Role Of Diffusion Tensor Imaging Research Articles

The diagnostic efficacy of diffusion tensor imaging in children with chronic kidney disease: correlation with histopathology and serum biomarkers

BackgroundChildren with chronic kidney disease (CKD) usually present with disease impact on growth besides cardiovascular problems that not only impact the patient's health during childhood but also affect their adult life. We aimed to identify the diagnostic role of diffusion tensor imaging (DTI) in CKD in pediatric using its metrics: apparent diffusion coefficient (ADC) and fraction anisotropy (FA).ResultsThis prospective study was performed on thirty-five CKD patients (16 girls, 19 boys; mean age 12.3 ± 2.6 years) and 19 sex- and age-matched controls. Both groups underwent renal DTI and renal function tests. Based on renal biopsy, patients with CKD were further categorized into sclerotic CKD (n = 25) and non-sclerotic CKD (n = 10). Mean FA renal medulla/cortex in CKD (0.18 ± 0.18 and 0.20 ± 0.17) was lower significantly (p = 0.001) than volunteers' (0.31 ± 0.19, 0.27 ± 0.18). The cutoff FA of renal medulla/cortex used for CKD diagnosis was 0.22 and 0.23 with AUC of 0.828, 0.838 and accuracy of 80.8%, 82.8%. Mean of renal medulla/cortex ADC in CKD (2.13 ± 0.23 and 1.93 ± 0.22 × 10−3 mm2/s) was higher significantly (p = 0.001) than that of volunteers' (1.67 ± 0.15 and 1.64 ± 0.133 × 10−3 mm2/s. ADC cutoff value of renal medulla/cortex used for CKD diagnosis was 1.86 and 1.74 × 10−3 mm2/s with AUC of 0.827, 0.82, 0.827, and 0.911, and accuracy of 80.6%, 79.6%, 82.8%, and 84.2%. Renal medulla/cortex FA in sclerotic CKD was significantly different (p = 0.001) from non-sclerotic CKD (0.25 ± 0.07 and 0.26 ± 0.08). Cortical and medullary FA in CKD patients correlated with e-GFR (r = 0.363, r = 0.317) and serum creatinine (r = − 0.467, r = − 0.383).ConclusionsRenal cortical/medullary FA can assist in diagnosing pediatric CKD, predict sclerotic CKD, and correlate with some serum biomarkers.

Role of Diffusion Tensor Imaging in Early Diagnosis and Characterization of Movement Disorders.

Symptoms of movement disorders in early stages are similar, which makes definite diagnosis difficult. Hence this study was conducted to explore the role of diffusion tensor imaging (DTI) in enhancing the early diagnosis and characterization of movement disorders. A cross-sectional study was conducted including 60 subjects. All of them were reviewed using conventional magnetic resonance imaging (MRI) and movement disorder DTI protocol. Commercially available software was used to produce fractional anisotropy (FA) maps. Post-processing 3D reconstruction was done to obtain tractograms. Both single and multiple regions of interest (ROIs) were selected for tractography in the pons, midbrain, substantia nigra (SN) and cerebellum. MRIandDTI images were interpretedand correlated with confirmatory diagnosis. According to DTI diagnosis, out of the 30 cases, 28 had movement disorders. Among cases, 36.67% had Parkinson's disease (PD), 23.33% had progressive supranuclear palsy (PSP), 16.67% had essential tremor, 13.33% had multi-system atrophy (MSA) C, and 3.33% had MSA P. DTI correctly classified all cases with PD and PSP. All cases with long disease duration and 88.24% of cases with short disease duration were also correctly classified. A statistically significant difference was observed in the proportion of diagnosis between DTI and conventional MRI. DTI has high sensitivity and specificity for the diagnosis of movement disorders. It is capable of early diagnosis of movement disorders and also differentiating and subcategorizing them.

