Corticospinal Tract Change in the Unaffected Hemisphere at the Early Stage of Intracerebral Hemorrhage: A Diffusion Tensor Tractography Study

Introduction: Intracerebral hemorrhage (ICH) is a devastating disease with poor outcome. Established predictive markers include initial hematoma size, clinical status, intraventricular bleeding and age. However, prognostic assessment is often difficult which additionally burdens patients and caregivers and complicates rehabilitation. Functional outcome especially relies on motor function which is correlated with the integrity of the Corticospinal Tract (CST). Diffusion Tensor (DT) Tractography allows visualization of the CST. However, sufficient data about the prognostic impact of quantitative CST assessment is lacking. Methods: We prospectively enrolled patients with spontaneous supratentorial ICH admitted between 08/2012 und 08/2015. Informed consent and ethical approval was obtained. MRI scan was performed on day 5±1. DT data was normalized to MNI Space and Q-Space diffeomorphic reconstruction was performed using DSI-studio. CST was reconstructed based on quantitative anisotropy (QA) using the CST region (JHU white matter atlas) as seeding region and cerebral peduncle as region of interest (ROI). Fractional Anisotropy (FA) and QA were analyzed in the seeding and ROI region and in the posterior limb of the internal capsule (PLIC). Dichotomized modified Rankin Scale on day 90 (favorable outcome = mRS 0-2) was assessed as primary outcome variable. Results: 33 patients, mean age 70.7 y (standard deviation (SD) 12.9), 12 male, 21 with lobar hemorrhage, mean ICH volume on admission 16.5 (SD 11.3) cm 3 were included. 16 patients had a favorable outcome on day 90 (median mRS 3 (IQR 1-3.5). Mean number of reconstructed CST fiber pathways ipsilateral to ICH was higher in patients with favorable outcome (11343 (SD 8201)) than in patients with unfavorable outcome (4868 (SD 3221), p=0.008). Median QA and FA values in the PLIC ipsilateral to ICH were also higher in patients with favorable outcome (QA: 18.9 (IQR 16.2-23.3) vs. 14.6 (IQR 11.7 - 17.7), p=0.016, FA: 0.49 (IQR 0.45-0.53) vs. 0.41 (IQR 0.38-0.49), p=0.026). Conclusion: Higher FA- and QA-values in the PLIC and higher numbers of CST fiber pathways ipsilateral to ICH seem to be associated with a favorable outcome. DT Imaging may turn out as a useful quantitative predictive marker in the acute phase of ICH.

Download Full-text

DIFFUSION TENSOR TRACTOGRAPHY

Neurosurgery ◽

10.1227/01.neu.0000325259.95571.20 ◽

2008 ◽

Vol 63 (3) ◽

pp. 452-459 ◽

Cited By ~ 6

Author(s):

Wai Hoe Ng ◽

Dennis Lai-Hong Cheong ◽

Kathleen Joy Khu ◽

Govidasamy Venkatesh ◽

Yee Kong Ng ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Magnetic Resonance ◽

Fractional Anisotropy ◽

Corticospinal Tract ◽

Tumor Volume ◽

Diffusion Tensor ◽

Diffusion Tensor Tractography ◽

Significant Difference ◽

Fiber Number ◽

And Diffusion

ABSTRACT OBJECTIVE Benign extracerebral lesions such as meningiomas may cause hemiparesis by compression and deviation without infiltrating the white matter. We used magnetic resonance diffusion tensor imaging and diffusion tensor tractography to investigate the effects of benign extracerebral lesions on the corticospinal tract (CST). METHODS Thirteen patients with extracerebral lesions (11 benign meningiomas and 2 benign cysts) underwent magnetic resonance diffusion tensor imaging and diffusion tensor tractography of the CST using fiber assignment by continuous tractography. The CST was reconstructed and assessed by comparing the ipsilateral and unaffected contralateral fibers. The tumor volume, relative fractional anisotropy, fiber deviation, relative fiber number, and relative fiber per voxel were compared between patients without and with temporary presurgical hemiparesis. RESULTS Seven patients without hemiparesis and five patients with temporary hemiparesis were analyzed; one patient had permanent weakness and was excluded from analysis. There was no significant difference in the tumor volume, relative fractional anisotropy, presence of cerebral edema, or CST deviation between groups. In patients with temporary hemiparesis, the median relative fiber number (mean, 0.35 ± 0.32) and relative fiber per voxel (mean, 0.49 ± 0.14) were significantly reduced compared with patients without hemiparesis (0.92 ± 0.55, P = 0.04; and 0.96 ± 0.28, P < 0.01, respectively). CONCLUSION In patients with benign extracerebral lesions, reduction in fiber number and fiber per voxel, but not fiber deviation, correlated with temporary hemiparesis. Clinical recovery was possible even if the CST fibers detected by diffusion tensor tractography were reduced by benign extracerebral lesions.

