scholarly journals Assessment of lumbar disc herniaton using fractional anisotropy in diffusion tensor imaging along with conventional T2-weighted imaging

2019 ◽  
Vol 33 (1) ◽  
pp. 24-31
Author(s):  
Marco Perri ◽  
Marialuisa D’Elia ◽  
Giulia Castorani ◽  
Rosario Francesco Balzano ◽  
Annamaria Pennelli ◽  
...  

Objective To assess the usefulness of diffusion tensor imaging and its fractional anisotropy map along with conventional T2-weighted imaging in evaluating the anisotropic water diffusion variations of annulus fibres involved in herniation disc pathology. Materials and methods Seventy-five patients with previous medical ethics committee approval and informed consent experiencing low back pain were selected for this prospective randomised blinded trial. Lumbar disc fractional anisotropy maps were obtained acquiring diffusion tensor sequences on a 3T machine. The matrix of nucleus pulposus and structures of annulus fibres were analysed using fractional anisotropy textural features to highlight any presence of lumbar disc herniation. Observer variability and reliability between two neuroradiologists were evaluated. The χ2 test, two-tailed t test and linear regression analysis were used to focus differences in patients’ demographic data and magnetic resonance imaging findings. Results Annular fissures with extrusions were identified using diffusion tensor imaging in 10 out of 17 discs (study group) previously assessed as bulging discs using conventional magnetic resonance imaging. Eighteen extrusions out of 39 (study group) disc levels were identified on diffusion tensor imaging compared to eight extrusions highlighted on T2-weighted imaging ( P < 0.01). All eight (study group) disc extrusions evaluated on T2-weighted imaging showed annular fissures on diffusion tensor imaging. Seven out of 14 (study group) protrusions highlighted on T2-weighted imaging had no annular fissures on diffusion tensor imaging; thirty-six disc levels in the control group had no evidence of annular fissures on diffusion tensor imaging ( P > 0.01). Conclusions The addition of diffusion tensor imaging sequences and fractional anisotropy mapping to a conventional magnetic resonance imaging protocol could be useful in detecting annular fissures and lumbar disc herniation.

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. 901-905 ◽  
Author(s):  
Florian Roser ◽  
Florian Ebner ◽  
Gottlieb Maier ◽  
Marcos Tatagiba ◽  
Thomas Nägele ◽  
...  

Abstract BACKGROUND: Syringomyelia can result in major functional disability. Conventional imaging techniques frequently fail to detect the underlying cause of syringomyelia. The prediction as to whether syringomyelia might lead to neurological deficits is still challenging. OBJECTIVE: We hypothesized that fractional anisotropy (FA) derived from diffusion tensor imaging (DTI) is a parameter to detect dynamic forms of syringomyelia. METHODS: Six patients with cervical syringomyelia, all comparable in size, shape, and location, were examined, along with 2 volunteers. Patients underwent electrophysiological recordings (somatosensory evoked potentials, motor evoked potentials, silent periods). Magnetic resonance imaging (1.5 T) was performed with a 6-element spine coil. Anatomic images were acquired with a 3-dimensional, constructive interference in steady-state sequence, and DTI with an echo-planar imaging sequence (5-mm thickness, b value 800 s/mm2) using the generalized autocalibrating partially parallel acquisitions technique. The positions were centered on the syrinx in the volunteers between the C2 and Th1. DTI data were interpolated to a spatial resolution of 0.5 mm. After calculation of a diffusion tensor in each pixel, an FA map was calculated and profiles of the FA values across the spinal cord were calculated in all slices. RESULTS: FA values were lower at the level of all examined syrinxes and reached normal values beyond them. Electrophysiological results correlated with the decrease in FA value. There were no presyrinx changes in the white matter tracts in terms of signs of FA changes beneath the syrinx. CONCLUSION: DTI of syringomyelia can demonstrate white matter fiber tracts around and beyond the syrinx consistent with electrophysiological values. DTI of the cervical spine can provide quantitative information about the pathological characteristics beyond the abnormalities visible on magnetic resonance imaging.


Neurosurgery ◽  
2011 ◽  
Vol 69 (5) ◽  
pp. 1124-1130 ◽  
Author(s):  
Mark Sedrak ◽  
Alessandra Gorgulho ◽  
Andrew Frew ◽  
Eric Behnke ◽  
Antonio DeSalles ◽  
...  