Role of diffusion tensor imaging in stenotic and non-stenotic spinal canal

Background and purposeCervical Spondylotic Myelopathy (CSM) is a gradually escalating spinal cord disturbance set in motion by the degenerative narrowing of the vertebral canal. Routine MRI may fail to detect the subtle early alterations of the cord. MRI Diffusion Tensor Imaging (DTI) possesses the potential to detect these changes. This study intends to estimate the potential of the DTI technique in non-stenotic & stenotic spinal canals in individuals affected with CSM. MethodologySixty-four subjects who met the requirements of the inclusion criteria were incorporated into the investigation. All subjects underwent routine MRI sequences in addition to DTI of the cervical spine region. Scalars such as Fractional Anisotropy (FA), besides Apparent Diffusion Coefficient (ADC), were computed at each cervical intervertebral fibrocartilaginous disc level for all subjects. DTI fiber tractography was then performed to qualitatively assess the microstructural integrity of the tracts. ResultsA noteworthy difference (p<0.05) was seen in the FA parameter and ADC parameter values between the stenotic and non-stenotic groups, with the non-stenotic group having a higher mean FA and a lower ADC than the stenotic group (at the level of stenosis). A significant difference in age was seen between both groups, with most of the patients in the stenotic group belonging to 40 years and above. Tractography helped in demonstrating the morphology of the fiber tracts. ConclusionDTI parameters, namely FA and ADC, are sensitive to damage to the white matter and can be used to detect microstructural changes in the cord. However, standardization of the protocol is necessary when imaging the spinal canal.

Diffusion tensor imaging in trigeminal neuralgia: beyond the normal morphology

BackgroundTrigeminal neuralgia (TN) is an electric-like recurrent pain of a sudden onset and is localized to the area supplied by the trigeminal nerve, and the patients are usually free in between the attacks. It’s one of the most common causes of facial pain and is commonly induced by mechanical irritation, and there’s strong evidence suggesting an insult at the trigeminal nerve root which is usually caused by a neurovascular compression. The aim of the study was to evaluate the role of diffusion tensor imaging (DTI) in the detection of microstructural changes of normal appearing trigeminal nerve in patients with trigeminal neuralgia and the correlation between DTI parameters and pain severity.ResultsThirty one cases were included in the study (16 patients with TN and 15 healthy controls) underwent MRI with diffusion tensor imaging. The fractional anisotropy (FA) values of the trigeminal nerves were recorded and then comparison between the affected and unaffected sides in TN patients and healthy controls was done, also the degree of FA reduction was correlated with the pain severity in TN groups. The mean FA value of the affected trigeminal nerves was 0.43 ± 0.083, while that of the unaffected sides was 0.56 ± 0.058. The mean FA value of the trigeminal nerves in the healthy controls was 0.54 ± 0.057. A significant statistical differences was found between affected and unaffected sides (P < 0.00001) and between the affected sides and healthy controls (P < 0.0003), while no statistically significant difference was detected between the unaffected side and the healthy controls. A strong negative correlation was found between the pain score and the degree of FA reduction (P < 0.001).ConclusionsDiffusion tensor imaging is a functional MRI technique which can detect the microstructural changes in the normal appearing trigeminal nerves in patients with trigeminal neuralgia with a strong negative correlation between the severity of pain and the degree of FA reduction of the affected trigeminal nerve.

Potential Role of MR Diffusion Tensor Imaging of the Spinal Cord in Early Detection of Cervical Spondylotic Myelopathy and Assessment of Its Severity

Background Cervical spondylotic myelopathy is the most common cause of spinal dysfunction in adults. Recent studies have shown a potential role for diffusion tensor imaging as a novel method for early detection of cervical cord myelopathy as compared with conventional MR sequences. Aim of the Work To evaluate the role of MR diffusion tensor imaging in the early detection of cervical spondylotic myelopathic changes in comparison to conventional MRI sequences to determine best clinical management and outcome for the patients. Patients and Methods Our study is a prospective study that included patients from August 2021 to December 2021. The study included 20 patients with clinical symptoms of cervical spondylotic myelopathy, referred to the Radiology department, Ain Shams University Hospitals for MRI cervical study. Results Our results showed a highly significant reduction of FA values and highly significant increase of ADC values of the cord opposite to the level of the most affected disc (P value &amp;lt;0.001 and 0.002 respectively). We also found that the magnitude of FA reduction and ADC increase correlated positively with the severity of disc affection, with the highest drop in FA values and increase in ADC values found to be in patients with established spinal cord hyperintensity on T2WI. Conclusion Diffusion tensor imaging could be used in early detection of cervical cord myelopathy before the appearance of altered cord intensity on conventional MRI sequences and in assessment of its severity.

