Echo-planar Diffusion Tensor Imaging Research Articles

Diffusion Tensor Imaging for Characterizing Changes in Triple-Negative Breast Cancer During Neoadjuvant Systemic Therapy.

Assessment of treatment response in triple-negative breast cancer (TNBC) may guide individualized care for improved patient outcomes. Diffusion tensor imaging (DTI) measures tissue anisotropy and could be useful for characterizing changes in the tumors and adjacent fibroglandular tissue (FGT) of TNBC patients undergoing neoadjuvant systemic treatment (NAST). To evaluate the potential of DTI parameters for prediction of treatment response in TNBC patients undergoing NAST. Prospective. Eighty-six women (average age: 51 ± 11 years) with biopsy-proven clinical stage I-III TNBC who underwent NAST followed by definitive surgery. 47% of patients (40/86) had pathologic complete response (pCR). 3.0 T/reduced field of view single-shot echo-planar DTI sequence. Three MRI scans were acquired longitudinally (pre-treatment, after 2 cycles of NAST, and after 4 cycles of NAST). Eleven histogram features were extracted from DTI parameter maps of tumors, a peritumoral region (PTR), and FGT in the ipsilateral breast. DTI parameters included apparent diffusion coefficients and relative diffusion anisotropies. pCR status was determined at surgery. Longitudinal changes of DTI features were tested for discrimination of pCR using Mann-Whitney U test and area under the receiver operating characteristic curve (AUC). A P value <0.05 was considered statistically significant. 47% of patients (40/86) had pCR. DTI parameters assessed after 2 and 4 cycles of NAST were significantly different between pCR and non-pCR patients when compared between tumors, PTRs, and FGTs. The median surface/average anisotropy of the PTR, measured after 2 and 4 cycles of NAST, increased in pCR patients and decreased in non-pCR patients (AUC: 0.78; 0.027 ± 0.043 vs. -0.017 ± 0.042 mm2 /s). Quantitative DTI features from breast tumors and the peritumoral tissue may be useful for predicting the response to NAST in TNBC. 1 TECHNICAL EFFICACY: Stage 4.

Diagnosis of Major Depressive Disorder Using Machine Learning Based on Multisequence MRI Neuroimaging Features.

Previous studies have found qualitative structural and functional brain changes in major depressive disorder (MDD) patients. However, most studies ignored the complementarity of multisequence MRI neuroimaging features and cannot determine accurate biomarkers. To evaluate machine-learning models combined with multisequence MRI neuroimaging features to diagnose patients with MDD. Prospective. A training cohort including 111 patients and 90 healthy controls (HCs) and a test cohort including 28 patients and 22 HCs. A 3.0 T/T1-weighted imaging, resting-state functional MRI with echo-planar sequence, and single-shot echo-planar diffusion tensor imaging. Recruitment and integration were used to reflect the dynamic changes of functional networks, while gray matter volume and fractional anisotropy were used to reflect the changes in the morphological and anatomical network. We then fused features with significant differences in functional, morphological, and anatomical networks to evaluate a random forest (RF) classifier to diagnose patients with MDD. Furthermore, a support vector machine (SVM) classifier was used to verify the stability of neuroimaging features. Linear regression analyses were conducted to investigate the relationships among multisequence neuroimaging features and the suicide risk of patients. The comparison of functional network attributes between patients and controls by two-sample t-test. Network-based statistical analysis was used to identify structural and anatomical connectivity changes between MDD and HCs. The performance of the model was evaluated by receiver operating characteristic (ROC) curves. The performance of the RF model integrating multisequence neuroimaging features in the diagnosis of depression was significantly improved, with an AUC of 93.6%. In addition, we found that multisequence neuroimaging features could accurately predict suicide risk in patients with MDD (r=0.691). The RF model fusing functional, morphological, and anatomical network features performed well in diagnosing patients with MDD and provided important insights into the pathological mechanisms of MDD. 1. Stage 2.

Association between ambulatory skills and diffusion tensor imaging of corpus callosal white matter in infants with spina bifida.

To assess brain white matter using diffusion tensor imaging (DTI) at 1 year of age in infants diagnosed with open neural tube defect (ONTD) and explore the association of DTI parameters with ambulatory skills at 30 months of age. Magnetic resonance imaging (MRI) was performed at an average of 12 months of age and included an echo planar axial DTI sequence with diffusion gradients along 20 non-collinear directions. TORTOISE software was used to correct DTI raw data for motion artifacts, and DtiStudio, DiffeoMap and RoiEditor were used for further postprocessing. DTI data were analyzed in terms of fractional anisotropy (FA), trace, radial diffusivity and axial diffusivity. These parameters reflect the integrity and maturation of white-matter motor pathways. At 30 months of age, ambulation status was evaluated by a developmental pediatrician, and infants were classified as ambulatory if they were able to walk independently with or without orthoses or as non-ambulatory if they could not. Linear mixed-effects method was used to examine the association between study outcomes and study group. Possible confounders were sought, and analyses were adjusted for age at MRI scan and ventricular size by including them in the regression model as covariates. Twenty patients with ONTD were included in this study, including three cases that underwent postnatal repair and 17 cases that underwent prenatal repair. There were five ambulatory and 15 non-ambulatory infants evaluated at a mean age of 31.5 ± 5.7 months. MRI was performed at 50.3 (2-132.4) weeks postpartum. When DTI analysis results were compared between ambulatory and non-ambulatory infants, significant differences were observed in the corpus callosum (CC). Compared with non-ambulatory infants, ambulatory infants had increased FA in the splenium (0.62 (0.48-0.75) vs 0.41 (0.34-0.49); P = 0.01, adjusted P = 0.02), genu (0.64 (0.47-0.80) vs 0.47 (0.35-0.61); P = 0.03, adjusted P = 0.004) and body (0.55 (0.45-0.65) vs 0.40 (0.35-0.46), P = 0.01, adjusted P = 0.01). Reduced trace was observed in the CC of ambulatory children at the level of the splenium (0.0027 (0.0018-0.0037) vs 0.0039 (0.0034-0.0044) mm2 /s; P = 0.04, adjusted P = 0.03) and genu (0.0029 (0.0020-0.0038) vs 0.0039 (0.0033-0.0045) mm2 /s; P = 0.04, adjusted P = 0.01). In addition, radial diffusivity was reduced in the CC of the ambulatory children at the level of the splenium (0.00057 (0.00025-0.00089) vs 0.0010 (0.00084-0.00120) mm2 /s; P = 0.02, adjusted P = 0.02) and the genu (0.00058 (0.00028-0.00088) vs 0.0010 (0.00085-0.00118) mm2 /s; P = 0.02, adjusted P = 0.02). There were no differences in axial diffusivity between ambulatory and non-ambulatory children. This study demonstrates a significant association between white matter integrity of connecting fibers of the corpus callosum, as assessed by DTI, and ambulatory skills at 30 months of age in infants with ONTD. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Geometric Distortion Correction of Renal Diffusion Tensor Imaging Using the Reversed Gradient Method.

Renal echo planar diffusion tensor imaging (DTI) has clinical potential but suffers from geometric distortion. We evaluated feasibility of reversed gradient distortion correction in 10 diabetic patients and 6 volunteers. Renal area, apparent diffusion coefficient, fractional anisotropy, and tensor eigenvalues were measured on uncorrected and distortion-corrected DTI. Corrected DTI correlated better than uncorrected DTI (r = 0.904 vs 0.840, P = 0.002) with reference anatomic T2-weighted imaging, with no significant difference in DTI metrics.

Diffusion tensor-based fiber tracking of the male urethral sphincter complex in patients undergoing radical prostatectomy: a feasibility study

ObjectivesTo study the diffusion tensor-based fiber tracking feasibility to access the male urethral sphincter complex of patients with prostate cancer undergoing Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP).MethodsTwenty-eight patients (median age of 64.5 years old) underwent 3 T multiparametric-MRI of the prostate, including an additional echo-planar diffusion tensor imaging (DTI) sequence, using 15 diffusion-encoding directions and a b value = 600 s/mm2. Acquisition parameters, together with patient motion and eddy currents corrections, were evaluated. The proximal and distal sphincters, and membranous urethra were reconstructed using the deterministic fiber assignment by continuous tracking (FACT) algorithm, optimizing fiber tracking parameters. Tract length and density, fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) were computed. Regional differences between structures were accessed by ANOVA, or nonparametric Kruskal–Wallis test, and post-hoc tests were employed, respectively, TukeyHSD or Dunn’s.ResultsThe structures of the male urethral sphincter complex were clearly depicted by fiber tractography using optimized acquisition and fiber tracking parameters. The use of eddy currents and subject motion corrections did not yield statistically significant differences on the reported DTI metrics. Regional differences were found between all structures studied among patients, suggesting a quantitative differentiation on the structures based on DTI metrics.ConclusionsThe current study demonstrates the technical feasibility of the proposed methodology, to study in a preoperative setting the male urethral sphincter complex of prostate cancer patients candidates for surgical treatment. These findings may play a role on a more accurate prediction of the RS-RARP post-surgical urinary continence recovery rate.

Evaluation of trigeminal nerve tractography using two-fold-accelerated simultaneous multi-slice readout-segmented echo planar diffusion tensor imaging.

Simultaneous multi-slice (SMS) imaging with short repetition time (TR) accelerates diffusion tensor imaging (DTI) acquisitions. However, its impact when combined with readout-segmented echo planar imaging (RESOLVE) on the cranial nerves given the challenging skull base/posterior fossa terrain is unexplored. We evaluated the reliability of trigeminal nerve DTI metrics using SMS with RESOLVE-DTI. Eight healthy controls and six patients with unilateral trigeminal neuralgia (TN) underwent brain MRI scan. Three different RESOLVE-DTI protocols were performed on a 3-T MRI system: non-SMS (TR = 4330ms), SMS with identical TR (4330ms), and SMS with short TR (2400ms). Pontine signal-to-noise ratio (SNR) and DTI metrics of the trigeminal nerve streamlines tracked by two independent raters using deterministic tractography and standardized tracking protocol were obtained. These were statistically analyzed and compared across the three protocols using intra-rater and inter-rater intraclass correlation coefficients (ICCs), one-way analysis of variance (ANOVA), post hoc analysis, and linear regression. On visual screening, there were no artifacts across the trigeminal nerves. All data also cleared objective image quality assurance analysis. Pontine SNR was similar for the two SMS protocols and higher for the non-SMS RESOLVE-DTI (F(2,36) = 4.40, p = 0.02). Intra-rater and inter-rater ICCs were very good (> 0.85). Trigeminal nerve DTI metrics were consistently measured by the three protocols, revealing significant linear relationships between non-SMS- and SMS-derived DTI metrics. SMS RESOLVE-DTI enables fast and reliable evaluation of microstructural integrity of the trigeminal nerve, with potential application in the clinical management of TN. • Readout-segmented diffusion-weighted echo planar imaging (RESOLVE-DTI) reduces image distortion artifacts in the posterior fossa but its long acquisition time limits clinical utility. • Simultaneous multi-slice (SMS) imaging combined with RESOLVE-DTI provides reliable trigeminal nerve tractography with potential applications in trigeminal neuralgia. • Two-fold-accelerated RESOLVE-DTI yields comparable trigeminal nerve streamlines and DTI metrics while near-halving acquisition time.

Correlation between diffusion tensor imaging parameters of the distal femoral physis and adjacent metaphysis, and subsequent adolescent growth.

Diffusion-tensor imaging (DTI) depicts the movement of water through columns of cartilage and newly formed bone and provides information about velocity of growth and growth potential. To determine the correlation between DTI tractography parameters of the distal femoral physis and metaphysis and the height change after DTI in pubertal and post-pubertal children. We retrospectively analyzed DTI images of the knee in 47 children with a mean age of 14.1years in a 2-year period. In sagittal echoplanar DTI studies, regions of interest were placed in the femoral physis. Tractography was performed using a fractional anisotropy threshold of 0.15 and a maximum turning angle of 40°. The sample was divided to assess short-term and long-term growth after DTI. Short-term growth (n=25) was the height change between height at MRI and 1year later. Long-term growth (n=36) was the height gain between height at MRI and at the growth plateau. For the short-term group, subjects with larger tract volume (R2=0.40) and longer track lengths (R2=0.38) had larger height gains (P<0.01). For the long-term group, subjects with larger tract volume (R2=0.43) and longer track lengths (R2=0.32) had a larger height gain at the growth plateau (P<0.01). Intra- and inter-observer variability were good-excellent. Follow-up data of growth 1year after DTI evaluation and at skeletal maturity confirms that DTI parameters are associated with the amount of post-imaging growth.

GP.05 Intraoperative acquisition of diffusion tensor imaging in cranial neurosurgery: readout-segmented DTI versus standard single-shot DTI

Background: Diffusion-tensor imaging (DTI) tractography is commonly used in neurosurgical practice, but is largely limited to the preoperative setting. This is due primarily to image degradation caused by susceptibility artifact when conventional single-shot (SS) echo-planar imaging DTI is acquired for open cranial, surgical position intraoperative DTI (iDTI). A novel, artifact-resistant, readout-segmented (RS) DTI has not yet been evaluated in the intraoperative MRI (iMRI) environment. Our objective was to evaluate the performance of RS-DTI versus SS-DTI for intraoperative white matter imaging. Methods: Pre- and intraoperative 3T, T1-weighted and DTI (RS-iDTI and SS-iDTI) in 22 adults undergoing intraaxial iMRI resections (low-grade glioma: 14, 64%; high-grade glioma: 7, 32%; cortical dysplasia: 1). Regional susceptibility artifact, anatomical deviation relative to T1WI, and tractographic output were compared between iDTI sequences. Results: RS-iDTI resulted in less regional susceptibility artifact and mean anatomic deviation (RS-iDTI: 2.7±0.2 mm versus SS-iDTI 7.5±0.4 mm; p&amp;lt;0.0001). Tractographic failure occurred in 8/22 (36%) patients for SS-iDTI whereas RS-iDTI permitted successful reconstruction in 4 of these 8. Maximal tractographic differences between DTI sequences were substantial (mean 9.7±5.7 mm). Conclusions: Readout-segmented EPI enables higher quality and more accurate DTI for surgically relevant tractography of major white matter tracts in intraoperative, open cranium, neurosurgical applications at 3T.

Quantitative MRI of visually intact rotator cuff muscles by multiecho Dixon-based fat quantification and diffusion tensor imaging.

Quantitative MRI allows assessment of shoulder rotator cuff (RC) muscles by Dixon MR sequences with calculation of fractional fat content (FF%) maps and diffusion tensor imaging (DTI) including tractography. To compare FF% and DTI derived parameters among visually intact RC muscles, to compare 2D with 3D DTI measurements and to establish normative values. Prospective. Forty patients aged >18 years undergoing shoulder MR arthrography were included. MR arthrography of the shoulder including 3D multiecho Dixon and 3D echo-planar DTI sequences (15 gradient encoding directions, b-value 600 s/mm2 ) was performed at 3.0T. Muscles affected by RC tears or fatty infiltration of Goutallier grade ≥1 were excluded. Two independent radiologists measured FF%, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) by region-of-interest (ROI) placements at the Y-position of the scapula and 3D tractography of each muscle with qualitative evaluation was performed. Intraclass correlation coefficients (ICCs) and Cohen's kappa were used for interreader agreement and Pearson correlation coefficient to correlate quantitative measures with each other and age, independent-samples t-test, one-way analysis of variance (ANOVA), and Kruskal-Wallis test were performed to investigate differences between genders and muscles. Qualitative and quantitative measurements showed moderate (κ = 0.41-0.56) to almost perfect (ICC = 0.75-0.99) agreement. There were weak but significant positive correlations of FF% with age (r = 0.273, P < 0.05) and FA-2D (r = 0.319-0.383, P < 0.05). Significant differences were found among RC muscles for ADC, radial diffusivity (RD), and tract homogeneity (all P < 0.05) but not between genders (all P ≥ 0.05). High correlations of 2D with 3D measurements for ADC (r = 0.639, P < 0.001) and FA (r = 0.628, P < 0.001) were seen. Quantitative MRI with estimation of FF% and DTI parameters shows significant age-associated changes and differences among visually intact RC muscles. High reproducibility and correlations of 2D with 3D DTI measurements can be expected. 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:109-117.

