“Cerebellar peduncle quarter notes” formed by the superior and middle cerebellar peduncles: comparison with a diffusion tensor study of spinocerebellar degeneration

ObjectiveTo assess white matter integrity in patients with essential tremor (ET) and Parkinson disease (PD) with moderate to severe motor impairment.MethodsSedated participants with ET (n = 57) or PD (n = 99) underwent diffusion tensor imaging (DTI) and fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity values were computed. White matter tracts were defined using 3 well-described atlases. To determine candidate white matter regions that differ between ET and PD groups, a bootstrapping analysis was applied using the least absolute shrinkage and selection operator. Linear regression was applied to assess magnitude and direction of differences in DTI metrics between ET and PD populations in the candidate regions.ResultsFractional anisotropy values that differentiate ET from PD localize primarily to thalamic and visual-related pathways, while diffusivity differences localized to the cerebellar peduncles. Patients with ET exhibited lower fractional anisotropy values than patients with PD in the lateral geniculate body (p < 0.01), sagittal stratum (p = 0.01), forceps major (p = 0.02), pontine crossing tract (p = 0.03), and retrolenticular internal capsule (p = 0.04). Patients with ET exhibited greater radial diffusivity values than patients with PD in the superior cerebellar peduncle (p < 0.01), middle cerebellar peduncle (p = 0.05), and inferior cerebellar peduncle (p = 0.05).ConclusionsRegionally, distinctive white matter microstructural values in patients with ET localize to the cerebellar peduncles and thalamo-cortical visual pathways. These findings complement recent functional imaging studies in ET but also extend our understanding of putative physiologic features that account for distinctions between ET and PD.

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Another Piece of the Puzzle of Anomalous Connectivity in Joubert's Syndrome

Neuropediatrics ◽

10.1055/s-0041-1732310 ◽

2021 ◽

Author(s):

Avner Meoded ◽

Marcia Kukreja ◽

Gunes Orman ◽

Eugen Boltshauser ◽

Thierry A.G.M. Huisman

Keyword(s):

White Matter ◽

Diffusion Tensor ◽

Three Dimensional ◽

Axonal Guidance ◽

Molar Tooth ◽

Superior Cerebellar Peduncle ◽

Corticospinal Tracts ◽

Cerebellar Peduncles ◽

Cerebellar Peduncle ◽

Magnetic Resonance Imaging Mri

AbstractWe report on the conventional and diffusion tensor imaging (DTI) findings of a 2-year-old child with clinical presentation of Joubert's Syndrome (JS) and brainstem structural abnormalities as depicted by neuroimaging.Conventional magnetic resonance imaging (MRI) showed a “molar tooth” configuration of the brainstem. A band-like formation coursing in an apparent axial plane anterior to the interpeduncular fossa was noted and appeared to partially cover the interpeduncular fossa.DTI maps and three-dimensional (3D) tractography demonstrated a prominent red-encoded white matter bundle anterior to the midbrain. Probable aberrant course of the bilateral corticospinal tracts (CST) was also depicted. Absence of the decussation of the superior cerebellar peduncles and elongated thickened, horizontal superior cerebellar peduncle (SCP) reflecting the molar tooth sign were also shown.Our report and the review of the published cases suggest that DTI and tractography may be very helpful to differentiate between interpeduncular heterotopias and similarly located white matter bundles corroborating the underlying etiology of axonal guidance disorders in the complex group of ciliopathies including JS. Our case represents an important additional puzzle piece to explore the variability of these ciliopathies.

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Progression of Pathological Changes in the Middle Cerebellar Peduncle by Diffusion Tensor Imaging Correlates With Lesser Motor Gains After Pontine Infarction

Neurorehabilitation and Neural Repair ◽

10.1177/1545968308331142 ◽

2009 ◽

Vol 23 (7) ◽

pp. 692-698 ◽

Cited By ~ 20

Author(s):

Zhijian Liang ◽

Jinsheng Zeng ◽

Cuimei Zhang ◽

Sirun Liu ◽

Xueying Ling ◽

...

