Interactive Diffusion Tensor Tractography Visualization for Neurosurgical Planning

Abstract

Background Diffusion Tensor Imaging (DTI) infers the trajectory and location of large white matter tracts by measuring anisotropic diffusion of water. DTI data may then be analyzed and presented as tractography for visualization of the tracts in three dimensions. Despite the important information contained in tractography images, usefulness for neurosurgical planning has been limited by the inability to define which are critical structures within the mass of demonstrated fibers and to clarify their relationship to the tumor. Objective Our goal was to develop a method to allow the interactive querying of tractography datasets for surgical planning and to provide a working software package for the research community. Methods Tool was implemented within open-source software project. Echoplanar DTI at 3T was performed on five patients, followed by tensor calculation. Technical Development Software was developed allowing placement of dynamic seedpoint for local selection of fibers, and for fiber display around a segmented structure - both with tunable parameters. A neurosurgeon was trained in use of software in less than one hour and used to review cases. Results Tracts near tumor and critical structures were interactively visualized in three dimensions to determine spatial relationships to lesion. Tracts were selected using 3 methods: (1) anatomical and fMRI-defined regions of interest (ROIs), (2) distance from the segmented tumor volume, (3) dynamic seedpoint spheres. Conclusion Interactive tractography successfully enabled inspection of white matter structures that were in proximity to lesions, critical structures, and functional cortical areas allowing the surgeon to explore the relationships between them.

The utility of preoperative diffusion tensor imaging in the surgical management of brainstem cavernous malformations

“…In this subtype of BSCMs, DTI/DTT may assist in the selection of the surgical approach and brainstem entry zone. In the future, intraoperative DTT visualization for neurosurgical planning can be integrated with the neurosurgical microscope and real-time querying tractography obtained, 17,23,44 maximizing resection while preserving structure and, subsequently, function. DTI/DTT could be a potential tool for preoperative counseling of patients with critically located lesions, anticipating neurological deficits that-even transiently-can impact negatively on quality of life.…”

Diffusionsgewichtete Bildgebung und „diffusion tensor imaging“ in der präoperativen Diagnostik

“…B. bei Gliomen, Highgrade-, aber auch Low-grade-Gliomen ist es oft hilfreich, die Faserverbindungen nachzuweisen, um zu sehen, ob entsprechende Verbindungen bereits zerstört sind, noch intakt sind, im Tumorgewebe liegen oder vom Tumor bzw. dessen Ödem nur verdrängt werden [26].…”

Diffantom: whole-brain diffusion MRI phantoms derived from real datasets of the Human Connectome Project

“…Tractography is fundamental to gain information about white matter (WM) morphology in many clinical applications like neurosurgical planning (Golby et al, 2011), post-surgery evaluations (Toda et al, 2014), and the study of neurological diseases as in Chua et al (2008) addressing multiple sclerosis and Alzheimer's disease. The analysis of structural brain networks using graph theory is also applied on tractography, for instance in the definition of the unique subject-wise patterns of connectivity (Sporns et al, 2005), in the assessment of neurological diseases (Griffa et al, 2013), and in the study of the link between structural and functional connectivity (Messé et al, 2015).…”