI) can demonstrate the structural integrity and white matter tracts of the brain. In this paper, we will overview the basic principles and techniques of DTI. We will also review the application of DTI in neurosurgery, particularly its application in the resection of gliomas. Tractography provides visualization of the motor tracts and language tracts, which has been corroborated using subcortical mapping/direct stimulation. Furthermore, DTI can also provide information about the arrangement of visual fibers in relation to tumors. Given these advantages, DTI is becoming increasingly used as a surgical planning tool. DTI may provide a safer means for tumor resection by minimizing iatrogenic injury of important functional tracts. Some studies suggest that the use of DTI in tumor surgery may lead to greater Karnofsky performance status scores, greater extent of tumor resection, and increased overall survival.