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Neuro Oncol. 2015 Sep;17(9):1199-209. doi: 10.1093/neuonc/nov113. Epub 2015 Jun 27.

High-definition fiber tractography for the evaluation of perilesional white matter tracts in high-grade glioma surgery.

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Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (K.A., J.C.F.-M.); Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania (F.-C.Y); Department of Neurosurgery, University of Toronto, Toronto, Canada (A.M., G.Z.).


Conventional white matter (WM) imaging approaches, such as diffusion tensor imaging (DTI), have been used to preoperatively identify the location of affected WM tracts in patients with intracranial tumors in order to maximize the extent of resection and potentially reduce postoperative morbidity. DTI, however, has limitations that include its inability to resolve multiple crossing fibers and its susceptibility to partial volume effects. Therefore, recent focus has shifted to more advanced WM imaging techniques such as high-definition fiber tractography (HDFT). In this paper, we illustrate the application of HDFT, which in our preliminary experience has enabled accurate depiction of perilesional tracts in a 3-dimensional manner in multiple anatomical compartments including edematous zones around high-grade gliomas. This has facilitated accurate surgical planning. This is illustrated by using case examples of patients with glioblastoma multiforme. We also discuss future directions in the role of these techniques in surgery for gliomas.


Diffusion tensor imaging; edema; glioblastoma multiforme; intracranial mass lesions

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