Brain metastases represent a significant challenge in cancer care, affecting approximately 150,000 to 200,000 individuals annually. Among patients with stage 4 breast cancer, an estimated 10–15% develop metastatic tumors in the brain, often requiring surgical intervention. While conventional magnetic resonance imaging (MRI) is routinely used for diagnosis and treatment planning, it provides limited visualization of white matter fiber tracts that are critical for preserving neurological function during tumor resection. Diffusion-tensor imaging (DTI) is an advanced neuroimaging technique that addresses this limitation by mapping the microstructural organization of white matter through directional water diffusion.

This presentation explores the role of DTI as a translational imaging tool in cancer research and neuro- oncology, highlighting its application in pre- and post-surgical planning for patients with brain metastases. DTI employs gradient pulses that selectively capture diffusion patterns, enabling visualization of fiber tract displacement, compression, or disruption caused by tumor growth. Imaging outputs can be represented quantitatively or through three-dimensional glyphs, offering clinicians detailed insights into tumor–brain interactions that are not discernible with standard MRI.

A representative clinical case involving a 45-year-old patient with stage 4 breast cancer and brain metastases demonstrates how DTI-guided imaging enabled precise identification of tumor-affected regions and preserved neural pathways. This information informed surgical strategy and contributed to successful tumor removal while minimizing neurological risk. The presentation also discusses the broader implications of DTI in cancer research, including its potential integration with AI-driven predictive models to enhance surgical decision-making and personalize treatment strategies. Future prospective cohort studies are proposed to further validate DTI’s role in improving outcomes for patients with metastatic brain tumors.