Clinical Applications of Diffusion Tensor MRI & Fiber ...KHMB 2003 Seoul, Korea Yonsei University...
Transcript of Clinical Applications of Diffusion Tensor MRI & Fiber ...KHMB 2003 Seoul, Korea Yonsei University...
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Clinical Applications ofClinical Applications ofDiffusion Tensor MRI &Diffusion Tensor MRI &
Fiber TractographyFiber Tractography
SeungSeung--Koo Lee, M.D., Ph.D.Koo Lee, M.D., Ph.D.NeuroradiologyNeuroradiology Division, Department of RadiologyDivision, Department of Radiology
YonseiYonsei University College of Medicine University College of Medicine Seoul, KoreaSeoul, Korea
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
DTI & FT Protocol in DTI & FT Protocol in YonseiYonsei1.5T 1.5T InteraIntera (Philips Medical Systems) with explorer gradient (Philips Medical Systems) with explorer gradient (60mT/m)(60mT/m)
66--channel SENSE head coilchannel SENSE head coil
Single shot spin echo EPI with SENSE factor 2Single shot spin echo EPI with SENSE factor 2
TR: Shortest, TE: 70msec TR: Shortest, TE: 70msec
2.3 mm thickness, no gap, 96 matrix reconstructed to 128 2.3 mm thickness, no gap, 96 matrix reconstructed to 128 matrix, 2 NSA, 45 (child) to 55 (adult) slicesmatrix, 2 NSA, 45 (child) to 55 (adult) slices
Scan time: 7:28 Scan time: 7:28 –– 9:23 minutes according to slice #9:23 minutes according to slice #
FOV=220mm (RFOV 100%)FOV=220mm (RFOV 100%)
b=600, 32 diffusion direction (High angular diffusion MRI)b=600, 32 diffusion direction (High angular diffusion MRI)
PRIDE package (Philips Medical Systems)PRIDE package (Philips Medical Systems)
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Fiber TractographyFiber TractographyCorticospinalCorticospinal tracttract Corpus Corpus callosumcallosum
Termination of Tracking: FA < 0.2 ~ 0.3 Angle < 0.75 ~0.85
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Single Single vsvs Multiple Multiple ROIsROIs
LongitudinalPontine Fiber
PLIC
Crus Cerebri
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Fiber TractographyFiber TractographyCorticospinal tract and fibers in brain stem
SCP
MCP
ICPCST
PLIC
CR
6 directions 32 directions
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Fiber TractographyFiber TractographyOther fibersOther fibers
CST PeriventricularWhite Matter
ILF
SLF
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Overview of Clinical DTIOverview of Clinical DTIStrokeStroke
Initial FA changes in ischemic tissueInitial FA changes in ischemic tissueThe value of FA maps in the evaluation of The value of FA maps in the evaluation of lacunarlacunar strokestrokeDTI & FT in acute strokeDTI & FT in acute stroke
PrePre--surgical planningsurgical planningCNS neoplasm and AVMCNS neoplasm and AVM
White matter diseaseWhite matter diseaseCerebellarCerebellar degenerationdegenerationDiffuse axonal injuryDiffuse axonal injuryWallerianWallerian degenerationdegeneration
Pediatric BrainPediatric BrainCongenital anomaliesCongenital anomaliesCerebral palsy (Cerebral palsy (periventricularperiventricular leukomalacialeukomalacia))
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
DTI & FT in StrokeDTI & FT in Stroke
•Initial FA changes in acute stroke
•FA maps in lacunar infarctions
•DTI & FT in acute stroke
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
FA of Ischemic TissueFA of Ischemic TissueInitially elevated and
decreased progressively
Cytotoxic edema with
preserved structure
Yang et al, Stroke 1999;30:2382-2390
Measurement and calculation
problem
Green et al, Stroke 2002;33:1517-1521
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Localization of Localization of LacunarLacunar InfarctionInfarctionF/43 Pure motor stroke
M/70 Ataxic hemiparesis
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Localization of Localization of LacunarLacunar InfarctionInfarctionDiagnostic accuracyDiagnostic accuracy
T2 + DWI:T2 + DWI: 70 ~ 90 %70 ~ 90 %T2 + DWI + FA:T2 + DWI + FA: 100%100%
InterInter--observer agreementobserver agreementT2WI + DWIT2WI + DWI
KappaKappa = 0.446= 0.446 (Moderate)(Moderate)Standard errorStandard error = 0.158= 0.15895% CI95% CI = 0.136 to 0.756= 0.136 to 0.756
T2WI + DWI + FA mapT2WI + DWI + FA mapPerfect agreementPerfect agreement (Kappa = 1)(Kappa = 1)
JeongJeong HK et al, Proceedings of Korean Soc HK et al, Proceedings of Korean Soc RadiolRadiol, 2003, 2003
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
DTI & FT in Acute StrokeDTI & FT in Acute StrokeM/65 Lt MCA infarctionM/65 Lt MCA infarction
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
DTI & FT in Acute StrokeDTI & FT in Acute StrokeDay1Day1 Day 7Day 7
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
PresurgicalPresurgical PlanningPlanning
•Evaluation of corticospinal tract
•Problems of peritumoral edema
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
F/65 Metastasis F/65 Metastasis –– AphagiaAphagia, normal motor function, normal motor function
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
M/63 Diffuse M/63 Diffuse AstrocytomaAstrocytoma –– Lt side weaknessLt side weakness
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
M/63 Diffuse M/63 Diffuse AstrocytomaAstrocytoma –– Lt side weaknessLt side weakness
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
M/20 AVM M/20 AVM –– Motor Motor SxSx ((--))
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F/52 F/52 MeningiomaMeningioma –– Lt side weaknessLt side weakness
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
F/52 F/52 MeningiomaMeningioma –– Lt side weaknessLt side weakness
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
DTI in CNS NeoplasmDTI in CNS NeoplasmInvasion Invasion vsvs periperi--tumoraltumoral edemaedema
FA is decreased in both situations.FA is decreased in both situations.
