扩散磁共振成像（Diffusion Magnetic Resonance Imaging Tractography，DMRI）是一种非侵入性技术，可以对大脑的白质束进行可视化和定量化。它被广泛应用于脑肿瘤、癫痫和深部脑刺激等功能神经外科手术的术前规划。在过去的25年中，成像采集、纤维方向估计和追踪方法取得了显著进展，从而极大地提高了路径追踪的准确性。该技术能够绘制手术部位周围的功能关键通路，以避免永久性功能障碍。当充分认识和考虑到其限制时，路径追踪可以作为一个有价值的工具，用于保护关键的白质束，并提供关于正常白质和整个大脑结构连接的变化的见解，超越局部病变。在深部脑刺激等功能神经外科手术中，它在优化刺激部位和参数以最大化治疗效果方面起着重要作用，并可作为直接治疗靶点。这些见解可以帮助患者风险分层和预后评估。本文旨在讨论最先进的追踪方法学及其在术前规划中的应用，并强调追踪技术在日常临床实践中的挑战和新前景。版权© 2023作者们。由 Wolters Kluwer Health, Inc. 出版。

Diffusion magnetic resonance imaging tractography is a noninvasive technique that enables the visualization and quantification of white matter tracts within the brain. It is extensively used in preoperative planning for brain tumors, epilepsy, and functional neurosurgical procedures such as deep brain stimulation. Over the past 25 years, significant advancements have been made in imaging acquisition, fiber direction estimation, and tracking methods, resulting in considerable improvements in tractography accuracy. The technique enables the mapping of functionally critical pathways around surgical sites to avoid permanent functional disability. When the limitations are adequately acknowledged and considered, tractography can serve as a valuable tool to safeguard critical white matter tracts and provides insight regarding changes in normal white matter and structural connectivity of the whole brain beyond local lesions. In functional neurosurgical procedures such as deep brain stimulation, it plays a significant role in optimizing stimulation sites and parameters to maximize therapeutic efficacy and can be used as a direct target for therapy. These insights can aid in patient risk stratification and prognosis. This article aims to discuss state-of-the-art tractography methodologies and their applications in preoperative planning and highlight the challenges and new prospects for the use of tractography in daily clinical practice.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.