Keyword(s):

Wallerian Degeneration ◽

Diffusion Tensor ◽

Percentage Reduction ◽

Middle Cerebellar Peduncle ◽

Absolute Value ◽

Pontine Infarction ◽

Cerebellar Peduncles ◽

Cerebellar Peduncle ◽

Over Time ◽

Pontine Infarct

Background. Wallerian degeneration in pyramidal tract following supratentorial stroke has been detected by some studies using diffusion tensor imaging (DTI), but the Wallerian degeneration in middle cerebellar peduncle after pontine infarction and its potential clinical significance remain to be confirmed. Methods. Seventeen patients with a recent focal pontine infarct underwent 3 DTIs at week 1 (W1), week 4 (W4), and week 12 (W12) after onset. Seventeen age-matched and gender-matched controls underwent DTI one time. Mean diffusivity and fractional anisotropy (FA) were measured in the basis pontis and bilateral middle cerebellar peduncles. Neurological deficit, motor deficit, functional independence, and limbs ataxia were assessed with the National Institutes of Health (NIH) Stroke Scale, Fugl-Meyer scale, Barthel Index, and the second part of International Cooperative Ataxia Rating Scale. Results. FA values at the bilateral middle cerebellar peduncles decreased significantly from W1 to W12 progressively ( P < .01). The patients improved on the NIH Stroke Scale, Fugl-Meyer scale, and Barthel Index over time ( P < .01). Greater absolute value of percentage reduction of FA at the bilateral middle peduncles, however, was associated with the less absolute value of percentage reduction of the NIH Stroke Scale and less increase in the Fugl-Meyer scale, as well as greater ataxia over time. Conclusions. Wallerian degeneration in the middle cerebellar peduncle revealed by DTI may hinder the process of neurological recovery following a focal pontine infarct.

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Alternative Microstructural Measures to Complement Diffusion Tensor Imaging in Migraine Studies with Standard MRI Acquisition

Brain Sciences ◽

10.3390/brainsci10100711 ◽

2020 ◽

Vol 10 (10) ◽

pp. 711

Author(s):

Álvaro Planchuelo-Gómez ◽

David García-Azorín ◽

Ángel L. Guerrero ◽

Rodrigo de Luis-García ◽

Margarita Rodríguez ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Chronic Migraine ◽

Diffusion Tensor ◽

Mean Diffusivity ◽

Episodic Migraine ◽

Healthy Controls ◽

Axial Diffusivity ◽

Average Diffusion ◽

Cerebellar Peduncle

The white matter state in migraine has been investigated using diffusion tensor imaging (DTI) measures, but results using this technique are conflicting. To overcome DTI measures, we employed ensemble average diffusion propagator measures obtained with apparent measures using reduced acquisitions (AMURA). The AMURA measures were return-to-axis (RTAP), return-to-origin (RTOP) and return-to-plane probabilities (RTPP). Tract-based spatial statistics was used to compare fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity from DTI, and RTAP, RTOP and RTPP, between healthy controls, episodic migraine and chronic migraine patients. Fifty healthy controls, 54 patients with episodic migraine and 56 with chronic migraine were assessed. Significant differences were found between both types of migraine, with lower axial diffusivity values in 38 white matter regions and higher RTOP values in the middle cerebellar peduncle in patients with a chronic migraine (p < 0.05 family-wise error corrected). Significantly lower RTPP values were found in episodic migraine patients compared to healthy controls in 24 white matter regions (p < 0.05 family-wise error corrected), finding no significant differences using DTI measures. The white matter microstructure is altered in a migraine, and in chronic compared to episodic migraine. AMURA can provide additional results with respect to DTI to uncover white matter alterations in migraine.

