The ability of fiber tractography to delineate non-invasively the white matter fiber pathways of the brain raises possibilities for clinical applications and offers enormous potential for neuroscience. In the last decade, fiber tracking has become the method of choice to investigate quantitative MRI parameters in specific bundles of white matter. For neurosurgeons, it is quickly becoming an invaluable tool for the planning of surgery, allowing for visualization and localization of important white matter pathways before and even during surgery. Fiber tracking has also claimed a central role in the field of "connectomics," a technique that builds and studies comprehensive maps of the complex network of connections within the brain, and to which significant resources have been allocated worldwide. Despite its unique abilities and exciting applications, fiber tracking is not without controversy, in particular when it comes to its interpretation. As neuroscientists are eager to study the brain's connectivity, the quantification of tractography-derived "connection strengths" between distant brain regions is becoming increasingly popular. However, this practice is often frowned upon by fiber-tracking experts. In light of this controversy, this paper provides an overview of the key concepts of tractography, the technical considerations at play, and the different types of tractography algorithm, as well as the common misconceptions and mistakes that surround them. We also highlight the ongoing challenges related to fiber tracking. While recent methodological developments have vastly increased the biological accuracy of fiber tractograms, one should be aware that, even with state-of-the-art techniques, many issues that severely bias the resulting structural "connectomes" remain unresolved.

Diffusion MRI‐based tractography is the most commonly‐used technique when inferring the structural brain connectome, i.e., the comprehensive map of the connections in the brain. The utility of graph theory—a powerful mathematical approach for modeling complex network systems—for analyzing tractography‐based connectomes brings important opportunities to interrogate connectome data, providing novel insights into the connectivity patterns and topological characteristics of brain structural networks. When applying this framework, however, there are challenges, particularly regarding methodological and biological plausibility. This article describes the challenges surrounding quantitative tractography and potential solutions. In addition, challenges related to the calculation of global network metrics based on graph theory are discussed.Evidence Level: 5Technical Efficacy: Stage 1

Diffusion magnetic resonance imaging is a noninvasive imaging modality that has been extensively used in the literature to study the neuronal architecture of the brain in a wide range of neurological conditions using tractography. However, recent studies highlighted that the anatomical accuracy of the reconstructions is inherently limited and challenged its appropriateness. Several solutions have been proposed to tackle this issue, but none of them proved effective to overcome this fundamental limitation. In this work, we present a novel processing framework to inject into the reconstruction problem basic prior knowledge about brain anatomy and its organization and evaluate its effectiveness using both simulated and real human brain data. Our results indicate that our proposed method dramatically increases the accuracy of the estimated brain networks and, thus, represents a major step forward for the study of connectivity.

The human brain is a complex and organized network, where the connection between regions is not achieved with single axons crisscrossing each other but rather millions of densely packed and well-ordered axons. Reconstruction from diffusion MRI tractography is only an attempt to capture the full complexity of this network, at the macroscale. This review provides an overview of the misconceptions, biases and pitfalls present in structural white matter bundle and connectome reconstruction using tractography. The goal is not to discourage readers, but rather to inform them of the limitations present in the methods used by researchers in the field in order to focus on what they can do and promote proper interpretations of their results. It also provides a list of open problems that could be solved in future research projects for the next generation of PhD students.

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