Korean J Radiol.  2011 Dec;12(6):651-661. 10.3348/kjr.2011.12.6.651.

Diffusion Tensor Imaging: Exploring the Motor Networks and Clinical Applications

• Ahn S
• Lee SK

• KMID: 1101918
• DOI: http://doi.org/10.3348/kjr.2011.12.6.651

Abstract

With the advances in diffusion magnetic resonance (MR) imaging techniques, diffusion tensor imaging (DTI) has been applied to a number of neurological conditions because DTI can demonstrate microstructures of the brain that are not assessable with conventional MR imaging. Tractography based on DTI offers gross visualization of the white matter fiber architecture in the human brain in vivo. Degradation of restrictive barriers and disruption of the cytoarchitecture result in changes in the diffusion of water molecules in various pathological conditions, and these conditions can also be assessed with DTI. Yet many factors may influence the ability to apply DTI clinically, so these techniques have to be used with a cautious hand.

Keyword

Diffusion tensor imaging; Tractography; Diffusion weighted imaging

MeSH Terms

Anisotropy
Brain/anatomy & histology/surgery
Brain Diseases/*diagnosis/surgery
Diffusion Magnetic Resonance Imaging
*Diffusion Tensor Imaging/methods
Humans
Motor Cortex/*anatomy & histology
Neural Pathways/*anatomy & histology
Pyramidal Tracts/anatomy & histology

Figure

• 

  Fig. 1 Calculation of fractional anisotropy. Largest vector of diffusion ellipsoid is eigenvector 1 and its value is λ1. Shortest one is λ3 and remainder is λ2. Fractional anisotropy is calculated by each of eigenvalues. Fractional anisotropy varies from 0 (infinite isotropy) to 1 (infinite anisotropy).

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  Fig. 2 Gray and color scale fractional anisotropy maps. High signal on fractional anisotropy map indicates higher anisotropy such as corpus callosum and internal capsule. On color scale fractional anisotropy map, red fibers represent transverse direction, green represents anterior to posterior direction and blue represents head to foot direction. ALIC = anterior limb of internal capsule, CC = corpus callosum, CR = corona radiata, CST = corticospinal tract, EC = external capsule, MCP = middle cerebellar peduncle, MLF = medial longitudinal fasciculus, OR = optic radiation, PLIC = posterior limb of internal capsule, PTR = posterior thalamic radiation, SLF = superior longitudinal fasciculus.

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  Fig. 3 Principle of streamline fiber tracking. From starting point, automatic 3-D fiber tracking is done by connecting voxel to voxel with pre-defined threshold values of fractional anisotropy (FA) and trajectory angle. Fiber tracking terminates when fractional anisotropy is lower and trajectory angle exceeds threshold values. For clinical fiber tracking, fractional anisotropy of 0.1-0.2 and trajectory angle of 30-45 degrees are usually used.

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  Fig. 4 Probabilistic map of left corticospinal tract. Yellow area has higher probability of connection such as longitudinal pontine fibers and corticospinal tract that innervates the lower extremities. There can be some connectivity to ipsilateral temporal lobe, contralateral hemisphere or basal ganglia, although probability is very low. Overall shape is similar to streamline tractography in next figure.

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  Fig. 5 Streamline tractography of corticospinal tract. Three regions of interests are placed at longitudinal pontine fibers, mid-1/3 of posterior limb of internal capsule and primary sensory-motor cortex. These anatomic landmarks are preferred because they are easily localized and they are reliable pathways of corticospinal tract.

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  Fig. 6 Diffusion tensor imaging shows 4 different tracts intermingled in centrum semiovale. Cingular fibers (Cng) runs antero-posteriorly. CC = corpus callosum, CR = corona radiata, SLF = superior longitudinal fasciculus.

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  Fig. 7 Arcuate fasciculus (superior longitudinal fasciculus) connecting Broca's area and Wernicke's area. Right-left asymmetry is reported and usually dominant hemisphere has larger volume of arcuate fasciculus.

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  Fig. 8 Dentato-rubro-thalamo-cortical connection, which is major ascending fiber system from cerebellum to cerebral cortex. Region of interests are placed in each of anatomic locations (A = primary and premotor, B = thalamus, C = red nucleus, D = superior cerebellar peduncle).

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  Fig. 9 28-year-old female with anaplastic astrocytoma. Tractography clearly visualizes that mass is located at center of corticospinal tract.

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  Fig. 10 14-year-old male with intractable seizure and previous right frontal lobectomy status. Selective callosotomy was planned because patient complained of repeated seizure attacks. Yellow fibers indicate commissural fibers between bilateral sensory-motor cortex, which were preserved after callosotomy, while other callosal fibers were disconnected (thick arrow at frontal fibers and thin arrows at splenial fibers).

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  Fig. 11 60-year-old male with left middle cerebral artery infarct. Initial diffusion weighted MRI shows acute infarct affecting left middle cerebral artery territory, including left corona radiate at level of centrum semiovale. Internal capsule at basal ganglia level is not affected. Initial tractography shows intact corticospinal tract, yet follow up scan 7 days after stroke reveals early injury to corticospinal tract, i.e., early start of Wallerian degeneration after major infarct.

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  Fig. 12 8-year-old male with intractable seizure. Conventional spin-echo and inversion recovery (IR) MRI shows no definite abnormality of frontal cortex. PET demonstrates decreased metabolism at right frontal cortex (thick arrow). MR spectroscopy describes increased choline level in right frontal cortex. Tractography of both hemispheres reveals decreased subcortical fiber connectivity in left frontal cortex (thin arrows). In this case, tractography was more sensitive than other conventional MRI modalities and it can be compared with PET or MR spectroscopy.

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