A note on the validity of statistical bootstrapping for estimating the uncertainty of tensor parameters in diffusion tensor images.

Diffusion tensors are estimated from magnetic resonance images (MRIs) that are diffusion-weighted, and those images inherently contain noise. Therefore, noise in the diffusion-weighted images produces uncertainty in estimation of the tensors and their derived parameters, which include eigenvalues, eigenvectors, and the trajectories of fiber pathways that are reconstructed from those eigenvalues and eigenvectors. Although repetition and wild bootstrap methods have been widely used to quantify the uncertainty of diffusion tensors and their derived parameters, we currently lack theoretical derivations that would validate the use of these two bootstrap methods for the estimation of statistical parameters of tensors in the presence of noise. The aim of this paper is to examine theoretically and numerically the repetition and wild bootstrap methods for approximating uncertainty in estimation of diffusion tensor parameters under two different schemes for acquiring diffusion weighted images. Whether these bootstrap methods can be used to quantify uncertainty in some diffusion tensor parameters, such as fractional anisotropy (FA), depends critically on the morphology of the diffusion tensor that is being estimated. The wild and repetition bootstrap methods in particular cannot quantify uncertainty in the principal direction (PD) of isotropic (or oblate) tensor. We also examine the use of bootstrap methods in estimating tensors in a voxel containing multiple tensors, demonstrating their limitations when quantifying the uncertainty of tensor parameters in those locations. Simulation studies are also used to understand more thoroughly our theoretical results. Our findings raise serious concerns about the use of bootstrap methods to quantify the uncertainty of fiber pathways when those pathways pass through voxels that contain either isotropic tensors, oblate tensors, or multiple tensors.