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Plasticity of the Superior and Middle Cerebellar Peduncles in Musicians Revealed by Quantitative Analysis of Volume and Number of Streamlines Based on Diffusion Tensor Tractography

The Cerebellum ◽

10.1007/s12311-011-0274-1 ◽

2011 ◽

Vol 10 (3) ◽

pp. 611-623 ◽

Cited By ~ 19

Author(s):

Ihssan A. Abdul-Kareem ◽

Andrej Stancak ◽

Laura M. Parkes ◽

May Al-Ameen ◽

Jamaan AlGhamdi ◽

...

Keyword(s):

Quantitative Analysis ◽

Diffusion Tensor ◽

Diffusion Tensor Tractography ◽

Cerebellar Peduncles

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

Journal of Neurosurgery ◽

10.3171/2014.11.jns13680 ◽

2015 ◽

Vol 122 (3) ◽

pp. 653-662 ◽

Cited By ~ 21

Author(s):

Bruno C. Flores ◽

Anthony R. Whittemore ◽

Duke S. Samson ◽

Samuel L. Barnett

Keyword(s):

Diffusion Tensor ◽

Medial Longitudinal Fasciculus ◽

Medial Lemniscus ◽

Cavernous Malformations ◽

Fiber Tracts ◽

The Mean ◽

Cerebellar Peduncle ◽

Selection Of

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 cm3, 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 correlate with long-term outcome. CONCLUSIONS Preoperative DTI and DTT should be considered in the resection of symptomatic BSCMs. These imaging studies may influence the selection of surgical approach or brainstem entry zones, especially in deep-seated lesions without pial or ependymal presentation. DTI/DTT findings may allow for more aggressive management of lesions previously considered surgically inaccessible. Preoperative DTI/DTT changes do not appear to correlate with functional postoperative outcome in long-term follow-up.

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White matter and nigral alterations in multiple system atrophy-parkinsonian type

npj Parkinson s Disease ◽

10.1038/s41531-021-00236-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Takashi Ogawa ◽

Taku Hatano ◽

Koji Kamagata ◽

Christina Andica ◽

Haruka Takeshige-Amano ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

White Matter ◽

Multiple System Atrophy ◽

Volume Fraction ◽

Diffusion Tensor ◽

Free Water ◽

Substantia Nigra Pars Compacta ◽

Healthy Controls ◽

Cerebellar Peduncle

AbstractMultiple system atrophy (MSA) is classified into two main types: parkinsonian and cerebellar ataxia with oligodendrogliopathy. We examined microstructural alterations in the white matter and the substantia nigra pars compacta (SNc) of patients with MSA of parkinsonian type (MSA-P) using multishell diffusion magnetic resonance imaging (dMRI) and myelin sensitive imaging techniques. Age- and sex-matched patients with MSA-P (n = 21, n = 10 first and second cohorts, respectively), Parkinson’s disease patients (n = 19, 17), and healthy controls (n = 20, 24) were enrolled. Magnetization transfer saturation imaging (MT-sat) and dMRI were obtained using 3-T MRI. Measurements obtained from diffusion tensor imaging (DTI), free-water elimination DTI, neurite orientation dispersion and density imaging (NODDI), and MT-sat were compared between groups. Tract-based spatial statistics analysis revealed differences in diffuse white matter alterations in the free-water fractional volume, myelin volume fraction, and intracellular volume fraction between the patients with MSA-P and healthy controls, whereas free-water and MT-sat differences were limited to the middle cerebellar peduncle in comparison with those with Parkinson’s disease. Region-of-interest analysis of white matter and SNc revealed significant differences in the middle and inferior cerebellar peduncle, pontine crossing tract, corticospinal tract, and SNc between the MSA-P and healthy controls and/or Parkinson’s disease patients. Our results shed light on alterations to brain microstructure in MSA.

