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fMRI-Driven DTT Assessment of Corticospinal Tracts Prior to Cortex Resection

Published online by Cambridge University Press:  23 September 2014

Xiao-xiong Jia
Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China
Yang Yu
Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China
Xiao-dong Wang
Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China
Hui Ma
Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China
Qing-hua Zhang
Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China
Xue-yin Huang
Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China
He-chun Xia*
Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China
Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China.
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The role of diffusion tensor tractography (DTT) has become increasingly important in the preoperative mapping of brain white matter. Recently, functional magnetic resonance imaging (fMRI) driven DTT has provided the ability to evaluate the spatial relationship between the corticospinal tract (CST) and motor resection tumor boundaries. The main objective of this study was improvement of the preoperative assessment of the CST in patients with gliomas involving the motor cortical areas.


Seventeen patients with gliomas involving motor cortical areas underwent 3 dimensions (3D) T1-weighted imaging for anatomical referencing, using both fMRI and diffusion tensor imaging (DTI). We used the fast-marching tractography (FMT) algorithm to define the 3D connectivity maps within the whole brain using seed points selected in the white matter adjacent to the location of fMRI activation. The target region of interest (ROI) was placed in the cerebral peduncle. Karnofsky performance status (KPS) scores were evaluated for each patient before and after surgery.


The CST of a total seventeen patients were successfully tracked by choosing seed and target ROI on the path of the fibers. What is more, DTT can indicate preoperatively the possibility for total glioma removal or the maximum extent of surgical resection. The postoperative average KPS score for the seventeen patients enrolled increased by more than 10 points.


Incorporation of fMRI driven DTT showed a maximum benefit in surgical treatment of gliomas. Our study of the assessment precision should enhance the accuracy of glioma operations with a resulting improvement in postoperative patient outcome.

