Assessment of the corticospinal tract alterations before and after resection of brainstem lesions using Diffusion Tensor Imaging (DTI) and tractography at 3T

Kovanlıkaya, İlhami; Fırat, Zeynep; Kovanlıkaya, Arzu; Uluğ, Aziz M.; Cihangiroğlu, Mutlu; John, Majnu; Bingöl, Canan Aykut; Türe, Uğur

doi:10.1016/j.ejrad.2009.08.012

Cited by 62 publications

(59 citation statements)

References 19 publications

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“…4,5,29,33,39,40,47,57 The physical principles and rationale of this technique have been extensively debated, and a more profound discussion is beyond the scope of the current study. 61 Others have shown good concordance between tractography results and intraoperative direct electric stimulations.…”

Section: Dti/dtt Datamentioning

confidence: 99%

“…A default fractional anisotropy (FA) threshold of 0.20 and minimum fiber length of 50 mm were used for construction of DTT, as validated by Kunimatsu et al 10,34,38 Patterns of fiber tract alterations (based on morphological appearance on color map FA threshold and reconstructed 3D tractography) were classified into 4 groups, as described by Lazar et al (Table 1). 33,36 Areas of interest were limited to the neuroanatomical region of the brainstem correlating to the BSCM site and its hemorrhage. The following major fiber tracts were selected for evaluation: 1) corticospinal tract (CST), 2) medial lemniscus (ML) and medial longitudinal fasciculus (MLF), 3) inferior cerebellar peduncle (ICP), 4) middle cerebellar peduncle, and 5) superior cerebellar peduncle (Fig.…”

Section: Conventional Mr and Dtimentioning

confidence: 99%

“…As a result of this predictable pattern of diffusion, which is orientation dependent (or anisotropic), location and orientation of white matter tracts can be determined. 6,13,14,33,34,50 Several articles have described the implementation of DTI for a multitude of neurological diseases and neuroanatomical studies; 8,10,14,22,38,42,50,58,59 however, none has addressed its specific application in the management of brainstem cavernous malformations (BSCMs).…”

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confidence: 99%

“…10,11 Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) are promising neuroimaging techniques that help overcome some of those limitations. 6,8,10,11,33,36 They have become useful clinical tools that can delineate functionally important white matter tracts for surgical planning. 6 Tractography based on diffusion MRI explores the correlation between water diffusion and brain structure to delineate the course of white matter pathways.…”

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confidence: 99%

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The utility of preoperative diffusion tensor imaging in the surgical management of brainstem cavernous malformations

Flores¹,

Whittemore

Samson³

et al. 2015

JNS

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abbreviatioNs BSCM = brainstem CM; CM = cavernous malformation; CST = corticospinal tract; DTI = diffusion tensor imaging; DTT = diffusion tensor tractography; FA = fractional anisotropy; ICP = inferior cerebral peduncle; ML = medial lemniscus; MLF = medial longitudinal fasciculus; mRS = modified Rankin Scale. submitted April 9, 2013. accepted November 18, 2014. iNclude wheN citiNg Published online January 9, 2015; DOI: 10.3171/2014.11.JNS13680. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect Resection of brainstem cavernous malformations (BSCMs) may reduce the risk of stepwise neurological deterioration secondary to hemorrhage, but the morbidity of surgery remains high. Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) are neuroimaging techniques that may assist in the complex surgical planning necessary for these lesions. The authors evaluate the utility of preoperative DTI and DTT in the surgical management of BSCMs and their correlation with functional outcome. methods A retrospective review was conducted to identify patients who underwent resection of a BSCM between 2007 and 2012. All patients had preoperative DTI/DTT studies and a minimum of 6 months of clinical and radiographic follow-up. Five major fiber tracts were evaluated preoperatively using the DTI/DTT protocol: 1) corticospinal tract, 2) medial lemniscus and medial longitudinal fasciculus, 3) inferior cerebellar peduncle, 4) middle cerebellar peduncle, and 5) superior cerebellar peduncle. Scores were applied according to the degree of distortion seen, and the sum of scores was used for analysis. Functional outcomes were measured at hospital admission, discharge, and last clinic visit using modified Rankin Scale (mRS) scores. results Eleven patients who underwent resection of a BSCM and preoperative DTI were identified. The mean age at presentation was 49 years, with a male-to-female ratio of 1.75:1. Cranial nerve deficit was the most common presenting symptom (81.8%), followed by cerebellar signs or gait/balance difficulties (54.5%) and hemibody anesthesia (27.2%). The majority of the lesions were located within the pons (54.5%). The mean diameter and estimated volume of lesions were 1.21 cm and 1.93 cm 3 , respectively. Using DTI and DTT, 9 patients (82%) were found to have involvement of 2 or more major fiber tracts; the corticospinal tract and medial lemniscus/medial longitudinal fasciculus were the most commonly affected. In 2 patients with BSCMs without pial presentation, DTI/DTT findings were important in the selection of the surgical approach. In 2 other patients, the results from preoperative DTI/DTT were important for selection of brainstem entry zones. All 11 patients underwent gross-total resection of their BSCMs. After a mean postoperative follow-up duration of 32.04 months, all 11 patients had excellent or good outcome (mRS Score 0-3) at the time of last outpatient clinic evaluation. DTI score did not corre...

