Young, Fiona; (2024) Fibre tract imaging with intraoperative diffusion MRI for neurosurgical navigation. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Mapping and understanding the brain's structure and function is never more critical than when it suffers injury or illness. Lifesaving neurosurgical procedures may put essential neural communication pathways called white matter tracts at risk, with grave consequences for the patient, so accurately depicting their location using diffusion-weighted magnetic resonance imaging dMRI is becoming a key component of modern neurosurgical practice. More recently, obtaining new intraoperative magnetic resonance imaging iMRI partway through surgery has demonstrated potential to further improve outcomes by providing updated anatomical information after the dynamic effects of intraoperative brain shift have diminished the accuracy of preoperative imaging. With the ability to sample directional water diffusivity in tissue, dMRI produces millimetre-scale maps of white matter Fibre orientations which are key to reconstructing individual tracts. However, established image computational methods suffer from limitations in accuracy and practicality which restrict the wider clinical uptake of dMRI white matter imaging generally, and particularly for iMRI. After an in depth review of the state of the art in white matter imaging and image-guided neurosurgery, this thesis explores the development of a novel white matter tract mapping tool, named tractfinder, which applies a priori anatomical knowledge encoded within a statistical tract orientation and location atlas to achieve rapid tract segmentation in a patient dMRI scan. The proposed pipeline includes explicit patient-specific modelling of tumour deformation effects, an element missing from many research-oriented tract reconstruction approaches. Tractfinder's effectiveness in a range of applications is detailed through thorough quantitative evaluation, while clinical case studies demonstrate its key advantages over existing approaches. In addition, the technical and practical challenges of intraoperative imaging are explored together with their implications for effective clinical translation of advanced dMRI-based white matter imaging.

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