Diffusion-tensor MR imaging of optic pathway in idiopathic intracranial hypertension.

To investigate the role of diffusion tensor imaging (DTI) of optic pathway in patients with idiopathic intracranial hypertension (IIH). This study included 41 IIH patients and 22 controls. They underwent DTI of the optic nerve (ON) and optic radiation (OR). Their fractional anostrophy (FA) and mean diffusivity (MD) were calculated by two reviewers and correlated with papilledema grade. The optic nerve mean FA and MD of patients for reviewer-1 were 0.21 ± 0.047 and 2.189 ± 0.52 ×10-3mm2/s and for reviewer-2 were 0.216 ± 0.047 and 2.17 ± 0.54 ×10-3mm2/s. The mean ON FA and MD of controls for reviewer-1 were 0.33 ± 0.048 and 1.29 ± 0.26 ×10-3mm2/s and for reviewer-2 were 0.34 ± 0.05 and 1.3 ± 0.26 ×10-3mm2/s. There was significant difference in FA and MD between patients and controls (p < 0.00001). The OR mean FA and MD of patients for reviewer-1 were 0.61 ± 0.03 and 2.26 ± 0.55 ×10-3mm2/s and for reviewer-2 were 0.6 ± 0.03 and 2.24 ± 0.57 ×10-3mm2/s The mean OR FA and MD of controls for reviewer-1 were 0.6 ± 0.03 and 2.19 ± 0.49 ×10-3mm2/s and for reviewer-2 were 0.6 ± 0.03 and 2.18 ± 0.49 ×10-3mm2/s. There was no significant difference in FA and MD obtained in patients and controls. Both the FA and the MD of the ON showed strong correlation with the papilledema grade (r = -0.8 and 0.951, respectively). Our findings suggest that, IIH is associated mainly with pre-chiasmatic or ON involvement rather than post-chiasmatic parenchymal or OR involvement. DTI MD and FA parameters of the ON may be a reliable imaging biomarker for diagnosis of IIH and well correlated with papilledema grades.

Diffusion Tensor MR Imaging Evaluation in Children with Developmental Delay

Context: Developmental delay (DD) has a significant detrimental effect on the child’s quality of life. The critical time of diagnosis has a significant impact in preventing the decreased quality of life that the children with DD face, for which magnetic resonance imaging (MRI) with its new imaging techniques plays a pivotal role. Diffusion tensor imaging (DTI), a MRI technique, identifies microscopic features that are thought to be precursors to the ultimate stage of macroscopic tissue atrophy. Objectives: Spectrum of abnormal MRI brain findings was characterized, and role of DTI was evaluated in children with DD. Methods: Observational, descriptive study was performed on 80 children. Fifty cases of DD between the age of 1 month and 16 years, and 30 normal age-matched controls, underwent brain MRI with DTI for structural assessment of brain with measurement of fractional anisotropy (FA) of white matter tracts. “One sample t test” determined whether statistical significance existed between mean FA values of cases and controls. Results: Spectrum of hypoxic-ischemic insult and white matter abnormalities were the common findings seen in 21 (42%) and 19 (38%) children, respectively, amongst cases. On DTI, reduced FA was observed in white matter tracts of 24 (48%) children, most commonly in the corpus callosum of 13 (26%) children. Abnormal FA values in certain white matter tracts were observed in 6 (40%) out of 15 children with normal MRI brain. Conclusion: DTI exhibited the ability to pick up white matter tract abnormalities in the form of reduced FA values in children with DD, including some who showed structurally normal MRI.

