Activity of the glymphatic system may be evaluated with diffusion images. Lower diffusivity along the perivascular space on DTI-APLS seems to reflect impairment of the glymphatic system. This method may be useful for evaluating the activity of the glymphatic system.

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An FA value of about 0.20 was found to be the optimal trackability threshold.

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Diffusion tensor MR imaging (DTI) provides information on diffusion anisotropy, which can be expressed with three-dimensional (3D) white matter tractography. We used 3D white matter tractography to show the corticospinal tract in eight patients with acute or early subacute ischaemic stroke involving the posterior limb of the internal capsule or corona radiata and to assess involvement of the tract. Infarcts and the tract were shown simultaneously, providing information on their spatial relationships. In five of the eight patients, 3D fibre tract maps showed the corticospinal tract in close proximity to the infarct but not to pass through it. All these patients recovered well, with maximum improvement from the lowest score on manual muscle testing (MMT) up to the full score through rehabilitation. In the other three patients the corticospinal tract was shown running through the infarct; reduction in MMT did not necessarily improve favourably or last longer, other than in one patient. As 3D white matter tractography can show spatial relationships between the corticospinal tract and an infarct, it might be helpful in prognosis of gross motor function.

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