DTI and Tractography

What is DTI ??
• Noninvasive MRI modality
• Probable location and orientation of subcortical white matter tracts in
vivo.
Clinical Application
• Prediction of neurologic outcome from tumor and stroke
• Targeting for functional and stereotactic neurosurgery
• pre- and intra-operative planning for the surgical resection of space
occupying lesions

• MRI can define structural anatomy; they do not provide reliable

information on functional anatomy in the individual
• Functional mapping can be performed by invasive and non-invasive
methods
• Invasive examinations include pre-operative cortical electrode grid
recordings and intra-operative cortical and subcortical stimulation.
• Non-invasive examinations include functional MRI and
magnetoencephalography (MEG).
Scientific principle of DTI
• Diffusion MRI scans image the molecular diffusion of water at the
same scale as cellular dimensions and therefore allow the
microarchitecture of the brain to be investigated
• Constant random motion of molecules is described by Brownian
motion and is exploited by diffusion imaging to specifically detect the
displacement of water molecules through the brain tissue medium.
• Direction of the passage of water is different depending on the nature
of tissue in which it is found
• Where no structural boundaries exist nearby, the molecular motion of
water is unimpeded and equal in all directions. This is known as
isotropic diffusion
• exhibited within the cerebrospinal fluid spaces of the brain, except for
sites of bulk flow such as the aqueduct of Sylvius or foramen of
Munro
• Isotropic diffusion is also believed to occur in grey matter
• Myelinated white matter fiber tracts are arranged into parallel,
densely packed bundles that impede the diffusion of water molecules
perpendicular to the fibers’ direction.
• Diffusion of water molecules in this situation is not equal in all
directions and is defined as anisotropic diffusion.
• Detection of water molecule anisotropy is the basis of diffusion tensor
imaging and tractography.
• DTI fiber tract data can be presented in two forms.
• Functional anisotropy maps provide information on fiber anatomy in
cross-sectional two-dimensional (2D) images with color-coded axes
where the brightness is proportional to the degree of anisotropy
• By convention,
• The anteroposterior axis is represented by green
• Left-right by red
• Up-down by blue
• Deterministic or probabilistic functional tractography performs a
3Ddimensional reconstruction and portrayal of the fiber pathways
based on following a white matter tract from voxel to voxel
Limitations of DTI
• DTI does not directly trace fibers unlike tracer injection studies, which
remain the gold standard for defining neural connectivity
• Neuronal axons are micrometers wide, but the voxels used are in the
order of a few millimeters in each plane; therefore, one voxel may
contain some tens of thousands of axons.
• Inability to decipher whether a tract is projecting retrograde or
anterograde