Utility of diffusion tensor imaging and tractography (DTI/DTT) in the surgical resection of intramedullary spinal cord tumors: A scoping review.

BACKGROUND: Diffusion tensor imaging (DTI) and tractography (DTT) are advanced magnetic resonance imaging (MRI) techniques which have gained traction in spinal cord injury and degenerative cervical myelopathy for being able to predict functional outcomes. Intramedullary spinal cord tumors (IMSCTs) are a challenging disease entity, for which surgery is the mainstay of treatment. Despite technological advances, post-operative neurological deficits are common. We conducted a scoping review with the aim of understanding the use of DTI and DTT in aiding surgical management of IMSCTs. METHODS: A systematic search was conducted for studies on IMSCT patients, between the years 2000 to 2024. All quantitative MRI techniques were included in the search parameters, but only DTI and DTT were used for surgically treated IMSCTs. Inclusion and exclusion criteria were applied to select for appropriate articles. RESULTS: Sixteen studies related to DTI and DTT use in surgically managed IMSCTs were included for analysis. There was agreement amongst authors of the benefits of DTI and DTT in delineating the cleavage plane between tumor and cord, operative suitability and demarcating fiber tracts to avoid intra-operative injury. Studies that performed intraoperative neuromonitoring found that electrophysiological findings were concordant with tractography findings of tract disruption. Two studies used DTI and DTT intra-operatively with preservation of fiber tracts. CONCLUSION: The use of DTI and DTT in the surgical treatment of IMSCTs is able to classify tumors, identify fiber tracts and aid intra-operatively to avoid damage to eloquent anatomy but has yet to be shown to improve functional outcomes.