TU/e research brings new MRI technology for nerve tracts in the brain into practice
Insight into the structure of the brain is essential for successfully performing brain surgery with as little permanent damage to the patient as possible. MRI is the only non-invasive in vivo technique to reconstruct and visualize nerve tracts in the brain. For various reasons, however, this method is not yet used in practice. Professor of Mathematical Image Analysis Luc Florack will change this with an NWO grant of almost € 700,000. With this grant he will improve the techniques developed by science and put them into clinical practice.
Tractography is a method to visually reconstruct neural connections in the brain. For this, diffusion-weighted MRI is used, a technique based on the fact that water molecules in the brain are in motion as a result of diffusion; the natural tendency of particles to be evenly distributed over a space. The movement of these water molecules is limited by the white matter (consisting of nerve tracts) in the brain. A diffusion-weighted MRI scan measures how strongly the diffusion is limited in many different directions and therefore contains indirect information about the underlying white matter pathways. With advanced mathematical techniques these pathways can be reconstructed and then visualized for the neurosurgeon.
Although scientific studies on tractography show promising results, there is skepticism among clinicians about the use of this technique. One of the reasons for this is that reliable tractography images are very difficult to obtain and validate. Furthermore, reliable visualization is a big problem due to the complexity of such images. A high level of neurological expertise and a significant amount of training is required to avoid misinterpretations.
In addition, diseases that affect the anatomy of the brain, such as cancer that causes tumors, distort the tractography in an unpredictable way. And is there still insufficient knowledge about the variability between different patients. The tractography method itself also contains all sorts of uncertainties that impede a correct interpretation. Uncertainties that cannot be removed will have to be included in the visualization to prevent misleading neurosurgeons, which is not easy given that the images without such uncertainties are already complicated enough.
The goal of Luc Florack's research is to eliminate these uncertainties wherever possible by methodologically improving tractography, and by developing an open source software tool for visual analysis - including remaining uncertainties - that can be used directly in clinical practice. With this tool neurosurgeons will get a better patient-specific insight into the anatomy of the brain. This allows them to make a better risk assessment in preparation for the brain surgery, they receive better support during the operation, and the tool helps them to assess whether and how long-term functional recovery is possible after an operation.
For this research, Luc Florack will work closely with Anna Vilanova from TU Delft, expert in visualization techniques, and Geert-Jan Rutten, neurosurgeon at the Elisabeth-TweeSteden Hospital. Together they supervise two PhD students and one postdoctoral researcher during the research project.