The Pre-Surgical Planning of Brain Neoplasms: From Diffusion Tensor Imaging to More Advanced Approaches.
The pre-surgical planning of brain neoplasms is strongly contributing to change the prognosis of neoplastic patients. Indeed, it supplies more and more detailed and reliable functional and morphological information before as well as during surgery.
Both invasive and noninvasive approaches are available to achieve this goal. A powerful technique for the pre-surgical planning of brain neoplasms is Diffusion Weighted Imaging based tractography.
Differently from other approaches, tractography is able to provide, non-invasively, morphological information regarding brain pathways relationship with the neoplasm, by analyzing water diffusion within white matter.
This is important especially for eloquent bundles, such as Cortico-Spinal Tract and Arcuate Fasciculus, whose damages have a bad impact on the patient’s Quality of Life. Tractography can be performed through several diffusion signal modeling techniques, among which Diffusion Tensor Imaging is the most known.
DTI has been widely used for neurosurgery both in pre-operative and intra-operative contexts,
also in combination with other functional approaches such as functional MRI and cortical stimulation.
This useful technique was able to reduce post-surgical deficits as well as to improve the survival of neoplastic patients, through a better delineation of maximal safe resection. Moreover, its use provided great benefits in patients with high-grade gliomas in terms of risk of death.
Radiol Open J. 2015; 1(1): e1-e5. doi: 10.17140/ROJ-1-e001