Diffusion tensor imaging and tractography of distal peripheral nerves at 3 T.

OBJECTIVE: We studied whether distal peripheral nerves could be imaged using quantitative diffusion tensor imaging (DTI) with a 3-T MRI scanner, and visualized using tractography. METHODS: Altogether 6 healthy subjects were studied. The diffusion was quantified with apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps, and the direction of main diffusivity was visualized with color-coded orientation maps and tractography. RESULTS: We present the first DTI and tractography results of human distal peripheral nerves. The courses of median, ulnar, and radial nerves in the upper limb and of tibial and peroneal nerves in the lower limb were first analyzed quantifying ADC and FA, and then visualized in 3D with tractography. Tractography illustrated nicely the 3D courses of both upper and lower limb nerves which were reliably distinguished from the surrounding muscle tissue and ligaments. CONCLUSIONS: Quantitative DTI and tractography can be used to image and visualize distal peripheral nerves. SIGNIFICANCE: DTI is a quantitative method that could provide useful information for the diagnosis and follow-up of nerve lesions, entrapments, and regeneration. Peripheral nerves as well-delineated structures also containing abundant branching into bundles of different diameters, could be used as 'living phantoms' for testing and validating different tractography methods.     

Representations of visual proportions in the primate posterior parietal and prefrontal cortices

The primate prefrontal (PFC) and posterior parietal cortices (PPC) have been shown to be cardinal structures in processing abstract absolute magnitudes, such as numerosity or length. The neuronal representation of quantity relations, however, remained largely elusive. Recent functional imaging studies in humans showed that blood flow changes systematically both in the PFC and the PPC as a function of relational distance between proportions. We investigated the response properties of single neurons in the lateral PFC and the inferior parietal lobule (IPL, area 7) in rhesus monkeys performing a lengths-proportion-discrimination task. Neurons in both areas shared many characteristics and showed peaked tuning functions with preferred proportions. However, a significantly higher percentage of neurons coding proportions was found in the PFC compared with the IPL. In agreement with human studies, our study shows that proportions are represented in the fronto-parietal network that has already been implicated for absolute magnitude processing.     

Diffusion tensor imaging and tractography of central pontine myelinolysis

OBJECTIVES: To illustrate the value of diffusion tensor imaging and tractography in the diagnosis and follow-up of central pontine myelinolysis. CASE REPORT: We report a case of central pontine myelinolysis in a 29 year old woman, also anorexic, studied using MR Diffusion Tensor Imaging (DTI) and Fibre Tracking (FT) focused on the pons, and compared with the studies of 5 normal volunteers. Tractography showed a swollen aspect of the right corticospinal fiber tract correlating with mild left lower extremity deficit at clinical evaluation. The pontine fibers were posteriorly displaced but intact. The sensory tracts were also intact. Apparent Diffusion Coefficient values were increased and Fractional Anisotropy was decreased in the lesions. Follow up imaging showed persistent abnormal ADC and FA values in the pons although the left cortico-spinal tract returned to normal, consistent with the clinical outcome. CONCLUSION: Diffusion Tensor Imaging MR and Fiber tractography are a new method to analyse white matter tracts. It can be used to prospectively evaluate the location of white matter tract lesions at the acute phase of central pontine myelinolysis and follow up.     

Diffusion tensor imaging and tractography of human brain development

Over the past decade, diffusion tensor imaging (DTI) has offered researchers and clinicians a new noninvasive window into the developing human brain, from preterm infants through adolescents and young adults. DTI improves on conventional MR imaging, such as T1-weighted and T2-weighted sequences, through its sensitivity to many microstructural features of neural organization. This has enabled visualization of the early cerebral laminar architecture in premature infants, of developing white matter before myelination, and of the microarchitecture of the cerebral cortex during preterm maturation. DTI provides reproducible quantitative measures, such as mean diffusivity and fractional anisotropy, that reflect the underlying tissue properties of gray matter and white matter and may therefore become useful as developmental milestones for the improved assessment of abnormal brain maturation. Furthermore, three-dimensional fiber tractography based on DTI can reveal the developing axonal connectivity of the human brain as well as aberrant connectivity in structural brain malformations. In this article, applications of DTI and fiber tractography to the study of human brain development are reviewed. The new insights into brain maturation afforded by DTI promise to improve the diagnostic evaluation of an array of congenital, metabolic, and neurodevelopmental disorders.     

Diffusion tensor imaging of the superior cerebellar peduncle identifies patients with posterior fossa syndrome

Introduction

Posterior fossa tumors are the most common brain tumor of children. Aggressive resection correlates with long-term survival. A high incidence of posterior fossa syndrome (PFS), impairing the quality of life in many survivors, has been attributed to damage to bilateral dentate nucleus or to cerebellar output pathways. Using diffusion tensor imaging (DTI), we examined the involvement of the dentothalamic tracts, specifically the superior cerebellar peduncle (SCP), in patients with posterior fossa tumors and the association with PFS.

Methods

DTI studies were performed postoperatively in patients with midline (n?=?12), lateral cerebellar tumors (n?=?4), and controls. The location and visibility of the SCP were determined. The postoperative course was recorded, especially with regard to PFS, cranial nerve deficits, and oculomotor function.

Results

The SCP travels immediately adjacent to the lateral wall of the fourth ventricle and just medial to the middle cerebellar peduncle. Patients with midline tumors that still had observable SCP did not develop posterior fossa syndrome (N?=?7). SCPs were absent, on either preoperative (N?=?1, no postoperative study available) or postoperative studies (N?=?4), in the five patients who developed PFS. Oculomotor deficits of tracking were observed in patients independent of PFS or SCP involvement.

Conclusion

PFS can occur with bilateral injury to the outflow from dentate nuclei. In children with PFS, this may occur due to bilateral injury to the superior cerebellar peduncle. These tracts sit immediately adjacent to the wall of the ventricle and are highly vulnerable when an aggressive resection for these tumors is performed.     

Diffusion tensor MRI and fiber tractography of cerebellar atrophy in phenytoin users

PURPOSE: The usefulness of diffusion tensor magnetic resonance imaging (DT-MRI) is still in debate, and the development of clinically feasible scan protocol is encouraged. The purpose of this study was to investigate the afferent fiber system to the cerebellum in patients with phenytoin (PHT)-induced cerebellar atrophy in comparison with cerebellar atrophy of other etiologies by using DT-MRI. METHODS: Thirteen patients (M/F ratio, 7:6; mean age, 42.5 years) and age-matched normal controls (n = 8) participated in this study. The patient group consisted of epilepsy patients who had received PHT therapy (n = 9) and clinically diagnosed as having olivopontocerebellar atrophy (OPCA; n = 4). DT-MRI was performed by using diffusion weighting of b = 600 s/mm2, and fractional anisotropy (FA) and color-coded vector maps were generated. FA of the middle cerebellar peduncle (MCP), the cerebellum, and transverse pontine fibers (TPF) was measured and compared between PHT and OPCA patients. RESULTS: Normal subjects showed FA values of 0.81 +/- 0.07 in MCP, 0.69 +/- 0.04 in TPF, and PHT users showed FA values of 0.84 +/- 0.09 in MCP, 0.72 +/- 0.08 in TPF, and 0.21 +/- 0.04 in cerebellum. OPCA patients showed FA values of 0.39 +/- 0.11 in MCP, 0.46 +/- 0.12 in TPF, and 0.22 +/- 0.07 in cerebellum. PHT users showed a statistically significant reduction of FA only in cerebellum, whereas OPCA demonstrated significant decrease of FA in MCP, TPF, and cerebellum (one-way analysis of variance, p < 0.01). Three-dimensional reconstruction of fiber tracts demonstrated decreased volume and altered fiber integrity within the peduncles and transverse pontine fibers in the OPCA group, whereas fiber course patterns in PHT users were similar to those in controls. CONCLUSIONS: PHT users showed normal orientation and anisotropy of MCP and TPF, whereas OPCA demonstrated impaired values, suggesting that PHT directly affects the cerebellum. DT-MRI can demonstrate detailed fiber configurations in degenerative diseases of brainstem and cerebellum and provides insight into the pathomechanisms of cerebellar atrophy.     