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Section: Dti/dtt Datamentioning

confidence: 99%

Section: Conventional Mr and Dtimentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The utility of preoperative diffusion tensor imaging in the surgical management of brainstem cavernous malformations

Flores¹,

Whittemore

Samson³

et al. 2015

JNS

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“…Anisotropy threshold values for FA and deflection parameters were set between 0.27-0.35 and 700-915 (where 0 refers to full deflection and 1000 to no deflection) respectively to obtain the maximum tract conspicuity. A knowledge-based multiple-ROI technique was used [8,19,20]. To delineate the relevant white matter fibers, multiple ROIs were placed in the white matter of the occipital region, and the regions of the lateral geniculate body and the optic tract according to previously described anatomical reference methods to identify the lateral geniculate body and optic tracts in T1-weighted images and color-coded FA images [21][22][23].…”

Section: Methodsmentioning

confidence: 99%

Meyer’s Loop Anatomy Demonstrated Using Diffusion Tensor MR Imaging and Fiber Tractography at 3T

Goga

Fırat

Brînzaniuc

et al. 2014

Acta Medica Marisiensis

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Objective: The ultimate anatomy of the Meyer's loop continues to elude us. Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) may be able to demonstrate, in vivo, the anatomy of the complex network of white matter fibers surrounding the Meyer's loop and the optic radiations. This study aims at exploring the anatomy of the Meyer's loop by using DTI and fiber tractography. Methods: Ten healthy subjects underwent magnetic resonance imaging (MRI) with DTI at 3 T. Using a region-of-interest (ROI) based diffusion tensor imaging and fiber tracking software (Release 2.6, Achieva, Philips), sequential ROI were placed to reconstruct visual fibers and neighboring projection fibers involved in the formation of Meyer's loop. The 3-dimensional (3D) reconstructed fibers were visualized by superimposition on 3-planar MRI brain images to enhance their precise anatomical localization and relationship with other anatomical structures. Results: Several projection fiber including the optic radiation, occipitopontine/parietopontine fibers and posterior thalamic peduncle participated in the formation of Meyer's loop. Two patterns of angulation of the Meyer's loop were found. Conclusions: DTI with DTT provides a complimentary, in vivo, method to study the details of the anatomy of the Meyer's loop. Meyer's loop is commonly known as the temporal loop of the anterior fibers of the optic radiation that originate in the lateral geniculate body and course anteriorly, into the temporal lobe, before turning posteriorly to reach the occipital visual cortex. Adolf Meyer applied histological, brain lesion studies to describe this peculiar course into the temporal lobe of the visual projection fibers, in 1907 [1]. Histological staining techniques that are applicable in humans provide an ambiguous visualization of the myelinstained white matter fibers and are limited by an inability to precisely trace and reconstruct the course of these fibers. Therefore, the composition and course of the Meyer's loop, or the fact that this temporal loop is composed exclusively by the optic radiation fibers remains unclear.A unique 3D perspective on the white matter architecture can be achieved by applying the fiber dissection technique, but with this technique it is difficult to differentiate individual visual projection fibers, because of the intrinsic limitations of this technique to distinguish and trace individual fibers among the complex network of many neighboring fibers [2,3]. Furthermore, the delineation of the Meyer's loop using the fiber dissection technique is challenging and its exact fiber composition and location are a point of controversy. Knowledge of the anatomy of the Meyer's loop is essential for minimizing the risk of damaging this structure during surgery for temporal lobe lesions and epilepsy. However, the ultimate anatomical details of the Meyer's loop remain even today obscure, because both histological and fiber dissection techniques are less suitable to accurately demonstrate its precise fiber composition and exact lo...

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Alterations of white matter integrity associated with cognitive deficits in patients with glioma

Liu

et al. 2020

Brain and Behavior

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Objective This study aimed to investigate the characteristic of brain structural connections in glioma patients and further evaluate the relationship between changes in the white matter tracts and cognitive decline. Methods This retrospective study included a total of 35 subjects with glioma and 14 demographically matched healthy controls, who underwent diffusion tensor imaging scans and formal neuropsychological assessment tests. Fractional anisotropy (FA) values of white matter tracts were derived from atlas‐based analysis to compare group differences. Furthermore, subgroup‐level analysis was performed to differentiate the effects of tumor location on white matter tracts. Partial correlation analysis was used to examine the associations between neurocognitive assessments and the integrity of tracts. Region of interest‐based network analysis was performed to validate the alteration of structural brain network in subjects with glioma. Results Compared with controls, subjects with glioma exhibited reduced FA values in the right uncinate fasciculus. Besides, subjects with glioma exhibited worse performance in several cognitive assessments. Partial correlation analysis indicated that the FA value in the right superior longitudinal fasciculus temporal part was significantly positively correlated with scores of visual–spatial abilities in subjects with glioma in the right temporal lobe ( r = .932, p = .002). Region of interest‐based network analysis revealed that subjects with glioma exhibited reduced FA, fiber length (FL), and fiber number (FN) between specific brain regions compared with controls. Conclusion The present study demonstrated the reduced integrity of white matter tracts and altered structural connectivity in brain networks in patients with glioma. Notably, white matter tracts in the right hemisphere might be vulnerable to the effects of a frontal or temporal lesion and might be associated with deficient cognitive function.

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Assessment of the corticospinal tract alterations before and after resection of brainstem lesions using Diffusion Tensor Imaging (DTI) and tractography at 3T

Cited by 62 publications

References 19 publications

The utility of preoperative diffusion tensor imaging in the surgical management of brainstem cavernous malformations

The utility of preoperative diffusion tensor imaging in the surgical management of brainstem cavernous malformations

Meyer’s Loop Anatomy Demonstrated Using Diffusion Tensor MR Imaging and Fiber Tractography at 3T

Alterations of white matter integrity associated with cognitive deficits in patients with glioma

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