Research Article
Copyright © The Canadian Journal of Neurological 2013


1. Sunaert, S, Yousry, TA. Clinical applications of functional magnetic resonance imaging. Neuroimaging Clin N Am. 2001;11(2):221–36.Google Scholar
2. Haughton, VM, Turski, PA, Meyerand, B, Wendt, G, Moritz, CH, Ulmer, J. The clinical applications of functional magnetic resonance imaging. Neuroimaging Clin N Am. 1999;9(2): 285–93.Google Scholar
3. Werring, DJ, Clark, CA, Parker, GJM, Miller, DH, Thompson, AJ, Barker, GJ. A direct demonstration of both structure and function in the visual system: combining diffusion tensor imaging with functional magnetic resonance imaging. Neuroimage. 1999;9(3): 352–61.CrossRefGoogle ScholarPubMed
4. Holodny, AL, Ollenschleger, MD, Liu, WC, Schulder, M, Kalnin, AJ. Identification of the corticospinal tracts achieved using blood-oxygen-level-dependent and diffusion functional magnetic resonance imaging in patients with brain tumors. AJNR Am J Neuroradiol. 2001;22(1):83–8.Google ScholarPubMed
5. Schonberg, T, Pazit, P, Hendler, T, Pasternak, O, Assaf, Y. Characterization of displaced white matter by brain tumors using combined diffusion tensor imaging and functional magnetic resonance. Neuroimage. 2006;30(4):1100–11.CrossRefGoogle Scholar
6. Smits, M, Vernooij, MW, Wielopolski, PA, Vincent, AJ, Houston, GC, van der Lugt, A. Incorporating functional magnetic resonance imaging into diffusion tensor tractograghy in the preoperative assessment of the corticospinal tract in patients with brain tumors. AJNR Am J Neuroradiol. 2007;28(7):1354–61.CrossRefGoogle Scholar
7. Qiu, TM, Zhang, Y, Wu, JS, et al. Virtual reality presurgical planning for cerebral glioma adjacent to motor pathways in an integrated 3-D stereoscopic visualization of structural magnetic resonance imaging and diffusion tensor imaging tractography. Acta Neurochir. 2010;152(11):1847–57.CrossRefGoogle Scholar
8. Mori, S, van Ziji, PC. Fiber tracking: principles and strategies a technical review. NMR Biomed. 2002;15(7-8):468–80.CrossRefGoogle ScholarPubMed
9. Mori Masutani, Y, Aoki, S, et al. Simple visualization of the corticospinal pathway using tractography: one-roi and two-roi methods. Nippon Acta Radiologica. 2003;63(1):51–3.Google Scholar
10. Holodny, AI, Gor, DM, Watts, R, Gutin, PH, Uluq, AM. Diffusiontensor magnetic resonance tractography of somatotopic organization of corticospinal tracts in the internal capsule: initial anatomic results in contradistinction to prior reports. Radiology. 2005;234(3):649–53.CrossRefGoogle ScholarPubMed
11. Catani, M, Howard, RJ, Pajevic, S, Jones, DK. Virtual in vivo interactive dissection of white matter fasciculi in the human brain. Neuroimage. 2002;17(1):7794.CrossRefGoogle Scholar
12. Akai, H, Mori, H, Aoki, S, et al. Diffusion tensor tractography of gliomatosis cerebri: fiber tracking through the tumor. J Comput Assist Tomogr. 2005;29(1):127–9.CrossRefGoogle ScholarPubMed
13. Stieltjes, B, Kaufmann, WE, van Zijl, PC, et al. Diffusion tensor imaging and axonal tracking in the human brainstem. Neuroimage.2001;14(3):723–35.CrossRefGoogle ScholarPubMed
14. Tao, XF, Wang, ZQ, Gong, WQ, Jiang, QJ, Jiang, QJ, Shi, ZR. A new study on diffusion tensor imaging of the whole visual pathway fiber bundle and clinical application. Chinese Med J. 2009;122(2):178–82.Google ScholarPubMed
15. Wu, CX, Pu, S, Lin, Y, Wang, YZ, et al. Fractionated resection on low grade gliomas involving Broca’s area and insights to brain plasticity. Chinese Med J. 2008;121(20):2026–30.Google Scholar
16. Pradeep, NM, Zhang, S, Todd, WV. Ictal high-frequency oscillations in neocortical epilepsy: implications for seizure localization and surgical resection. Epilepsia. 2011;52(10):1792–801.Google Scholar
17. Dorothee, S, Bjorn, WK, Susanne, S, et al. Ventral and dorsal pathways for language. PNAS of the USA. 2008;105(46): 1803540.Google Scholar
18. Guye, M, Parker, GJ, Symms, M, et al. Combined functional magnetic resonance imaging and tractography to demonstrate the connectivity of the human primary motor cortex in vivo. NeuroImage. 2003;19(4):1349–60.CrossRefGoogle ScholarPubMed
19. Krishnan, R, Raabe, A, Hattingen, E, et al. Functional magnetic resonance imaging-integrated neuronavigation: correlation between lesion-to-motor cortex distance and outcome. Neurosurgery. 2004;55(4):914–5.CrossRefGoogle ScholarPubMed
20. Ludemann, L, Forschler, A, Grieger, W, Zimmer, C. Bold signal in the motor cortex shows a correlation with the blood volume of brain tumors. J Magn Reson Imaging. 2006;23(4):435–43.CrossRefGoogle Scholar
21. Corie, W, Wei, GG, Mikulis, DJ. Tumor effects on cerebral white matter as characterized by diffusion tensor tractography. Can J Neurol Sci. 2007;34(1);62–9.Google Scholar
22. Holodny, AI, Watts, R, Korneinko, VN, et al. Diffusion tensor tractography of the motor white matter tracts in man: current controversies and future directions. Ann N Y Acad Sci. 2005;1064:8897.CrossRefGoogle ScholarPubMed
23. Field, AS, Alexander, AL, Wu, YC, Hasan, KM, Witwer, B, Badie, B. Diffusion tensor eigenvector directional color imaging patterns in the evaluation of cerebral white matter tracts altered by tumor. J Magn Reson Imaging. 2004;20(4):555–62.CrossRefGoogle Scholar
24. Ozawa, N, Muragaki, Y, Nakamura, R, Iseki, H. Identification of the pyramidal tract by neuronavigation based on intraoperative diffusion-weighted imaging combined with subcortical stimulation. Stereotact Funct Neurosurg. 2009;87(1):1824.CrossRefGoogle Scholar
25. Marla, JH, William, TS, Guy, MM, Perrine, K, Goodman, RR. Brain stimulation reveals critical auditory naming cortex. Brain. 2005;128(11):2742–9.Google Scholar
26. Lo, CY, Chao, YP, Chou, KH, Guo, WY, Su, JL, Lin, CP. DTI-based virtual reality system for neurosurgery. Conf Proc IEEE Eng Med Biol Soc. 2007;2007:1326–9.Google ScholarPubMed
27. Sanai, N, Berger, M. Glioma extent of resection and its impact on patient outcome. Neurosurgery. 2008;62(4):753–64.CrossRefGoogle ScholarPubMed
28. Satoshi, M, Masazumi, F, Norimoto, N, et al. Clinical indications for high-field 1.5 T intraoperative magnetic resonance imaging and neuro-navigation for neurosurgical procedures. Neurol Med Chir (Tokyo). 2009;49(8):349–50.Google Scholar
29. Baird, AA, Colvin, MK, Vanhorn, JD, Inati, S, Gazzaniga, MS. Functional connectivity: interating behavioral, diffusion tensor imaging, and functional magnetic resonance imaging data sets. J Cogn Neurosci. 2005;17(4):687–93.CrossRefGoogle Scholar
30. Bello, L, Gambini, A, Castellano, A, et al. Motor and language DTI fiber tracking combined with intraoperative subcortical mapping for surgical removal of gliomas. Neuroimage. 2008;39(1): 369–82.CrossRefGoogle ScholarPubMed
31. Raimund, K, Philipp, S, Anton, V, Boesiger, P, Kollias, S. Impact of fMRI-guided advanced DTI fiber tracking techniques on their clinical applications in patients with brain tumors. Neuroradiology. 2010;52(1):3746.Google Scholar