Use of diffusion tensor imaging to evaluate weakness

Chi Heon Kim M.D., Chun-Kee Chung M.D., Ph.D., June Sic Kim Ph.D., Tae Ahn Jahng M.D., Ph.D., June Ho Lee M.D., and In Chan Song Ph.D.
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Object

Recently, diffusion tensor (DT) imaging was introduced to demonstrate white matter tracts. However, research interest has focused on the anatomical rather than the functional aspects of this imaging modality. The authors undertook a functional analysis of DT imaging to determine the relationship between weakness and changes on DT images.

Methods

Diffusion tensor images were obtained in 23 patients with lesions located adjacent to the pyramidal tract. Patients were classified according to their motor deficit. Axial magnetic resonance image sections through the maximum tumor diameters were selected and the mean apparent diffusion coefficients (ADCs) and mean fractional anisotropies (FAs) were measured. One ovoid region of interest (ovROI) was placed in the center of the pyramidal tract and another was designed to include the whole pyramidal tract at the same axial level (wROI). To determine intraobserver variability, a single neurosurgeon measured mean ADCs and FAs four times by using these two different ROI types without knowledge of any clinical information. To determine interobserver variability, a second neurosurgeon who was also unaware of any clinical information measured the mean ADCs and FAs by using the wROI method.

The five measurements produced the same results. The mean FA at the lesion side of the pyramidal tract was significantly lower in patients with weakness (p < 0.01). Little intraobserver measurement variability occurred using the ovROI method, and no interobserver variability occurred using the wROI method.

Conclusions

Motor weakness was significantly related to a low mean FA in the pyramidal tract on the lesion side. Designing an ROI that includes the whole pyramidal tract is an easier and more reproducible method than using an ovROI method.

Abbreviations used in this paper:

ADC = apparent diffusion coefficient; DT = diffusion tensor; FA = fractional anisotropy; L/N = lesion side value/normal side value; MR = magnetic resonance; ovROI = ovoid region of interest; wROI = whole pyramidal tract ROI.

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  • 1

    Berman JI, , Berger MS, , Mukherjee P, & Henry RG: Diffusion-tensor imaging-guided tracking of fibers of the pyramidal tract combined with intraoperative cortical stimulation mapping in patients with gliomas. J Neurosurg 101:6672, 2004

    • Search Google Scholar
    • Export Citation
  • 2

    Clark CA, , Barrick TR, , Murphy MM, & Bell BA: White matter fiber tracking in patients with space-occupying lesions of the brain: a new technique for neurosurgical planning?. Neuroimage 20:16011608, 2003

    • Search Google Scholar
    • Export Citation
  • 3

    Hendler T, , Pianka P, , Sigal M, , Kafri M, , Ben-Bashat D, & Constantini S, et al.: Delineating gray and white matter involvement in brain lesions: three-dimensional alignment of functional magnetic resonance and diffusion-tensor imaging. J Neurosurg 99:10181027, 2003

    • Search Google Scholar
    • Export Citation
  • 4

    Henry RG, , Berman JI, , Nagarajan SS, , Mukherjee P, & Berger MS: Subcortical pathways serving cortical language sites: initial experience with diffusion tensor imaging fiber tracking combined with intraoperative language mapping. Neuroimage 21:616622, 2004

    • Search Google Scholar
    • Export Citation
  • 5

    Lu S, , Ahn D, , Johnson G, & Cha S: Peritumoral diffusion tensor imaging of high-grade gliomas and metastatic brain tumors. AJNR Am J Neuroradiol 24:937941, 2003

    • Search Google Scholar
    • Export Citation
  • 6

    Lu S, , Ahn D, , Johnson G, , Law M, , Zagzag D, & Grossman RI: Diffusion-tensor MR imaging of intracranial neoplasia and associated peritumoral edema: introduction of the tumor infiltration index. Radiology 232:221228, 2004

    • Search Google Scholar
    • Export Citation
  • 7

    Mori S, , Crain BJ, , Chacko VP, & van Zijl PC: Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol 45:265269, 1999

    • Search Google Scholar
    • Export Citation
  • 8

    Price SJ, , Burnet NG, , Donovan T, , Green HA, , Pena A, & Antoun NM, et al.: Diffusion tensor imaging of brain tumors at 3T: a potential tool for assessing white matter tract invasion?. Clin Radiol 58:455462, 2003

    • Search Google Scholar
    • Export Citation
  • 9

    Provenzale JM, , McGraw P, , Mhatre P, , Guo AC, & Delong D: Peritumoral brain regions in gliomas and meningiomas: investigation with isotropic diffusion-weighted MR imaging and diffusion-tensor MR imaging. Radiology 232:451460, 2004

    • Search Google Scholar
    • Export Citation
  • 10

    Sinha S, , Bastin ME, , Whittle IR, & Wardlaw JM: Diffusion tensor MR imaging of high-grade cerebral gliomas. AJNR Am J Neuroradiol 23:520527, 2002

    • Search Google Scholar
    • Export Citation
  • 11

    Tropine A, , Vucurevic G, , Delani P, , Boor S, , Hopf N, & Bohl J, et al.: Contribution of diffusion tensor imaging to delineation of gliomas and glioblastomas. J Magn Reson Imaging 20:905912, 2004

    • Search Google Scholar
    • Export Citation
  • 12

    Wieshmann UC, , Clark CA, , Symms MR, , Franconi F, , Barker GJ, & Shorvon SD: Reduced anisotropy of water diffusion in structural cerebral abnormalities demonstrated with diffusion tensor imaging. Magn Reson Imaging 17:12691274, 1999

    • Search Google Scholar
    • Export Citation
  • 13

    Witwer BP, , Moftakhar R, , Hasan KM, , Deshmukh P, , Haughton V, & Field A, et al.: Diffusion-tensor imaging of white matter tracts in patients with cerebral neoplasm. J Neurosurg 97:568575, 2002

    • Search Google Scholar
    • Export Citation
  • 14

    Yamada K, , Kizu O, , Mori S, , Ito H, , Nakamura H, & Yuen S, et al.: Brain fiber tracking with clinically feasible diffusion-tensor MR imaging: initial experience. Radiology 227:295301, 2003

    • Search Google Scholar
    • Export Citation

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