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From images to insights: a neuroradiologist’s practical guide on white matter fiber tract anatomy and DTI patterns for pre-surgical planning

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Diffusion tensor imaging (DTI) is a valuable non-invasive imaging modality for mapping white matter tracts and assessing microstructural integrity, and can be used as a “biomarker” in diagnosis, differentiation, and therapeutic monitoring. Although it has gained clinical importance as a marker of neuropathology, limitations in its interpretation underscore the need for caution.


This review provides an overview of the principles and clinical applicability of DTI. We focus on major white matter fiber bundles, detailing their normal anatomy and pathological DTI patterns, with emphasis on tracts routinely requested in our neurosurgical department in the preoperative context (uncinate fasciculus, arcuate fasciculus, pyramidal pathway, optic radiation, and dentatorubrothalamic tract).


We guide neuroradiologists and neurosurgeons in defining volumes of interest for mapping individual tracts and demonstrating their 3D reconstructions. The intricate trajectories of white matter tracts pose a challenge for accurate fiber orientation recording, with each bundle exhibiting specific characteristics. Tracts adjacent to brain lesions are categorized as displaced, edematous, infiltrated, or disrupted, illustrated with clinical cases of brain neoplasms. To improve structured reporting, we propose a checklist of topics for inclusion in imaging evaluations and MRI reports.


DTI is emerging as a powerful tool for assessing microstructural changes in brain disorders, despite some challenges in standardization and interpretation. This review serves an educational purpose by providing guidance for fiber monitoring and interpretation of pathological patterns observed in clinical cases, highlighting the importance and potential pitfalls of DTI in neuroradiology and surgical planning.

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Apparent Diffusion Coefficient


Diffusion Magnetic Resonance Imaging


Diffusion Tensor Imaging


Diffusion-Weighted Imaging


Fractional Anisotropy


Isocitrate Dehydrogenase


Mean Diffusivity


Magnetic Resonance Imaging




White Matter


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Authors and Affiliations



IF and DJP conceptualize the article. IF performed the literature search. IF and DJP performed the data analysis. IF wrote the first draft. All authors critically revised the manuscript.

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Correspondence to Inês S. Freire.

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In line with the above, the study was exempt from ethical approval.

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This report does not contain any personal information that could lead to the identification of the patient(s). In addition, this is an observational study, so the patients’ informed consent was waived. All the images used are anonymized and do not allow the individuals to be identified.

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Freire, I.S., Lopes, T.S., Afonso, S.G. et al. From images to insights: a neuroradiologist’s practical guide on white matter fiber tract anatomy and DTI patterns for pre-surgical planning. Neuroradiology (2024).

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