Purpose of review: After more than 10 years of methodological developments and clinical applications, diffusion imaging tractography has reached a crossroad. Although the method is still in its infancy, the time has come to address some important questions. Can tractography reproduce reliably known anatomy or describe new anatomical pathways? Are interindividual differences, for example in tract lateralization, important to understand heterogeneity of clinical manifestations? Do novel tractography algorithms provide a real advantage over previous methods? Here we focus on some of the most exciting recent advancements in diffusion tractography and critically highlight their advantages and limitations.
Recent findings: A flourishing of diffusion methods and models are bringing new solutions to the well known limitations of classical tractography based on the tensor model. However, these methods pose also new challenges and require the convergence and integration of different disciplines before they can replace what is currently widely available.
Summary: Rigorous postmortem validation, clinical optimization and experimental confirmation are obligatory steps before advanced diffusion technologies can translate into clear benefits for neurological patients.