Can Preoperative Diffusion Tensor Imaging Tractography Predict the Visual Outcomes of Patients with Pituitary Macroadenomas? A Prospective Pilot Study.

Visual impairment has been reported as the most common clinical manifestation of pituitary adenoma (PA) due to the compressive effect of the tumor. This prospective study aimed to evaluate the predictive role of diffusion tensor imaging (DTI) in the visual improvement of patients with PA, who were candidates for endoscopic endonasal surgery. A total of 13 patients (male, 8; female, 5) with visual impairment due to pituitary macroadenoma were enrolled in this study. The DTI findings and visual parameters, including visual acuity (VA), visual field (VF), and visual evoked potential (VEP), were recorded for all participants before and 3months after surgery. Significant recovery was reported in both VA and VF following PA surgery (P < 0.001). The results of perimetry indicated recovery in all quadrants, except for the lower nasal quadrant of the right eye. The tumor volume showed no significant association with the preoperative optic nerve, optic tract, and chiasm fractional anisotropy (FA) or mean diffusivity (MD). The VA and VF recoveries were more likely in patients with a lower preoperative optic nerve MD. Besides, increased preoperative FA of the optic nerve was associated with a higher probability of VA recovery. No significant correlation was found between the optic tract MD and FA values and visual improvement. Overall, MD values below 0.0021 and FA values above 0.1689 could predict a good prognosis of VA recovery after surgery. DTI may have a predictive value in estimating visual improvement in patients with PA preoperatively.

A meta-analysis of the role of diffusion tensor imaging in cervical spinal cord compression.

At present, the role of diffusion tensor imaging (DTI) remains controversial. This study aimed to confirm the role of DTI by comparing the differences in fractional anisotropy (FA) values between patients with cervical spinal cord compression (CSCC) and healthy individuals. A systematic and comprehensive literature search was conducted using the Web of Science, Embase, PubMed, and Cochrane Library databases to compare the mean FA values of patients with CSCC and healthy controls across all compression levels in the cervical spinal cord. Essential data from the literature, such as demographic information, imaging parameters, and DTI analysis method, were extracted. Fixed- or random-effect models based on I2 heterogeneity were applied to the pooled and subgroup analyses. Ten studies containing 445 patients and 197 healthy volunteers were eligible. The pooled results demonstrated a decrease in mean FA values across all compression levels in the experiment group compared to those in healthy controls (standardized mean difference=-1.54; 95% confidence interval=[-1.95, -1.14]; p<.001). Meta-regression revealed that the scanner field strength and DTI analysis method had a significant effect on heterogeneity. Our results show that FA values in the spinal cord decline in patients with CSCC, thus confirming the crucial role of DTI in CSCC.

Role of diffusion tensor imaging in neurological prognostication in spinal tuberculosis – A prospective pilot study

PurposeThe current study aims to explore the correlation between the Diffusion Tensor Imaging (DTI) indices and neurological status of individuals with TB spine with neurological deficit (TBSND). Further, factors affecting the rate of post-operative neurological recovery were also analysed with special emphasis on DTI indices. MethodsThe current study included 51 individuals with TBSND undergoing posterior instrumentation and posterolateral decompression. All individuals underwent DTI scanning at the site of compression and at a normal level proximal to the disease. The relationship of the DTI parameters with the pre-operative motor, sensory and total scores were analysed. All clinical and radiological parameters were further analysed on the basis of their recovery patterns after decompression surgery. ResultsThe FA values at the compressed segment were significantly lower while the ADC values were significantly higher when compared with the non-compressed levels. Pre-operative motor and total neurological scores were found to be significantly positively correlated to FA values and ADC values. Faster neurological recovery after decompression was associated with high FA values and younger age while incomplete neurological recovery was associated with high ADC values. ConclusionsHigher FA indices along with lower age constitute independent predictors for faster neurological recovery following decompression. FA values correlate with the neurological status of individuals with TBSND and its use may be explored as an adjunct to objectively assess the cord damage and for predicting neurological recovery pattern after decompression in such individuals.

