Advancements in diffusion MRI tractography for neurosurgery
Open accessAbstract
Diffusion magnetic resonance imaging tractography is a noninvasive technique that enables the visualization and quantification of white matter tracts within the brain. It is extensively used in preoperative planning for brain tumors, epilepsy, and functional neurosurgical procedures such as deep brain stimulation. Over the past 25 years, significant advancements have been made in imaging acquisition, fiber direction estimation, and tracking methods, resulting in considerable improvements in tractography accuracy. The technique enables the mapping of functionally critical pathways around surgical sites to avoid permanent functional disability. When the limitations are adequately acknowledged and considered, tractography can serve as a valuable tool to safeguard critical white matter tracts and provides insight regarding changes in normal white matter and structural connectivity of the whole brain beyond local lesions. In functional neurosurgical procedures such as deep brain stimulation, it plays a significant role in optimizing stimulation sites and parameters to maximize therapeutic efficacy and can be used as a direct target for therapy. These insights can aid in patient risk stratification and prognosis. This article aims to discuss state-of-the-art tractography methodologies and their applications in preoperative planning and highlight the challenges and new prospects for the use of tractography in daily clinical practice.
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Tractography is increasingly used to estimate the relationship between tumors and eloquent pathways before surgery, but infiltration, edema, mass effect, crossing fibers, reduced anisotropy, algorithmic choices, and intraoperative brain shift may generate false-positive or false-negative reconstructions.
“Tractography is increasingly used to estimate the relationship between tumors and eloquent pathways before surgery (Kamagata et al., 2024; Yang et al., 2021), but infiltration, edema, mass effect, crossing fibers, reduced anisotropy, algorithmic choices, and intraoperative brain shift may generate false-positive or false-negative reconstructions.”
From 40 Years of diffusion MRI in the brain: From history to emerging frontiers (2026) · cites this paper as Kamagata et al., 2024
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Individualized Map of White Matter Pathways
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Dysmature superficial white matter microstructure in developmental focal epilepsy
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Comparison of single-shot EPI and multi-shot EPI in prostate DWI at 3.0 T
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A majority rule approach for region-of-interest-guided streamline fiber tractography
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Enhanced Fiber Tractography Using Edema Correction: Application and Evaluation in High-Grade Gliomas
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Local and Global Fiber Tractography in Patients with Epilepsy
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Ultra-high field (10.5T) diffusion-weighted MRI of the macaque brain
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Clinical utility of structural connectomics in predicting memory in temporal lobe epilepsy
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GPi vs STN deep brain stimulation for Parkinson disease Three-year follow-up
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Predicting the true extent of glioblastoma based on probabilistic tractography
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Self-citationHow Many Gradients are Sufficient in High-Angular Resolution Diffusion Imaging (HARDI)?
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Blood-brain barrier breakdown in brain ischemia: Insights from MRI perfusion imaging
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Tractometry of Human Visual White Matter Pathways in Health and Disease
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Reconstructing the human brain’s wiring diagram from axons up
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The scientific value of tractography: accuracy vs usefulness
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Detailed connectomic cluster resource for white matter mapping from ultra-high-field diffusion MRI
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FibGrid: Characterizing Anatomical Pathways in Hypergrid for Direct Tract Segmentation
Xie, Y., Zhai, Y., He, Y., Yu, J., Qin, J., & Wu, Y. (2024) · IEEE International Conference on Bioinformatics and Biomedicine (BIBM) · doi:10.1109/bibm62325.2024.10822761 · Cited by 2 · see citing works
Microstructure of the residual corticofugal projection from primary motor cortex in chronic stroke
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A taxonomic guide to diffusion MRI tractography visualization tools
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Diffusion Tensor Tractography Studies for Causes of Dysphagia After Stroke: A Systematic Review
Jang, W.-H., Lee, S., & Lee, S.-H. (2025) · Brain Sciences · doi:10.3390/brainsci15090925 · Cited by 1 · see citing works
Filipiak, P., Shepherd, T. M., Clarke, K., Ressa, G., Placantonakis, D. G., Boada, F. E., & Baete, S. H. (2026) · Magnetic Resonance in Medicine · doi:10.1002/mrm.70314 · Cited by 2 · see citing works
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Jammal, R. E., Suzuki, H., Mattar, L. S., Hamre, T. A., Soubra, S. S., Ryan, M. A., Mathura, R. K., Mathew, S. J., Allawala, A. B., Storch, E. A., et al. (2026) · Deep Brain Stimulation · doi:10.1016/j.jdbs.2026.08.002 · Cited by 1 · see citing works
Three-Dimensional Identification of the Frontal Aslant Tract in the Human Brain: Tractography Study
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40 Years of diffusion MRI in the brain: From history to emerging frontiers
Le Bihan, D. (2026) · Imaging Neuroscience · doi:10.1162/imag.a.1365
“Tractography is increasingly used to estimate the relationship between tumors and eloquent pathways before surgery ( Kamagata et al., 2024; Yang et al., 2021), but infiltration, edema, mass effect, crossing fibers, reduced anisotropy, algorithmic choices, and intraoperative brain shift may generate…”
Mazzucchi, E., Hiepe, P., Pignotti, F., Rocca, G. L., Rinaldi, P., Olivi, A., & Sabatino, G. (2025) · Neurosurgical Review · doi:10.1007/s10143-025-03488-z
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Bildgebung der Konnektivität von Hirntumoren
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Introduction to diffusion MRI in neurodegenerative disorders
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Optimizing Brachial Plexus Diffusion Tensor Imaging
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- Authors
- Kamagata, K., Andica, C., Uchida, W., Takabayashi, K., Saito, Y., Lukies, M., Hagiwara, A., Fujita, S., Akashi, T., Wada, A., Hori, M., Kamiya, K., Zalesky, A., & Aoki, S.
- Affiliations
- Toho University (JP)
- Corresponding author
- Kamagata, Koji
- ORCID
- Venue
- Investigative Radiology
- Published
- 2023-09-14
- Volume
- 59
- Issue
- 1
- Pages
- 13-25
- ISSN
- 0020-9996 (ISSN-L)
- 1536-0210
- PMC
- PMC11805476
- OpenAlex
- W4386725533
- Cited by
- 50
- References
- 120
- Citations by year
- 2026: 22 · 2025: 21 · 2024: 7
- FWCI
- 8.28
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Investigative Radiology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc-nd)
- Funders
- Japan Agency for Medical Research and Development (JP21wm0425006, JP19dm0307101)
- Promotion and Mutual Aid Corporation for Private Schools of Japan
- Japan Society for the Promotion of Science (23H02865)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Keywords
- diffusion MRI tractography, white matter tracts, surgical planning, brain tumors, epilepsy, deep brain stimulation, functional neurosurgery, white matter connectivity, risk stratification
- MeSH terms
- Brain, Humans, Neurosurgery, Neurosurgical Procedures, Diffusion Magnetic Resonance Imaging, Diffusion Tensor Imaging
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