FT is based on the measurements of FA and FT is based on the measurements of FA and angles between ellipsoids.angles between ellipsoids.
Therefore, determination of tumor extent by DTI Therefore, determination of tumor extent by DTI seems to be inaccurate.seems to be inaccurate.
Further investigation is needed.Further investigation is needed.
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
•Cerebellar degeneration
•Diffuse axonal injury
•Wallerian degeneration
DTI & FT in White Matter DiseaseDTI & FT in White Matter Disease
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Lee SK, Mori S, Kim DI et al. Epilepsia 2003;44
Neurodegenerative Diseases of CerebellumNeurodegenerative Diseases of Cerebellum
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Neurodegenerative Diseases of CerebellumNeurodegenerative Diseases of Cerebellum
Lee SK, Mori S, Kim DI et al. Epilepsia 2003;44
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
WallerianWallerian Degeneration in Chronic InfarctDegeneration in Chronic Infarct
F/75 Spastic F/75 Spastic hemiplegiahemiplegia, Old Lt MCA infarct, Old Lt MCA infarct
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Diffuse Axonal InjuryDiffuse Axonal Injury
L R
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
DTI & FT in Pediatric DiseasesDTI & FT in Pediatric Diseases
•Cerebral palsy
•Callosal agenesis
•Joubert syndrome
•Cortical dysplasia
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
PeriventricularPeriventricular LeukomalaciaLeukomalaciaNormal childNormal child Spastic cerebral palsySpastic cerebral palsy
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
PVL PVL –– Corpus Corpus CallosumCallosumNormal childNormal child Spastic cerebral palsySpastic cerebral palsy
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
PVL PVL –– PeriventricularPeriventricular FibersFibersNormal childNormal child Spastic cerebral palsySpastic cerebral palsy
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
PET & MRI of PVLPET & MRI of PVL
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Partial Agenesis of CCPartial Agenesis of CC
Lee SK, Mori S, Kim DI et al. AJNR (In press)
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Complete Agenesis of CCComplete Agenesis of CC
Lee SK, Mori S, Kim DI et al. AJNR (In press)
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
FA increases in the area of band FA increases in the area of band heterotopiaheterotopia
Band Band HeterotopiaHeterotopia
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Band Band HeterotopiaHeterotopia
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
JoubertJoubert SyndromeSyndromeM/18m Unable to walk, delayed developmentM/18m Unable to walk, delayed development
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
JoubertJoubert SyndromeSyndromeIncreased connection from cerebellum to motor stripe via Increased connection from cerebellum to motor stripe via superior superior cerebellarcerebellar pedunclepeduncle
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
Current Problems of DTICurrent Problems of DTI--FTFTFiber tracking is operator dependentFiber tracking is operator dependent
Knowledge for detailed Knowledge for detailed neuroanatomyneuroanatomy
SolutionsSolutions
Standardization of ROIStandardization of ROI
Quantitative, volumetric data processingQuantitative, volumetric data processing
Threshold values affect fiber connectivityThreshold values affect fiber connectivity
Standardization of individual variation is necessaryStandardization of individual variation is necessary
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
ConclusionConclusionFiber tractography directly visualizes the aberrant or Fiber tractography directly visualizes the aberrant or modified fiber connections in congenital or modified fiber connections in congenital or acquired diseases.acquired diseases.
Powerful Powerful microanatomicalmicroanatomical imaging eventually imaging eventually represents the represents the neurologicneurologic function.function.
In a broad sense, DTI & FT are the objective In a broad sense, DTI & FT are the objective functional imaging because structural change functional imaging because structural change accompanies functional modification.accompanies functional modification.
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KHMB 2003Seoul, Korea
Yonsei University NeuroradiologySeoul, Korea
AcknowledgementsAcknowledgements
YonseiYonsei UniversityUniversityRadiologyRadiology
Dong Dong IkIk KimKimSiSi Yeon KimYeon KimSeiSei Young KimYoung Kim
NeurologyNeurologyJiJi Hoe Hoe HeoHeoByungByung In LeeIn LeeKyoungKyoung HeoHeo
Pediatric NeurologyPediatric NeurologyHeung Dong KimHeung Dong Kim
Rehabilitation MedicineRehabilitation MedicineDeogDeog Young KimYoung KimEun Eun SookSook ParkPark
Johns Hopkins Johns Hopkins UnivUnivSusumu MoriSusumu Mori
Philips Medical SystemsPhilips Medical SystemsMarc Van Marc Van CauterenCauterenFrank Frank HoogenraadHoogenraad