Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA, 94304, USA.
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Neurotherapeutics. 2019 Jan;16(1):36-51. doi: 10.1007/s13311-018-00697-x.
Magnetic resonance imaging tractography permits in vivo visualization of white matter structures. Aside from its academic value, tractography has been proven particularly useful to neurosurgeons for preoperative planning. Preoperative tractography permits both qualitative and quantitative analyses of tumor effects upon surrounding white matter, allowing the surgeon to specifically tailor their operative approach. Despite its benefits, there is controversy pertaining to methodology, implementation, and interpretation of results in this context. High-definition fiber tractography (HDFT) is one of several non-tensor tractography approaches permitting visualization of crossing white matter trajectories at high resolutions, dispensing with the well-known shortcomings of diffusion tensor imaging (DTI) tractography. In this article, we provide an overview of the advantages of HDFT in a neurosurgical context, derived from our considerable experience implementing the technique for academic and clinical purposes. We highlight nuances of qualitative and quantitative approaches to using HDFT for brain tumor surgery planning, and integration of tractography with complementary operative adjuncts, and consider areas requiring further research.
磁共振成像纤维束示踪技术可在活体中显示白质结构。除了具有学术价值外,纤维束示踪技术还被证明对神经外科医生的术前规划特别有用。术前纤维束示踪技术允许对肿瘤对周围白质的影响进行定性和定量分析,使外科医生能够专门调整手术方法。尽管有这些好处,但在这种情况下,关于方法、实施和结果解释存在争议。高清晰度纤维束追踪术(HDFT)是几种非张量纤维束追踪技术之一,可在高分辨率下显示穿过白质的轨迹,克服了众所周知的弥散张量成像(DTI)纤维束追踪技术的缺点。在本文中,我们根据我们在学术和临床应用该技术方面的丰富经验,概述了 HDFT 在神经外科环境中的优势。我们强调了使用 HDFT 进行脑肿瘤手术规划的定性和定量方法的细微差别,以及将纤维束示踪技术与互补的手术辅助手段相结合,并考虑了需要进一步研究的领域。