Division of Brain, Imaging, and Behaviour-Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Neuromodulation. 2020 Jun;23(4):427-435. doi: 10.1111/ner.13107. Epub 2020 Feb 11.
Conventional targeting methods for neuromodulation therapies are insufficient for visualizing targets along white matter pathways and localizing targets in patient-specific space. Diffusion tensor imaging (DTI) holds promise for enhancing neuromodulation targeting by allowing detailed visualization of white matter tracts and their connections on an individual level.
We review the literature on DTI and neuromodulation, focusing on clinical studies that have utilized DTI tractography for surgical neuromodulation planning. This primarily includes the growing number of studies on tractography-guided targeting in deep brain stimulation as well as magnetic resonance-guided focused ultrasound.
In this review, we discuss three main topics: 1) an overview of the basic principles of DTI, its metrics, and tractography, 2) the evolution and utility of DTI to better guide neuromodulation targets, and 3) the ability of DTI to investigate structural connectivity and brain networks, and how such a network perspective may be an integral part of identifying new or optimal neuromodulation targets.
There is increasing evidence that DTI is superior to conventional targeting methods with respect to improving brain stimulation therapies. DTI has the ability to better define anatomical targets by allowing detailed visualization of white matter tracts and localizing targets based on individual anatomy. Network analyses can lead to the identification of new or optimal stimulation targets based on understanding how target regions are connected. The integration of DTI as part of routine MRI and surgical planning offers a more personalized approach to therapy and may be an important path for the future of neuromodulation.
传统的神经调控治疗靶向方法在可视化白质通路靶点和在患者特定空间定位靶点方面存在不足。弥散张量成像（DTI）有望通过允许在个体水平上详细可视化白质束及其连接，从而增强神经调控靶向。
我们回顾了 DTI 和神经调控的文献，重点关注了利用 DTI 束追踪技术进行手术神经调控计划的临床研究。这主要包括越来越多的关于在深部脑刺激中进行束追踪引导靶向的研究，以及磁共振引导聚焦超声的研究。
在本综述中，我们讨论了三个主要主题：1）DTI 的基本原理、其指标和束追踪的概述，2）DTI 指导神经调控靶点的发展和应用，3）DTI 研究结构连接和脑网络的能力，以及这种网络视角如何成为识别新的或最佳神经调控靶点的一个组成部分。
有越来越多的证据表明，与传统的靶向方法相比，DTI 可以改善脑刺激疗法。DTI 能够更好地定义解剖学靶点，通过详细可视化白质束并根据个体解剖结构定位靶点。网络分析可以根据理解目标区域的连接方式来确定新的或最佳的刺激靶点。将 DTI 整合为常规 MRI 和手术计划的一部分提供了一种更个性化的治疗方法，可能是神经调控未来的重要途径。