Pre- and post-therapeutic evaluation of liver and spleen in type I and type III Gaucher’s disease using diffusion tensor imaging

PurposeTo assess the role of diffusion tensor imaging in assessing liver and splenic parenchymal infiltration in Gaucher’s disease (G.D.) type I and III before and after therapy. MethodsA prospective study was conducted upon 28 consecutive patients with G.D. type I and III and 28 age and sex-matched controls. They underwent an MRI and DTI of the liver and spleen. Mean diffusivity (M.D.) and fractional anisotropy (F.A.) values of the liver and spleen were evaluated before and after treatment and compared with control.ResultsThere was a statistically significant difference in the M.D. value of the liver and spleen between untreated patients and controls and between control and treated patients and in the M.D. value of the liver and spleen between untreated and treated patients. There is a statistically significant difference in the F.A. value of the liver and spleen between untreated patients and controls and in the F.A. value of the liver and spleen between untreated and treated patients. Hemoglobin level was positively correlated with the M.D. value of the spleen. Clinical score was negatively correlated with M.D. value of the spleen and was positively correlated with F.A. values of the liver and F.A. values of the spleen. Spleen volume was negatively correlated with M.D. values of the spleen.ConclusionSignificant difference in M.D. and F.A. values of liver and splenic parenchyma in patients with type I and III G.D. and controls, and between untreated and treated patients. The M.D. and F.A. values were well correlated with some biomarkers of disease activity.

Does liver diffusion tensor imaging (L-DTI) has a role in differentiation of hepatic focal lesions? Analytic study for assessment of the value of L-DTI in differentiating hepatic focal lesions according to LI-RADS

BackgroundMagnetic resonance imaging (MRI) plays an important role in the differentiation of hepatic focal lesions and diagnosis of hepatic malignancy, especially hepatocellular carcinoma which is a major health problem worldwide. Diffusion imaging is a functional MRI technique that became an essential part of MRI study of the liver. Recently, diffusion tensor imaging (DTI) is diffusion variant that can provide more information than conventional diffusion imaging based on the tissue anisotropy. The aim of this study was to present the role of DTI in the assessment and differentiation between hepatic focal lesions.ResultsFifty-one patients having 95 hepatic focal lesions who underwent dynamic MRI with conventional diffusion imaging and DTI acquisition were included in the study. A positive moderate significant correlation was found between Fractional anisotropy (FA) values and Liver Imaging Reporting and Data System (LI-RADS) category while substantial negative significant correlation and moderate negative significant correlation were found between DTI-ADC and DWI-ADC values, respectively, with the LI-RADS category. There was a significant negative correlation between DTI-ADC and FA values. DTI-ADC showed a significant role in differentiation of benign from malignant lesions with cut-off value 0.905 × 10−3 having 88.7% sensitivity and 88.3% specificity compared to 78.5% and 68.7% for DWI-ADC, respectively. Also, it was found that FA value had a significant role in differentiation between benign and malignant lesions with cut-off value 0.34 having 87.1% sensitivity and 73.9% specificity.ConclusionsDTI can be included in liver MRI studies for better tissue characterization as it may perform better than conventional DWI with higher sensitivity and specificity of DTI-ADC and FA values than conventional DWI-ADC.

Role of Diffusion Tensor Imaging in the Diagnosis of Traumatic Axonal Injury in Individual Patients with a Concussion or Mild Traumatic Brain Injury: A Mini-Review.

Present review paper aims to understand role of diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) in diagnosis of traumatic axonal injury (TAI), induced by head trauma, in individual patients with a concussion or mild traumatic brain injury (mTBI). Precise information on presence and severity of TAI in brain is necessary for determining appropriate therapeutic strategies. Several hundred DTI-based studies have reported TAI in concussion or mTBI. Majority of these DTI-based studies have been performed in a group of patients, whereas case studies that have reported TAI in individual patients with a concussion or mTBI are fewer. Summary of these DTI-based studies for individual patients is as follows: DTI can be used as a non-invasive tool for determining presence and severity of TAI in individual patients with concussion or mTBI. However, for diagnosis of TAI in an individual patient, several conditions are required to be met: no past history of head trauma, presence of possible conditions for TAI occurrence during head trauma, development of new clinical features after head trauma, and DTI observed abnormality of a neural structure that coincides with a newly developed clinical feature. However, further studies for a more precise diagnosis of TAI in individual patients should be encouraged.

Role of Diffusion Tensor Imaging in Diagnosis and Estimation of Shunt Effect for Hydrocephalus in Stroke Patients: A Narrative Review

Hydrocephalus is a dilatation of the brain ventricular system by the accumulation of cerebrospinal fluid within the ventricle caused by impaired cerebrospinal fluid circulation or clearance. A diagnosis of hydrocephalus at the chronic stage of stroke has been mainly made by clinical features and radiologic findings on brain computed tomography and magnetic resonance imaging. On the other hand, it could not determine the effect of hydrocephalus or shunt effect on the periventricular neural structures. By contrast, these effects on the periventricular neural structures can be estimated using diffusion tensor imaging (DTI). This article reviewed 10 DTI-based studies related to the diagnosis and estimation of the shunt effect for hydrocephalus in stroke patients. These studies suggest that DTI could be a useful diagnostic and estimation tool of the shunt effect for hydrocephalus in stroke patients. In particular, some studies suggested that fractional anisotropy value in the periventricular white matter could be a diagnostic biomarker for hydrocephalus. As a result, the role of DTI in diagnosing and estimating the shunt effect for hydrocephalus in stroke patients appears to be promising. However, the number of studies and patients of all reviewed studies were limited (10 studies including a total of 58 stroke patients with heterogenous brain pathologies).

Diffusion Tensor Imaging of Auditory Pathway in Patients With Crigler-Najjar Syndrome Type I: Correlation With Auditory Brainstem Response.

To evaluate the role of diffusion tensor imaging of the auditory pathway in patients with Crigler Najjar syndrome type I and its relation to auditory brainstem response. Prospective study was done including 12 patients with Crigler Najjar syndrome type I and 10 age- and sex-matched controls that underwent diffusion tensor imaging of brain. Mean diffusivity and fractional anisotropy at 4 regions of the brain and brainstem on each side were measured and correlated with the results of auditory brainstem response for patients. There was significantly higher mean diffusivity of cochlear nucleus, superior olivary nucleus, inferior colliculus, and auditory cortex of patients versus controls on both sides for all regions (P = .001). The fractional anisotropy of cochlear nucleus, superior olivary nucleus, inferior colliculus, and auditory cortex of patients versus controls was significantly lower, with P values of, respectively, .001, .001, .003, and .001 on the right side and .001, .001, .003, and .001 on left side, respectively. Also, a negative correlation was found between the maximum bilirubin level and fractional anisotropy of the left superior olivary nucleus and inferior colliculus of both sides. A positive correlation was found between the mean diffusivity and auditory brainstem response wave latency of the right inferior colliculus and left cochlear nucleus. The fractional anisotropy and auditory brainstem response wave latency of the right superior olivary nucleus, left cochlear nucleus, and inferior colliculus of both sides were negatively correlated. Diffusion tensor imaging can detect microstructural changes in the auditory pathway in Crigler Najjar syndrome type I that can be correlated with auditory brainstem response.

Role of diffusion tensor imaging in the evaluation of ulnar nerve involvement in leprosy.

Early detection of peripheral neuropathy is extremely important as leprosy is one of the treatable causes of peripheral neuropathy. The study was undertaken to assess the role of diffusion tensor imaging (DTI) in ulnar neuropathy in leprosy patients. This was a case-control study including 38 patients (72 nerves) and 5 controls (10 nerves) done between January 2017 and June 2019. Skin biopsy proven cases of leprosy, having symptoms of ulnar neuropathy (proven on nerve conduction study) were included. MRI was performed on a 3 T MR system. Mean cross-sectional area, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of ulnar nerve at cubital tunnel were calculated. Additional ancillary findings and appearance of base sequences were evaluated. Ulnar nerve showed thickening with altered T2W signal in all the affected nerves, having an average cross-sectional area of 0.26 cm2. Low FA with mean of 0.397 ± 0.19 and high ADC with mean of 1.28 ± 0.427 x 10 -3 mm2/s of ulnar nerve in retrocondylar groove was obtained. In the control group, mean cross-sectional area was 0.71cm2 with mean FA and ADC of 0.53 ± 0.088 and 1.03 ± 0.24 x 10 -3 mm2/s respectively. Statistically no significant difference was seen in diseased and control group. Cut-off to detect neuropathy for FA and ADC is 0.4835 and 1.1020 × 10 -3 mm2/s respectively. DTI though is challenging in peripheral nerves, however, is proving to be a powerful complementary tool for assessment of peripheral neuropathy. Our study validates its utility in infective neuropathies. 1. DTI is a potential complementary tool for detection of peripheral neuropathies and can be incorporated in standard MR neurography protocol.2. In leprosy-related ulnar neuropathy, altered signal intensity with thickening or abscess of the nerve is appreciated along with locoregional nodes and secondary denervation changes along with reduction of FA and rise in ADC value.3. Best cut-offs obtained in our study for FA and ADC are 0.4835 and 1.1020 × 10 -3 mm2/s respectively.

Characterization of Hepatic Focal Lesions by Diffusion Tensor Imaging and How Far it Can Predict Post-Treatment Response?

Abstract Background: Liver diseases have been known to be a major health problem principally because of their world-wide distribution. Focal liver disease is a common diagnostic problem referred to radiologists for evaluation owing to its nonspecific clinical presentation and marked interobserver variation on clinical examination. Aim of Study: The purpose of this study is to evaluate the role of diffusion tensor imaging in characterization of hepatic focal lesions and its value in post-treatment response. Patients and Methods: This prospective study included 30 patients previously diagnosed to have hepatic focal lesions (HFLs) by their characteristic triphasic computed tomography (CT), dynamic magnetic resonance imaging (MRI) features and/or biopsy. The study included 43 lesions in 30 patients (16 benign lesions, 23 malignant lesions, and 4 treated malig-nant lesions). MRI with diffusion tensor imaging (DTI) was performed for all patients. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were evaluated for all lesions. Results: There was a statistically significant difference in ADC values between the benign and malignant lesions (p 1.42x 10-3 mm2/s with 95.7% sensitivity and 82.8% specificity. The best cut-off ADC value to differ-entiate between treated malignant and malignant lesions respectively was >1.65x 10-3 mm2/s with 97.8% sensitivity and 95.7% specificity. The best cut-off FA value to differentiate between malignant and benign lesions respectively was >0.29 with 95% sensitivity and 70% specificity. The best cut-off FA value to differentiate between treated malignant and untreated malignant lesions respectively was <0.297 with 100% sensitivity and 69.2% specificity. Conclusion: Diffusion tensor imaging is an evolving technique that can be used to characterize different hepatic focal lesions either benign or malignant with significant additive value to dynamic contrast enhanced MRI examination. It can also be used to monitor treatment response.

Role of Diffusion Tensor Imaging in Parkinson's Disease Diagnosis

Background: Parkinson's disease (PD) is a chronic and progressive neurodegenerative disease that affects the dopamine-containing neurons. In this study, the role of the Diffusion Tensor imaging (DTI) method was investigated in the detection of PD. Objectives: The purpose of this study was to investigate the microstructural damage of the brain's white matter in PD using a non-invasive DTI technique. Methods: Twenty patients with PD were studied with comprehensive clinical assessments and DTI data. Also, 10 normal subjects were investigated. Fractional anisotropic (FA) and mean diffusivity (MD) values were calculated by drawing region of interest (ROI) on eight distinctive areas of the brain. Results: The level of FA and MD in substantia nigra (SN) was significantly different between the PD and healthy control (HC) groups. Also, differences were found in DTI parameters between PD and HC groups in some regions, such as genu, anterior limb of internal capsule (ALIC), splenium, and putamen. Conclusions: To summarize, DTI as a non-invasive method can be useful in the detection of Parkinson's disease.

Role of diffusion tensor imaging (DTI) as a quantitative diagnostic tool in assessing cervical spondylotic myelopathy

Aims and Objectives: To compare fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values obtained by DTI in stenotic and non-stenotic cervical spinal segments of patients with clinical evidence of cervical spondylotic myelopathy. Materials and Methods: A prospective study was conducted among 50 individuals over a period of 18 months. MRI of cervical spine was performed in patients referred/admitted to the institution with clinical suspicion of cervical spondylotic myelopathy. The protocol included: 2D sagittal T1WI, T2WI, STIR sequence, axial T2WI, T1WI, coronal STIR sequence and axial DTI sequences. Post-processing was done using Philips FIBRETRAK software. Results: In the study there was significant decrease in the values of FA at the levels with canal stenosis and a FA cut-off value ≤0.459 had sensitivity of 100% and specificity of 85.6% for diagnosing cervical spondylotic myelopathy. Similarly, there was a significant increase in the ADC value at the stenotic levels and the cut-off value >1.3265 x 10-3 mm2/s had a sensitivity of 100% and a specificity of 76%. Conclusions and Recommendations: DTI can thus be used as an efficient tool in early diagnosis of cervical spondylotic myelopathy in patients where there are no obvious changes in the signal intensity of the cord.

Role of Diffusion Tensor Imaging Combined with Neuron-Specific Enolase and S100 calcium-binding protein B Detection in Predicting the Prognosis of Moderate and Severe Traumatic Brain Injury

Background Traumatic brain injury (TBI) seriously affects the quality of life of patients. The present study evaluated the role of diffusion tensor imaging (DTI) combined with Neuron-Specific Enolase (NSE) and S100 calcium-binding protein B (S100B) protein in predicting the prognosis of moderate and severe TBI. Methods The TBI patients were divided into moderate TBI (TBIm) and severe TBI (TBIs) groups according to the Glasgow Coma Scale (GCS) after admission. The patients were then divided into good and poor prognosis groups according to the Glasgow Outcome Scale (GOS); moreover, their follow-ups were recorded at 3 and 6 months after injury. This study also included 65 healthy individuals with matched age and gender as the control group. The fractional anisotropy (FA) values of DTI, serum neuron-specific enolase (NSE), and S100B protein levels were detected in this study. The data were analyzed in SPSS software (version 22.0) to evaluate the role of DTI combined with NSE and S100B protein in predicting the prognosis in TBIm and TBIs. Results: After TBI, the FA values of DTI in the TBI group were lower than those in the control group (P&lt;0.05); moreover, the serum NSE and S100B values in the TBI group were higher than those in the control group (P&lt;0.05). In the TBIm patients, the FA values of the corpus callosum in the good prognosis group were higher than that in the poor prognosis group (P&lt;0.05); however, there was no significant difference between the two groups regarding the FA values of the internal capsule and the cerebral peduncle (P&gt;0.05). The serum levels of NSE and S100B in the good prognosis group were significantly lower than those in the poor prognosis group (P&lt;0.05). In the TBIs patients, the FA value of all areas in the good prognosis group was significantly higher than that in the poor prognosis group (P&lt;0.05). However, there was no significant difference between the two prognosis groups regarding the serum levels of NSE and S100B (P&gt;0.05). Conclusion Although DTI combined with NSE and S100B protein can effectively predict the prognosis of patients with moderate and severe TBI in the early stages, various other measures have been used in the studies to predict the prognosis of TBI patients. Accordingly, comparison with other measures is essential in further studies.