Download Full-text

The corticospinal tract in Sturge–Weber syndrome: A diffusion tensor tractography study

Brain and Development ◽

10.1016/j.braindev.2007.12.009 ◽

2008 ◽

Vol 30 (7) ◽

pp. 447-453 ◽

Cited By ~ 16

Author(s):

Lalitha Sivaswamy ◽

Kumar Rajamani ◽

Csaba Juhasz ◽

Mohsin Maqbool ◽

Malek Makki ◽

...

Keyword(s):

Corticospinal Tract ◽

Diffusion Tensor ◽

Diffusion Tensor Tractography ◽

Weber Syndrome ◽

Sturge Weber Syndrome

Download Full-text

Does Diffusion Tensor Tractography of the Corticospinal Tract Correctly Reflect Motor Function?

Medical Principles and Practice ◽

10.1159/000353463 ◽

2013 ◽

Vol 23 (2) ◽

pp. 174-176 ◽

Cited By ~ 5

Author(s):

Zhi-gang Min ◽

Netra Rana ◽

Chen Niu ◽

Huan-mei Ji ◽

Ming Zhang

Keyword(s):

Motor Function ◽

Corticospinal Tract ◽

Diffusion Tensor ◽

Diffusion Tensor Tractography

Download Full-text

DIFFUSION TENSOR TRACTOGRAPHY PREDICTS MOTOR FUNCTIONAL OUTCOME IN PATIENTS WITH SPONTANEOUS INTRACEREBRAL HEMORRHAGE

Neurosurgery ◽

10.1227/01.neu.0000311066.03121.b8 ◽

2008 ◽

Vol 62 (1) ◽

pp. 97-103 ◽

Cited By ~ 65

Author(s):

Hideyuki Yoshioka ◽

Toru Horikoshi ◽

Shigeki Aoki ◽

Masaaki Hori ◽

Keiichi Ishigame ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Motor Function ◽

Diffusion Tensor ◽

Case Series ◽

Contralateral Side ◽

Diffusion Tensor Tractography ◽

Manual Muscle Test ◽

Apparent Diffusion ◽

Adc Values

Abstract OBJECTIVE We prospectively investigated the predictive value of diffusion tensor tractography for motor functional outcome in a case series of patients with intracerebral hemorrhage. METHODS Diffusion tensor tractography was performed in 17 patients with intracerebral hemorrhage (putamen, nine patients; thalamus, seven patients; combined, one patient) within 5 days after onset. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values along the corticospinal tracts at the level of the hematoma were measured bilaterally, and the ratios of values (hematoma side/contralateral side) were determined as FA and ADC ratios, respectively. Patients were evaluated for motor function on admission and at 3 months after onset using the manual muscle test score and then divided into good (manual muscle test, 4–5) and poor (manual muscle test, 0–3) motor function groups. RESULTS FA ratio measured shortly after the onset of intracerebral hemorrhage correlated well with motor functional outcome at 3 months (P < 0.05) but not with motor function on admission. FA ratios in the group with good motor functional outcome were significantly higher than those in the group with poor motor functional outcome (P < 0.01). The ADC ratio did not correlate with motor function either on admission or at 3 months. All patients with an FA ratio greater than 0.8 had a good motor functional outcome. In three patients, however, motor functional outcomes were favorable even though FA ratios were not high; in these patients, ADC ratios tended to be elevated. CONCLUSION Motor functional outcome in patients with intracerebral hemorrhage can be predicted by measuring FA values using diffusion tensor tractography.

Download Full-text