Utility of 7T MRI and Diffusion Tractography in Preoperative Planning for Peripheral Nerve Sheath Tumors

Motivation: Peripheral nerve sheath tumors (PNSTs) challenge differentiation between benign and malignant forms and complicate surgical planning due to unclear tumor-nerve relationships. Goal(s): To demonstrate 7T diffusion tensor imaging (DTI) with tractography for preoperative evaluation, enhancing visualization of affected nerve fascicles. Approach: A patient with a suspected schwannoma was imaged using a 7T MRI system with DTI and high-resolution double echo steady state sequences. Tractography mapped nerve fibers and clarified their relation to the tumor. Results: Imaging showed nerve deformation and fascicle displacement, confirmed intraoperatively. DTI tractography supported surgical planning, with improved outcomes and only minor postoperative numbness. Impact: We highlight the potential of 7T DTI tractography to enhance surgical planning for peripheral nerve sheath tumors by precisely mapping tumor-nerve relationships, improving preoperative visualization, and ultimately supporting better patient outcomes with minimal nerve damage.