Diffusion tensor imaging (DTI) is an advanced MR imaging technique that provides noninvasive qualitative and quantitative information about the white matter microarchitecture. DTI and fiber tractography have been increasingly used in the past decade to investigate the microstructural neuroarchitecture of posterior fossa malformations. This article aimed to review DTI and fiber tractography findings in several posterior fossa malformations, and highlighted the added value of DTI and fiber tractography compared with conventional MR imaging. DTI and fiber tractography may provide information that is helpful to better understand the pathogenesis of selected posterior fossa malformations. In addition, DTI may elucidate the anatomic role of the cerebellum for neurocognitive functions in children with posterior fossa malformations and DTI scalars of the cerebellar, and brain stem white matter tracts may serve as a predictive biomarker for cognitive outcome. Finally, quantitative DTI analysis of cerebellar and brain stem white matter tracts may help to select candidates for therapeutic interventions and may enable monitoring of the therapy response.
Learning Objective: To recognize the utility of diffusion tensor imaging and fiber tractography to study malformations of the posterior fossa and highlight the additional information that diffusion tensor imaging and fiber tractography may provide compared with conventional MR imaging sequences.