title: Accuracy of diffusion tensor magnetic resonance imaging tractography assessed using intraoperative subcortical stimulation mapping and magnetic source imaging.
abstract: OBJECTIVE
  Resecting brain tumors involves the risk of damaging the descending motor pathway. Diffusion tensor (DT)-imaged fiber tracking is a noninvasive magnetic resonance (MR) technique that can delineate the subcortical course of the motor pathway. The goal of this study was to use intraoperative subcortical stimulation mapping of the motor tract and magnetic source imaging to validate the utility of DT-imaged fiber tracking as a tool for presurgical planning.
  
  
  METHODS
  Diffusion tensor-imaged fiber tracks of the motor tract were generated preoperatively in nine patients with gliomas. A mask of the resultant fiber tracks was overlaid on high-resolution T1- and T2-weighted anatomical MR images and used for stereotactic surgical navigation. Magnetic source imaging was performed in seven of the patients to identify functional somatosensory cortices. During resection, subcortical stimulation mapping of the motor pathway was performed within the white matter using a bipolar electrode.
  
  
  RESULTS
  A total of 16 subcortical motor stimulations were stereotactically identified in nine patients. The mean distance between the stimulation sites and the DT-imaged fiber tracks was 8.7 +/- 3.1 mm (+/- standard deviation). The measured distance between subcortical stimulation sites and DT-imaged fiber tracks combines tracking technique errors and all errors encountered with stereotactic navigation.
  
  
  CONCLUSIONS
  Fiber tracks delineated using DT imaging can be used to identify the motor tract in deep white matter and define a safety margin around the tract.
authors: Department of Radiology, University of California, San Francisco 94107, USA. jberman@mrsc.ucsf.edu
authors: Jeffrey I
authors: JI
authors: Berman
authors: Mitchel S
authors: MS
authors: Berger
authors: Sung Won
authors: SW
authors: Chung
authors: Srikantan S
authors: SS
authors: Nagarajan
authors: Roland G
authors: RG
authors: Henry
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005910:Glioma / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D038361:Neuronavigation; D011712:Pyramidal Tracts / Q000503:physiopathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies