SynthesisNeurosurgical review2026
Neural pathway-guided radiosurgery: A systematic review and meta-analysis of diffusion tensor imaging applications in stereotactic radiosurgery.
Synthesis in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
5 authors.
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Abstract
Diffusion tensor imaging (DTI) has increasingly been incorporated into stereotactic radiosurgery (SRS) to improve visualization of eloquent neural pathways and to evaluate treatment-related microstructural changes. However, its roles in tractography-guided treatment planning, dosimetric optimization, clinical outcomes, and prognostication have not been systematically characterized across intracranial SRS applications. A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420261349539). MEDLINE/PubMed, Scopus, Web of Science, and the Cochrane Library were searched, without date restriction, for studies evaluating diffusion MRI or tractography in intracranial SRS. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale where applicable. Random-effects meta-analysis was performed when 3 or more studies reported comparable outcomes. Forty-two studies involving 1464 patients met the inclusion criteria. Twenty-one studies evaluated tractography-guided planning, and 21 evaluated DTI-derived voxel-wise or region of interest-based quantitative diffusivity parameters. The feasibility of tractography reconstruction was reported in 22 studies, with an overall failure rate of 1.2%. Meta-analysis of comparative studies suggested a lower risk of motor deficits with tractography-guided planning than with conventional planning (risk ratio 0.31, 95% CI 0.14-0.67; I
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