Role of Diffusion Tensor Imaging (DTI) in White Matter Disorders: A Comprehensive Review

Abstract

White matter disorders encompass a broad spectrum of neurological conditions that disrupt myelinated axonal pathways, causing cognitive, motor, and sensory impairments. While conventional MRI provides macroscopic insights, it often fails to detect subtle microstructural changes. Diffusion tensor imaging (DTI), an advanced MRI technique sensitive to anisotropic water diffusion, enables in vivo characterization of white matter integrity through metrics such as fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). This review summarizes the clinical applications of DTI across multiple disorders, including multiple sclerosis, Alzheimer’s disease, traumatic brain injury, leukodystrophies, vascular white matter changes, and neurodevelopmental conditions. DTI identifies microstructural alterations in both lesions and normal-appearing white matter, offering early diagnostic, prognostic, and therapeutic insights. Technical innovations—including free-water imaging, diffusion kurtosis imaging, and AI-assisted tractography—enhance reliability and clinical translation. Despite limitations such as sensitivity to crossing fibers, motion artifacts, and variability in acquisition protocols, DTI is emerging as an indispensable tool for research and clinical management of white matter disorders. Future studies should focus on multicenter standardization, longitudinal assessment, and integration with multimodal imaging to fully realize the potential of DTI as a biomarker.