Anatomical investigation of projections to the basis pontis from posterior parietal association cortices in rhesus monkey

The projections to the basis pontis from cytoarchitectonically defined subregions of the superior (SPL) and inferior (IPL) parietal lobules were investigated in 14 rhesus monkeys by using the anterograde tracing techniques of autoradiography and horseradish peroxidase histochemistry. The results of our study confirm and complement available information regarding the parietopontine projections. The projections are found in clusters distributed in lamellae approximately concentric to the peduncle. They are directed most heavily towards the peripeduncular and lateral nuclei of the pons. There are also lesser, but nevertheless substantial projections to other nuclei including the intrapeduncular, ventral, dorsolateral, extreme dorsolateral, and dorsal nuclei. The dorsomedial, paramedian, and NRTP nuclei receive only minor projections. The SPL projections are relatively widespread with respect to the more focussed IPL projections. The IPL projections are, in general, situated more laterally and at more rostral levels of the pontine nuclei than are those of the SPL. The sulcal cortex of the SPL (area PEa) favors the dorsolateral, extreme dorsolateral, and ventral nuclei compared to the light projections to these nuclei from the convexity of the SPL. The sulcal cortex of the IPL, area POa, differs from the gyral cortex in favoring the ventral and extreme dorsolateral nuclei. The rostral IPL differs from the caudal IPL in that the intrapeduncular nucleus receives projections only from rostral regions, while the lateral nucleus receives projections preferentially from caudal regions. The pontine projections from the medial SPL, area PGm, are unique in the parietal lobe in that they include the paramedian nucleus. Projections arising from multimodal regions located caudally in the SPL (areas PEa and PGm) and IPL (areas PG and Opt) are more strongly represented and more laterally placed within the pontine nuclei than projections arising from more rostral, unimodal, posterior parietal regions. The heavy projections to the pontine nuclei from the posterior parietal cortex, and particularly from those caudal parietal regions that have prominent associative and limbic connections, seem to suggest that the corticopontocerebellar pathways permit a cerebellar contribution not only to the coordination of movement, but also to the modulation and integration of higher function.     

Numerical rule coding in the prefrontal, premotor, and posterior parietal cortices of macaques

Switching flexibly between behavioral goals is a hallmark of executive control and requires integration of external and internal information. We recorded single-neuron correlates of different numerical representations (sensory-, working memory-, and rule-related activity) in the dorsal premotor area (PMd), the cingulate motor areas (CMA), and the ventral intraparietal sulcus (VIP) and compared them to previous recordings in the lateral prefrontal cortex (PFC). Two monkeys were trained to encode and memorize numerosities and flexibly switch between two abstract quantitative rules based on rule cues. Almost 20% of randomly selected PFC and PMd neurons significantly represented the numerical rule in a behaviorally relevant manner, approximately twice as many as in the CMA and VIP. Rule selectivity was significantly better for PMd neurons than for PFC cells. Seemingly at the expense of rule selectivity, however, sensory- and memory-related numerosity activity was greatly diminished compared with previous delayed match-to-numerosity studies. These findings suggest the involvement of the frontal premotor areas in strategic planning such as rule following. Moreover, the results emphasize that the coding capacities of neurons in association cortical areas are far more dynamic depending on task demands than previously thought.     

Diffusion tensor imaging study of the middle cerebellar peduncles in patients with schizophrenia

Recent evidence from neuroimaging studies suggests that neural dysfunction is involved in the pathophysiology of schizophrenia. Diffusion tensor imaging (DTI) is a technique that has the potential to detect subtle disruptions of neural connectivity. Fractional anisotropy (FA), which is measured by DTI, is a measure of the directionality of diffusion anisotropy. Decrease in FA indicates abnormalities of white matter due to increased water diffusion accompanied by an increase in extracellular space. In the literature, previous studies reported that patients with schizophrenia showed widespread lower FA in the white matter. These findings suggest that patients with schizophrenia have microstructural lesions in the cerebral white matter. We used DTI to determine whether neural connectivity was disturbed in the middle cerebellar peduncles in schizophrenic subjects. We found a significant FA reduction in the middle cerebellar peduncle in patients with schizophrenia. Therefore, neural disconnectivity between the cerebellum and cerebrum was considered present in patients with schizophrenia and may be involved in the pathology of schizophrenia. This review provides current findings regarding DTI study on the cerebellar peduncle in patients with schizophrenia.     