Abstract BACKGROUND The ventralis intermedius (VIM) nucleus of the thalamus is the primary surgical target for treatment of tremor. Most centers rely on indirect targeting based on atlas-defined coordinates rather than patient-specific anatomy, making intraoperative physiological mapping critical. Detailed identification of this target based on patient-specific anatomic features can help optimize the surgical treatment of tremor. OBJECTIVE To study colored fractional anisotropic images and diffusion tensor imaging (DTI) tractography to identify characteristic magnetic resonance appearances of the VIM nucleus. METHODS Four patients undergoing stereotactic surgery for essential tremor (ET) were retrospectively studied with analysis of magnetic resonance imaging-based colored fractional anisotropy (FA) images and fiber tractography. All were scanned with a 1.5-T magnetic resonance imaging unit, and all sequences were obtained before frame placement. Because the goal of this study was to identify the DTI characteristics of physiologically defined VIM nucleus, we selected and studied patients who had undergone DTI and had efficacious tremor control with intraoperative microlesioning effect and tremor reduction with less than 2.0-V stimulation. RESULTS Analysis of color FA maps, which graphically illustrate fiber directionality, revealed consistent anatomic patterns. The region of the VIM nucleus can be seen as an intermediate region where there is a characteristic transition of color. Presumptive VIM nucleus interconnectivity with sensorimotor cortex and cerebellum was identified via the internal capsule and the superior cerebellar peduncle, respectively. FA maps could also be used to distinguish segments of gray matter, white matter, and gray-white matter boundaries. CONCLUSION Analysis of DTI and FA maps on widely available 1.5-T magnetic resonance imaging yields clear identification of various structures key to neurosurgical targeting. Prospective evaluation of integrating DTI into neurosurgical planning may be warranted.


Author(s):  
Nayera Mohamed El-Ganainy ◽  
Samah Ahmed Radwan ◽  
Ehab Mohamed El-Gamal ◽  
Mohamed Fouad Sherif

Background: The combination of Functional magnetic resonance imaging with Diffusion Tensor Imaging has proven scientific and clinical relevance. By measuring the directed provides complementary information on white matter architecture, i.e., on the course and integrity of functionally important white matter tracts. In the diffusion of protons along myelinated fibers, Diffusion Tensor neuroimaging research is mainly applied to study the human brain's structural connectivity, whereas diffusion tensor tractography is often also employed for clinical applications. Diffusion Tensor Imaging measurements can be obtained together with Functional magnetic resonance imaging in the same scanning session, which gives an even more complete picture of each patient's brain. This study aimed to assess cerebral lesions affecting optic radiations by magnetic resonance imaging with diffusion tensor imaging tractography. Methods: Our prospective study was conducted on 30 cases ages ranged from 17-83 years, 10 of them were normal and considered as the control group and 20 patients were presented with clinical neurological symptoms and signs associated with visual abnormalities. Results: There is a significant difference between the Fractional anisotropy difference and difference ratio between the two groups with a p-value of 0.016 and 0.017 respectively. There was a strong significant positive correlation between Fractional anisotropy difference ratio (%) and tractography; r = 0.716 (95% confidence interval: 0.470 - 0.858) and p-value <0.001. We correlated the pathological types with different patterns of tractography. optic radiations fiber tracts were displaced in 83.3% of benign tumors and infiltrated in 16.3%. while in malignant tumors optic radiations fiber tracts were displaced in 75%, infiltrated in 12.5%, and disrupted in 25%. There is no "gold standard" for in vivo tractography. Diffusion Tensor Imaging is the only method that permits the calculation and visualization of fiber tracts trajectories in vivo. Conclusions: Diffusion Tensor Imaging tractography is clinically feasible and provides useful information regarding the site of optic radiations and their affection by different brain lesions also, surgical strategy for lesions located in eloquent visual areas. Also, there was a strong significant positive correlation between Fractional anisotropy difference ratio (%) and tractography distribution. Also, probabilistic multifiber tractography applied to diffusion Magnetic resonance imaging data acquired at 3T may be better as it can cope with crossing and kissing fibers than deterministic models because it allows many more possible local pathway orientations for each Diffusion Tensor Imaging sample point.


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