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Brain MR Contribution to the Differential Diagnosis of Parkinsonian Syndromes: An Update

Parkinson s Disease ◽

10.1155/2016/2983638 ◽

2016 ◽

Vol 2016 ◽

pp. 1-27 ◽

Cited By ~ 4

Author(s):

Giovanni Rizzo ◽

Stefano Zanigni ◽

Roberto De Blasi ◽

Daniela Grasso ◽

Davide Martino ◽

...

Keyword(s):

Differential Diagnosis ◽

Diffusion Tensor ◽

Asymmetric Distribution ◽

Qualitative And Quantitative ◽

Parkinsonian Syndromes ◽

Quantitative Mr ◽

Atypical Parkinsonian Syndrome ◽

Frontoparietal Cortex ◽

Cerebellar Peduncles ◽

Diffusion Tensor Imaging Tractography

Brain magnetic resonance (MR) represents a useful and feasible tool for the differential diagnosis of Parkinson’s disease. Conventional MR may reveal secondary forms of parkinsonism and may show peculiar brain alterations of atypical parkinsonian syndromes. Furthermore, advanced MR techniques, such as morphometric-volumetric analyses, diffusion-weighted imaging, diffusion tensor imaging, tractography, proton MR spectroscopy, and iron-content sensitive imaging, have been used to obtain quantitative parameters useful to increase the diagnostic accuracy. Currently, many MR studies have provided both qualitative and quantitative findings, reflecting the underlying neuropathological pattern of the different degenerative parkinsonian syndromes. Although the variability in the methods and results across the studies limits the conclusion about which technique is the best, specific radiologic phenotypes may be identified. Qualitative/quantitative MR changes in the substantia nigra do not discriminate between different parkinsonisms. In the absence of extranigral abnormalities, the diagnosis of PD is more probable, whereas basal ganglia changes (mainly in the putamen) suggest the diagnosis of an atypical parkinsonian syndrome. In this context, changes in pons, middle cerebellar peduncles, and cerebellum suggest the diagnosis of MSA, in midbrain and superior cerebellar peduncles the diagnosis of PSP, and in whole cerebral hemispheres (mainly in frontoparietal cortex with asymmetric distribution) the diagnosis of Corticobasal Syndrome.

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Progressive Supranuclear Palsy and Diffusion Tensor Imaging

European Neurological Review ◽

10.17925/enr.2009.04.02.108 ◽

2009 ◽

Vol 4 (2) ◽

pp. 108 ◽

Cited By ~ 1

Author(s):

Shoichi Ito ◽

Keyword(s):

Diffusion Tensor Imaging ◽

Progressive Supranuclear Palsy ◽

Diffusion Tensor ◽

Anterior Part ◽

Internal Capsule ◽

Neural Systems ◽

Cerebellar Peduncles ◽

Magnetic Resonance Imaging Mri ◽

And Diffusion ◽

Diffusion Properties

Progressive supranuclear palsy (PSP) is a neurodegenerative disease affecting multiple neural systems, particularly the extrapyramidal system. Early differentiation of PSP from other diseases mainly featuring parkinsonism, such as Parkinson's disease and multiple system atrophy, is necessary because the therapeutic strategy and outcome are substantially different. Diffusion tensor imaging is a recently developed magnetic resonance imaging (MRI) sequence that is able to non-invasively evaluate neural tracts. Two approaches may be used to measure diffusion properties. One approach is to measure diffusion properties by setting the regions of interest on circular/square regions or along the tractography. The other approach is to perform voxel-by-voxel analysis of the diffusion properties. There are several reports evaluating diffusion tensor abnormalities in PSP, and regions with diffusion tensor abnormlities are distributed through frontal projection fibres, the anterior part of the corpus callosum, superior longitudinal fasciculus, arcuate fasciculus, posterior thalamic radiations, internal capsule and superior cerebellar peduncles. Here, diffusion tensor studies in PSP are reviewed and clinical applications, limitations and future perspectives of diffusion tensor analysis in PSP are discussed.

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