Diffusion tensor imaging tractography of the fornix and belief confidence in first-episode psychosis

Previous studies have demonstrated that patients with psychosis are more confident in beliefs and judgments compared to healthy participants and psychiatric controls with major depression. A recent study conducted by our research group has provided evidence for hippocampal pathology in association with overconfidence in a first-episode psychosis sample. The fornix is the primary efferent neural pathway of the hippocampus and may also play a role in self-certainty pathophysiology. The current investigation applied diffusion tensor imaging tractography to a first-episode psychosis sample to explore whether integrity of the fornix is associated with self-certainty. High resolution structural magnetic resonance and diffusion tensor images were obtained in 44 people with a first-episode psychosis. Diffusion tensor imaging tractography was used to estimate fractional anisotrophy (FA), a measure of white matter integrity, in the fornix. Confidence in beliefs and judgments was measured with the self-certainty subscale of the Beck Cognitive Insight Scale (BCIS). The analysis showed that self-certainty significantly correlated to FA values in the right fornix but was nonsignificant for the left fornix. The findings indicate anatomical dysconnectivity of the right fornix in correlation with BCIS-rated self-certainty in our first-episode psychosis sample. When considered with our previously published self-certainty-hippocampus result in a first-episode psychosis sample, overlapping with that of this study, the results indicate a concurrence of volumetric reductions in hippocampus and fornix pathology in correlation with self-certainty.     

Diffusion tensor imaging (DTI) and its importance for exploration of normal or pathological brain development

Diffusion tensor MR imaging (DTI) can provide in vivo unique information on integrity of white matter structures (anisotropy) and connectivity (fiber tracking) in the human brain. This is made possible by means of non-invasive MR-based technique. The purpose of this article is to review the method and the current applications of diffusion tensor MR imaging. Studies of the past decade featuring relevant neuropsychiatric disorders as well as disorders in child psychiatry are reviewed. Furthermore, this report offers a summary of DTI-studies in children and adolescents showing alterations in brain or CNS structures including neurological, traumatological and oncological investigations. In particular, it focuses on the importance of this method with respect to exploration of normal and pathological brain development.     

Paradoxical activities: insight into the relationship of parietal and prefrontal cortices

What are the functions of the parietal and prefrontal cortices and how do these regions interact to achieve their objectives? How does context change plans for action? Are 'visual' and 'motor' well-defined attributes of neuronal activity in the association cortex? Recent studies of the saccadic system in monkeys have revealed two sets of paradoxical data: in parietal cortex, activity has visual timing but motor direction; in prefrontal cortex, activity has motor timing but visual direction. Analyzing the prefrontal and parietal data together leads to surprising insights. It appears that these paradoxical activities are intermediates in a parietal-prefrontal-parietal loop that has a rapid turnaround, and that a possibly prefrontal context-contingent signal switches sensorimotor transformations in parietal cortex.     

Diffusion tensor imaging tractography of the optic radiation for epilepsy surgical planning: a comparison of two methods

The optic radiation is a key white matter structure at risk during epilepsy surgery involving the temporal, parietal or occipital lobes. It shows considerable anatomical variability, cannot be delineated on clinical MRI sequences and damage may cause a disabling visual field deficit. Diffusion tensor imaging tractography allows non-invasive mapping of this pathway. Numerous methods have been published but direct comparison is difficult as patient, acquisition and analysis parameters differ. Two methods for delineating the optic radiation were applied to 6 healthy controls and 4 patients with epileptogenic lesions near the optic radiation. By comparing methods with the same datasets, many of the parameters could be controlled. The first method was previously developed to accurately identify Meyer's loop for planning anterior temporal lobe resection. The second aimed to address limitations of this method by using a more automated technique to reduce operator time and to depict the entire optic radiation. Whilst the core of the tract was common to both methods, there was significant variability between the methods. Method 1 gave a more consistent depiction of Meyer's loop with fewer spurious tracts. Method 2 gave a better depiction of the entire optic radiation, particularly in more posterior portions, but did not identify Meyer's loop in one patient. These results show that whilst tractography is a promising technique, there is significant variability depending on the method chosen even when the majority of parameters are fixed. Different methods may need to be chosen for surgical planning depending on the individual clinical situation.