Abstract
Diffusion tensor imaging is a technique that enables physicians the portrayal of white matter tracts in vivo. We used this technique in order to depict the medial forebrain bundle (MFB) in 15 consecutive patients between 2012 and 2015. Men and women of all ages were included. There were six women and nine men. The mean age was 58.6 years (39–77). Nine patients were candidates for an eventual deep brain stimulation. Eight of them suffered from Parkinson‘s disease and one had multiple sclerosis. The remaining six patients suffered from different lesions which were situated in the frontal lobe. These were 2 metastasis, 2 meningiomas, 1 cerebral bleeding, and 1 glioblastoma. We used a 3DT1-sequence for the navigation. Furthermore T2- and DTI- sequences were performed. The FOV was 200 × 200 mm2, slice thickness 2 mm, and an acquisition matrix of 96 × 96 yielding nearly isotropic voxels of 2 × 2 × 2 mm. 3-Tesla-MRI was carried out strictly axial using 32 gradient directions and one b0-image. We used Echo-Planar-Imaging (EPI) and ASSET parallel imaging with an acceleration factor of 2. b-value was 800 s/mm2. The maximal angle was 50°. Additional scanning time was < 9 min. We were able to visualize the MFB in 12 of our patients bilaterally and in the remaining three patients we depicted the MFB on one side. It was the contralateral side of the lesion. These were 2 meningiomas and one metastasis. Portrayal of the MFB is possible for everyday routine for neurosurgical interventions. As part of the reward circuitry it might be of substantial importance for neurosurgeons during deep brain stimulation in patients with psychiatric disorders. Surgery in this part of the brain should always take the preservation of this white matter tract into account.
Highlights
Diffusion tensor imaging (DTI) is a technique that allows physicians the portrayal of white matter tracts (WMT) in vivo in healthy and non-healthy patients in a non-invasive way (Mesulam, 2005; Stadlbauer et al, 2006; Ciccarelli et al, 2008)
Some of the WMTs which are portrayed by means of DTI include the corticospinal tract (CST), visual pathway (VP), or the medial forebrain bundle (MFB)
The MFB seems to be a structure of loosely attached fibers that connects important brain areas together, among others the ventral tegmental area (VTA) of the midbrain, the lateral hypothalamus and the septal area (Coenen et al, 2009a)
Summary
Diffusion tensor imaging (DTI) is a technique that allows physicians the portrayal of white matter tracts (WMT) in vivo in healthy and non-healthy patients in a non-invasive way (Mesulam, 2005; Stadlbauer et al, 2006; Ciccarelli et al, 2008). The MFB seems to be a structure of loosely attached fibers that connects important brain areas together, among others the ventral tegmental area (VTA) of the midbrain, the lateral hypothalamus and the septal area (Coenen et al, 2009a) This WMT is composed of ascending and descending tributaries which differ in their length (Coenen et al, 2009a). Using special MRI modalities like DTI might help physicians distinguish between glioblatoma and metastasis (Chen et al, 2012) and be used during surgery when these lesions border the MFB in order to avoid a destruction of the tract by surgeons
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