Construction of Brain Structural Connectome Using PROPELLER Echo-Planar Diffusion Tensor Imaging with Probabilistic Tractography: Comparison with Conventional Imaging

Brain structural analysis has been widely utilized to investigate brain network alterations caused by diseases. However, susceptibility distortions have been shown to influence tracking results and may detrimentally affect structural connectivity networks. Hence, the purposes of this study were (a) to reduce susceptibility distortions in brain structural networks by using diffusion tensor imaging with PROPELLER echo-planar imaging (pDTI), (b) to compare the differences in brain structural networks between this technique and conventional DTI with single-shot echo-planar imaging (ssDTI), and (c) to investigate sex differences in brain structural networks according to the two techniques. Forty healthy subjects (M/F = 20/20, age = 20–22 y/o) with no history of neurological disease participated in this study. For each participant, the two techniques were utilized to acquire imaging data from a 3.0 T MR scanner. Structural connectivity was statistically compared between these two techniques, as well as between male and female subjects. In connectivity analysis, the pDTI generally had significantly high connectivity between most cortical regions, whereas it exhibited significantly lower connectivity than ssDTI only in regions near the frontal, occipital, and brain stem areas. Furthermore, both techniques revealed consistent sex differences except in regions with susceptibility distortions. We concluded that pDTI might be a suitable alternative technique for investigating alterations in brain structural networks in regions with susceptibility distortions.

Value of diffusion tensor imaging in differentiating malignant from benign parotid gland tumors

PurposeTo evaluate whether diffusion tensor imaging (DTI) can be used to differentiate malignant parotid gland tumors from the benign ones. Materials and methodsThe study population comprised 59 parotid gland tumors (24 Warthin’s tumors, 19 pleomorphic adenomas, seven other benign tumors, and nine malignant tumors). Single-shot echo-planar DTI was performed with motion-probing gradients along 30 noncollinear directions (b=1000s/mm2) at 3.0T. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values for benign and malignant tumors were compared using the Mann–Whitney U test. Receiver-operating characteristic (ROC) curve analysis was performed to assess the ability of the ADC and FA values to differentiate malignant tumors from the benign ones. ResultsADC values showed no significant difference between malignant (0.93±0.21×10−3mm2/s) and benign tumors (1.19±0.50×10−3mm2/s) (p=0.225). FA values of malignant tumors were significantly higher than those of benign tumors (0.26±0.06 vs. 0.17±0.05, p<0.001). The area under the ROC curve of FA was significantly greater than that under the curve of ADC (0.884 vs. 0.628, p=0.010). ConclusionsDTI, particularly FA, can help differentiate malignant parotid gland tumors from the benign ones.

Diffusion-Tensor Imaging of the Physes: A Possible Biomarker for Skeletal Growth-Experience with 151 Children.

Purpose To determine the changes of diffusion-tensor imaging (DTI) and tractography in the distal femur and proximal tibia related to age, sex, and height. Materials and Methods Following institutional review board approval, with waiver of consent and with HIPAA compliance, the authors retrospectively analyzed DTI images of the knee in 151 children, 73 girls (median age, 14.1 years; range, 6.5-17.8 years) and 78 boys (median age, 16.6 years; range, 6.9-17.9 years), studied from January 2013 to October 2014. At sagittal echo-planar DTI (20 directions, b values of 0 and 600 sec/mm2), regions of interest were placed in the tibial and femoral physes. Using a fractional anisotropy threshold of 0.15 and an angle threshold of 40°, the authors performed tractography and measured apparent diffusion coefficient (ADC) and tract length and volume. Changes related to age, sex, and height were evaluated by using fitted nonlinear polynomial functions on bootstrapped samples. Results Femoral tract volume and length increased and then decreased with age (P < .001); the peaks of femoral tract volume are consistent with the growth spurt, occurring earlier in girls (10.8 years) than in boys (13.0 years) (P < .001). Girls had smaller tract volumes in comparison to boys (P = .013). ADC peaks 2 years earlier than tract volume (girls at 9.3 years, boys at 11.0 years). Girls with greater than 50th percentile of height had longer tracts and greater tract volumes compared with girls with less than 50th percentile (P < .020). DTI parameters of boys do not correlate with percentile of height (P > .300). Conclusion DTI of the physis and metaphysis shows greater tract length and volumes in subjects who are at ages when the growth is fastest. ADC and tract length and volume have an earlier and smaller peak in girls than in boys. Femoral tract length and volume are larger in taller girls. © RSNA, 2017.

Fetal diffusion tensor quantification of brainstem pathology in Chiari II malformation.

