Figure 8.

Novel tractography approaches showing perilesional white matter pathways of a 65-year-old female patient with glioblastoma multiforme (GBM) to assist presurgical planning or postsurgical assessment. (a) Advanced tractography can be integrated with other imaging modalities to assist diagnostic and prognostic evaluation. The tractogram is color-coded by T₂/FLAIR to visualize pathways affected by peritumoral edema. (b) Tractograms can be color-coded according to cell densities estimated from restricted diffusion imaging (Yeh et al., 2017) to highlight tracts infiltrated by tumor cells (annotated by the white arrow). The results may inform the extent of surgical resection to achieve better surgical results. (c) Automated tractography maps the arcuate fasciculus (AF), corticospinal tract (CST), and optic radiation (OR) of the patient to facilitate presurgical planning. This new tractography approach uses prior anatomical information from a tractography atlas to identify white matter pathways, eliminate spurious tracks, and cluster tracks into anatomically defined bundles. This process can reduce the tedious manual placement of seed regions and can improve the test-retest reliability of tractography mapping.