This prenatal MRI study evaluated the potential of diffusion tensor imaging (DTI) metrics to identify changes in the midbrain of fetuses with Chiari II malformations compared to fetuses with mild ventriculomegaly, hydrocephalus and normal CNS development. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated from a region of interest (ROI) in the midbrain of 46 fetuses with normal CNS, 15 with Chiari II malformations, eight with hydrocephalus and 12 with mild ventriculomegaly. Fetuses with different diagnoses were compared group-wise after age-matching. Axial T2W-FSE sequences and single-shot echo planar DTI sequences (16 non-collinear diffusion gradient-encoding directions, b-values of 0 and 700s/mm(2), 1.5 Tesla) were evaluated retrospectively. In Chiari II malformations, FA was significantly higher than in age-matched fetuses with a normal CNS (p = .003), while ADC was not significantly different. No differences in DTI metrics between normal controls and fetuses with hydrocephalus or vetriculomegaly were detected. DTI can detect and quantify parenchymal alterations of the fetal midbrain in Chiari II malformations. Therefore, in cases of enlarged fetal ventricles, FA of the fetal midbrain may contribute to the differentiation between Chiari II malformation and other entities. • FA in the fetal midbrain is elevated in Chiari II malformations. • FA is not elevated in hydrocephalus and mild ventriculomegaly without Chiari II. • Measuring FA may help distinguish different causes for enlarged ventricles prenatally. • Elevated FA may aid in the diagnosis of open neural tube defects. • Elevated FA might contribute to stratification for prenatal surgery in Chiari II.

High‐resolution reduced field of view diffusion tensor imaging using spatially selective RF pulses

Diffusion tensor imaging (DTI) plays a vital role in identifying white matter fiber bundles. Achievable imaging resolution and imaging time demands remain the major challenges in detecting small fiber bundles with current clinical DTI sequences. A novel reduced field of view ultra-high-resolution DTI technique named eZOOM (elliptically refocused zonally oblique multislice) was developed. A small circular disk was imaged using spatially selective radiofrequency (RF) pulses, reducing the imaging matrix size. The frequency profile of the spectral-spatial refocusing RF pulse provided intrinsic fat suppression, eliminating the need for fat saturation pulses. Multislice DTI at a resolution of 0.35 × 0.35 mm in a celery fiber phantom was successfully performed by scanning an 8-cm field of view at 3T. An adequate diffusion-to-noise ratio (DNR >20) was achieved for a 25-min acquisition using a direct-sampling RF receiver. Human subjects (n = 7) were scanned at resolutions of 0.47 × 0.47 mm having a DNR <20 within a 75-min scanning time, requiring further enhancements to increase the signal-to-noise ratio. The new eZOOM-DTI method offers multislice DTI at ultra-high imaging resolutions substantially exceeding those available with current echo-planar DTI techniques. Parallel and fast spin echo methods can be combined with eZOOM to improve SNR and DNR in humans.

Diffusion tensor imaging of the corpus callosum in frontotemporal dementia: A study in the Indian population

Patients with FTD often present with cognitive deficits at an early stage. The corpus callosum (CC) is an important interhemispheric white matter tract relaying sensory, motor and cognitive information. We examined the regional pattern of corpus callosal white matter (WM) involvement in frontotemporal dementia (FTD). The purpose of this study was to determine whether corpus callosal WM abnormalities can be detected at an early stage using Diffusion Tensor Imaging (DTI) parameters on a 3 Tesla MRI scanner. Eight patients each with preclinical and symptomatic FTD and twenty healthy controls were evaluated with an echoplanar DTI sequence on a 3 Tesla MRI scanner. A dedicated CC segmentation technique was utilised to measure mid-sagittal callosal cross-sectional thickness. Selective corpus callosal DTI parameters were calculated using the Functool software, including fractional anisotropy (FA), a suggested index of axonal damage of the CC. Statistical analysis across groups was performed using the student t tests. FTD was associated with significant reduction of FA values in the anterior CC. These findings were more extensive in early symptomatic FTD subjects and correlated with performance on distinct cognitive measures. WM changes were found in the anterior CC in FTD subjects, supporting the selective involvement of the anterior interhemispheric tracts in FTD and pre-FTD subjects.

Bilateral substantia nigra and pyramidal tract changes following experimental intracerebral hemorrhage: an MR diffusion tensor imaging study

The amelioration of secondary neurological damage is among the most important therapeutic goals for patients with intracerebral hemorrhage (ICH). Secondary injury of the ipsilateral substantia nigra (SN) and pyramidal tract (PY) is common after cerebral stroke. Such injury has been characterized previously by anatomical or diffusion MRI, but not in a comprehensive manner, and the knowledge regarding the contralateral changes is relatively poor. This study examined longitudinally both contralateral and ipsilateral SN and PY changes following experimental ICH with diffusion tensor imaging (DTI) and histology. ICH was induced in 14 Sprague-Dawley rats by the infusion of collagenase into the right striatum. Four-shot, spin-echo, echo-planar DTI was performed at 7 T with a b value of 1000 s/mm(2) and 30 diffusion gradient directions at 3.5 h and days 1, 3, 7, 14, 42 and 120 after ICH. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ// ) and radial diffusivity (λ┴ ) were measured in SN and PY accordingly. Two to three rats were sacrificed at days 3, 7, 42 and 120 for histology. The contralateral SN showed an increase in λ// with perivascular enlargement during the first 3 days after ICH. The ipsilateral SN showed increases in FA, λ// , λ┴ and MD at day 1, dramatic decreases at day 3 with neuronal degeneration and neuropil vacuolation, and subsequent gradual normalization. The contralateral PY showed diffusivity decreases at day 1. The ipsilateral PY showed early decreases and then late increases in MD and λ┴, and continuously decreasing FA and λ// with progressive axonal loss and demyelination. In summary, DTI revealed early bilateral changes in SN and PY following ICH. The evolution of the ipsilateral parameters correlated with the histological findings. In the ipsilateral PY, λ// and λ┴ changes indicated evolving and complex pathological processes underlying the monotonic FA decrease. These results support the use of quantitative multiparametric DTI for the evaluation of SN and PY injuries in clinical and preclinical investigations of ICH.

Magnetic Resonance Diffusion Tensor Imaging for Evaluation of Histopathological Changes in a Rat Model of Diabetic Nephropathy

The aim of this study was to investigate whether magnetic resonance (MR) diffusion tensor imaging (DTI) allows assessment of renal pathologies in a rat model of diabetic nephropathy. Twenty-one male Sprague-Dawley rats were divided into 3 groups: (1) untreated controls, (2) diabetes (DM), (3) diabetes with uninephrectomy (DM UNX) to accelerate renal impairment. Eight weeks after diabetes induction with streptozotocin, MR imaging was performed in a 1.5-T scanner using an 8-channel wrist coil. Morphological proton density images and echoplanar DTI were obtained (b = 0 and 300 s/mm, 6 diffusion directions). Renal apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were calculated for each of the different anatomical layers of the kidney. Imaging results, laboratory parameters of diabetic state and kidney function, and renal histopathological changes (glomerulosclerosis, tubular dilatation, and renal fibrosis) were compared between groups. Correlations between FA and histopathological changes were evaluated. All diabetic animals developed hyperglycemia and hypoinsulinemia. Uremia, albuminuria, and histopathological changes were most pronounced in DM UNX animals. Fractional anisotropy was significantly reduced in DM UNX animals in the cortex (CO) (0.167; confidence interval [CI], 0.151-0.184; P < 0.001), outer stripe of the outer medulla (OS) (0.254; CI, 0.225-0.283; P = 0.038), and inner medulla (IM) (0.459; CI, 0.395-0.523; P = 0.008) compared with control animals (CO, 0.251; CI, 0.224-0.277; OS, 0.309; CI, 0.267-0.350; IM, 0.559; CI, 0.515-0.603). In DM-without-UNX animals, only cortical FA was significantly lower than in controls (P < 0.001). Between groups, ADC values were not different, except for cortical ADC, which was higher in DM UNX animals than in controls. Significant negative correlations were observed between the FA of different anatomical layers and the extent of glomerulosclerosis (CO, P = 0.003, r = -0.65; and OS, P = 0.022, r = -0.52), tubulointerstitial fibrosis (IM, P = 0.028, r = -0.50), and tubular dilatation (CO, P = 0.015, r = -0.55; and IM, P = 0.006, r = -0.61), respectively. Magnetic resonance DTI by reduction of FA identified renal pathologies of diabetic nephropathy such as glomerulosclerosis, interstitial fibrosis, and tubular damage. Representing different stages of disease, DM and DM UNX animals could be differentiated. Thus, MR DTI may be valuable for noninvasive detection and monitoring of renal pathology in patients with diabetes.

Robust fat suppression at 3T in high‐resolution diffusion‐weighted single‐shot echo‐planar imaging of human brain

Single-shot echo-planar imaging is the most common acquisition technique for whole-brain diffusion tensor imaging (DTI) studies in vivo. Higher field MRI systems are readily available and advantageous for acquiring DTI due to increased signal. One of the practical issues for DTI with single-shot echo-planar imaging at high-field is incomplete fat suppression resulting in a chemically shifted fat artifact within the brain image. Unsuppressed fat is especially detrimental in DTI because the diffusion coefficient of fat is two orders of magnitude lower than that of parenchyma, producing brighter appearing fat artifacts with greater diffusion weighting. In this work, several fat suppression techniques were tested alone and in combination with the goal of finding a method that provides robust fat suppression and can be used in high-resolution single-shot echo-planar imaging DTI studies. Combination of chemical shift saturation with slice-select gradient reversal within a dual-spin-echo diffusion preparation period was found to provide robust fat suppression at 3 T.

Interactive Diffusion Tensor Tractography Visualization for Neurosurgical Planning

Diffusion tensor imaging (DTI) infers the trajectory and location of large white matter tracts by measuring the anisotropic diffusion of water. DTI data may then be analyzed and presented as tractography for visualization of the tracts in 3 dimensions. Despite the important information contained in tractography images, usefulness for neurosurgical planning has been limited by the inability to define which are critical structures within the mass of demonstrated fibers and to clarify their relationship to the tumor. To develop a method to allow the interactive querying of tractography data sets for surgical planning and to provide a working software package for the research community. The tool was implemented within an open source software project. Echo-planar DTI at 3 T was performed on 5 patients, followed by tensor calculation. Software was developed that allowed the placement of a dynamic seed point for local selection of fibers and for fiber display around a segmented structure, both with tunable parameters. A neurosurgeon was trained in the use of software in < 1 hour and used it to review cases. Tracts near tumor and critical structures were interactively visualized in 3 dimensions to determine spatial relationships to lesion. Tracts were selected using 3 methods: anatomical and functional magnetic resonance imaging-defined regions of interest, distance from the segmented tumor volume, and dynamic seed-point spheres. Interactive tractography successfully enabled inspection of white matter structures that were in proximity to lesions, critical structures, and functional cortical areas, allowing the surgeon to explore the relationships between them.

A change in the apparent diffusion coefficient after treatment with bevacizumab is associated with decreased survival in patients with recurrent glioblastoma multiforme.

The aim of this study was to determine the prognostic significance of changes in parameters derived from diffusion tensor imaging (DTI) that occur in response to treatment with bevacizumab and irinotecan in patients with recurrent glioblastoma multiforme. 15 patients with recurrent glioblastoma multiforme underwent serial 1.5 T MRI. Axial single-shot echo planar DTI was obtained on scans performed 3 days and 1 day prior to and 6 weeks after initiation of therapy with bevacizumab and irinotecan. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were registered to whole brain contrast-enhanced three-dimensional (3D) spoiled gradient recalled and 3D fluid attenuation inversion recovery (FLAIR) image volumes. Anatomic image volumes were segmented to isolate regions of interest defined by tumour-related enhancement (TRE) and FLAIR signal abnormality (FSA). Mean ADC and mean FA were calculated for each region. A Bland-Altman repeatability coefficient was also calculated for each parameter based on the two pre-treatment studies. A patient was considered to have a change in FA or ADC after therapy if the difference between the pre- and post-treatment values was greater than the repeatability coefficient for that parameter. Survival was compared using a Cox proportional hazard model. DTI detected a change in ADC within FSA after therapy in nine patients (five in whom ADC was increased; four in whom it was decreased). Patients with a change in ADC within FSA had significantly shorter overall survival (p=0.032) and progression free survival (p=0.046) than those with no change. In patients with recurrent glioblastoma multiforme treated with bevacizumab and irinotecan, a change in ADC after therapy in FSA is associated with decreased survival.