Advanced Diffusion Imaging

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Advanced Diffusion Imaging

• Lawrence N. Tanenbaum, M.D. FACR
• Seton Hall School of Graduate Medical Education
• Edison Imaging -JFK Medical Center
• New Jersey Neuroscience Institute
• Edison, New Jersey

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Advanced Diffusion Imaging

• Spine and spinal cord
• High B values
• Diffusion tensor imaging and tractography

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Diffusion imagingspine indications

• cord lesions
• demyelinating disease
• infarction

Pusan 2000
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Diffusion imagingspine indications

• cord lesions
• demyelinating disease
• infarction
• vertebral lesion characterization

Pusan 2000
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Kuala Lumpur 2000
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Third generation gradients

• shorter TE per B value
• higher SNR, reduced susceptibility artifact

EchoSpeed 23 mT/m
EchoSpeed Plus 33 mT/m
B1000
TE95ms
TE75ms
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TwinSpeed
B 1200 TE 69.9
B 2000 TE 79.1
B 3000 TE 87.6
B 4000 TE 94.4
B 6000 TE 105.2
B 5000 TE 100.2
B 7000 TE 109.7
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EchoSpeed plus
B 1500
B800
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NVi
B800
B1900
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NVi
B800
B1900
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B 1200
B 10000
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B 1900
High B DWI
NVi/ CVi
white matter shine through
B 800
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1000
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NVi
B800
B1900
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B 800
B 2000
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6 55 directions
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High SNR DWI 1.5 T
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Diffusion tensor imaging

• quantitative evaluation of the rate and direction
  of water motion
• rate of diffusion measured by ADC
• directionality measured by relative or fractional
  anisotropy

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Diffusion tensor

• matrix of numbers derived from diffusion
  measurements in several different directions (at
  least 6)
• mathematical model of diffusion in 3D space
• diffusivity in any arbitrary direction
• direction of maximum diffusivity

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Diffusion tensor imaging

• fiber tracts impose directionality (anisotropy)
• direction of maximum diffusivity coincides with
  WM tract orientation
• anisotropy is the extent to which the ellipsoid
  deviates from that of a sphere

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Diffusion tensor imaging

• tensor matrix (water diffusivity) visualized as
  an ellipsoid
• diameter in any direction estimates diffusivity
  in that direction
• principle axis oriented in direction of maximum
  diffusivity
• orientation characterized by 3 eigenvectors
• shape determined by 3 eigenvalues

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fractional anisotropy
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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fractional anisotropy
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Diffusion anisotropy imaging

• tractography
• operative planning
• sensorimotor localization
• eloquent tract localization
• imaging occult disease
• neuropsychiatric applications
• TBI
• schizophrenia
• dementia (MID vs. DAT)
• epilepsy
• brain maturation

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real-time fMRI sensorimotor Cortex 35
seconds NVi / CVi
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Tensor imaging anisotropy study -- 55 directions
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relative anisotropy
Real-time FMRI
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Real-time FMRI
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cavernous malformation
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RT F M R I
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tensor DWI fractional anisotropy
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tensor DWI fractional anisotropy
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3T
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metastatic disease
FMRI 3T
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FA
RTIP
FA
FMRI 3T
avg
glioma
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3 mm diffusion tractography 3T
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Derek Jones, Institute of Psychiatry, UK
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Superior Longitudinal Fasciculus
Anterior Commissure
Cingulum
Uncinate Fasciculus
Inferior Fronto-Occipital Fasciculus
Fornix
Derek Jones, Institute of Psychiatry, UK
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WM fiber tracts

• association fibers
• interconnect cortical areas in each hemisphere
• projection fibers
• interconnect cortical areas with deep nuclei,
  brain stem, cerebellum and spinal cord
• efferent (corticofugal) and afferent
  (corticopetal)
• commissural fibers
• interconnect similar cortical areas between
  hemispheres

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association fibers
Cingulum
Superior Longitudinal Fasciculus

• cingulum
• superior occipitofrontal fasciculus
• inferior occipitofrontal fasciculus
• uncinate fasciculus
• superior longitudinal (arcuate) fasciculus
• inferior longitudinal (occipitotemporal)
  fasciculus

Uncinate Fasciculus
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cingulum

• begins in paraolfactory area of the cortex below
  the rostrum of the CC
• courses within the cingulate gyrus and arches
  around the CC
• extends forward into the parahippocampal gyrus
  and uncus

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Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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Inferior occipitofrontal fasciculus
cingulum
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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superior occipitofrontal f.

• lies beneath the superior aspect of the CC
• connects occipital and frontal lobes
• extends posteriorly along the dorsal border of
  the caudate nucleus
• separated from superior longitudinal f. by corona
  radiata and internal capsule

Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
67
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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inferior occipitofrontal fascic.

• connects occipital and frontal lobes
• far inferior to superior occipitofrontal f.
• extends along inferolateral edge of the claustrum
  below the insula
• mid portion bundled with the mid portion of the
  uncinate f.

Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
69
inferior occipitofrontalfasciculus

• posteriorly joins the inf longitudinal f., the
  descending portion of the sup longitudinal f. and
  portions of the geniculocalcarine t. to form much
  of the sagittal stratum
• connects the occipital lobe to the rest of the
  brain

Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004o
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inferior occipitofrontal fasciculus
Inferior occipitofrontal fasciculus
cingulum
Inferior longitudinal fasciculus
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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uncinate fasciculus (UF)

• hooks around the lateral fissure
• connects the orbital and inferior frontal gyri of
  the frontal lobe to the anterior temporal lobe
• anteriorly it is parallel and inferomedial to and
  in midportion joins the inferior occipitofrontal
  f. before heading inferolaterally into the
  anterior temporal lobe

Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
72
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
73
superior longitudinal f. (SLF)

• massive (largest) fiber bundle that sweeps along
  the superior margin of the insula
• arcuate fasciculus
• connects frontal lobe cortex to parietal,
  temporal and occipital lobe cortices

Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
74
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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superior longitudinal f. (SLF)
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inferior longitudinal f. (ILF)

• connects temporal and occipital lobe cortices
• traverses the length of the occipital lobe
• joins the IOFF, the inferior aspect of the SLF
  and the optic radiations to form much of the
  sagittal stratum traversing the occipital lobe

Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
77
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
78
inferior longitudinal f. (ILF)
Inferior occipitofrontal fasciculus
cingulum
Inferior longitudinal fasciculus
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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projection fibers

• corticospinal tracts
• corticobulbar tracts
• corticopontine tracts
• geniculocalcarine tracts (optic radiations)

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Corticospinal, pontine and bulbar tracts

• major efferent fibers connecting motor cortex to
  the brain stem and spinal cord
• cant be parsed with tractography techniques

corticospinal
frontopontine
temporoparieto occipito pontine
Diffusion Tensor MR Imaging of the Brain and
White Matter Tractography Elias R. Melhem1,2,
Susumu Mori1,2, Govind Mukundan1, Michael A.
Kraut1,2, Martin G. Pomper1 and Peter C. M. van
Zijl1,2 AJR 2002 1783-16
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corticospinal
frontopontine
temporo parieto occipito pontine
Diffusion Tensor MR Imaging of the Brain and
White Matter Tractography Elias R. Melhem1,2,
Susumu Mori1,2, Govind Mukundan1, Michael A.
Kraut1,2, Martin G. Pomper1 and Peter C. M. van
Zijl1,2 AJR 2002 1783-16
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corticospinal tracts

• fibers converge in CR
• continue through posterior limb internal capsule
• turn medially to the cerebral peduncle then
  vertically on the way to the lateral funiculus of
  the cord

Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
83
corticospinal tracts

• fibers converge in CR
• continue through posterior limb internal capsule
• turn medially to the cerebral peduncle then
  vertically on the way to the lateral funiculus of
  the cord

Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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cortico spinal fibers
peduncle
b stem
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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corticobulbar tracts

• fibers converge in CR
• continue through genu internal capsule
• turn medially to the cerebral peduncle (medial
  and dorsal to corticospinal fibers)
• predominantly terminate at CN nuclei

Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
86
internal capsule

• conduit of fibers to and from the cerebral cortex
• anterior limb
• primarily anteroposteriorly directed projection
  fibers to and from the thalamus (thalamocortical
  projections) as well as frontopontine tracts
• posterior limb
• superoinferiorly oriented fibers of the CS, CB
  and CP tracts

Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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ext capsule
opt rad
redL-R greenA-P blueS-I
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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geniculocalcarine tracts

• optic radiation connects the lateral geniculate
  nucleus to occipital cortex
• inferior fibers sweep around the posterior horns
  of the lateral ventricles and terminate in the
  calcarine cortex
• superior fibers take more direct route

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geniculocalcarine tracts

• optic radiation connects the lateral geniculate
  nucleus to occipital cortex
• inferior fibers sweep around the posterior horns
  of the lateral ventricles and terminate in the
  calcarine cortex
• superior fibers take more direct route

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redL-R greenA-P blueS-I
optic rad
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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commissural fibers

• corpus callosum
• anterior commissure

Anterior Commissure
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corpus callosum

• massive accumulation of fibers connecting
  corresponding areas of cortex between the
  hemispheres

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corpus callosum

• body fibers are transversely oriented
• genu and splenium fibers course anteriorly and
  posteriorly to reach the poles of the hemispheres
• near mid-sagittal plane fibers are left-right
  oriented

Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
94
redL-R greenA-P blueS-I
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
95
redL-R greenA-P blueS-I
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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anterior commissure

• crosses through the lamina terminalis
• anterior fibers connect the olfactory bulbs and
  nuclei
• posterior fibers connect middle and inferior
  temporal gyri

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cingulum
sup longitudinal f
sup occipitofrontal f.
inf occipitofrontal f.
ant commissure
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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brain stem
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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brain stem
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
100
brain stem
Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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Diffusion Tensor MR Imaging of the Brain and
White Matter Tractography Elias R. Melhem1,2,
Susumu Mori1,2, Govind Mukundan1, Michael A.
Kraut1,2, Martin G. Pomper1 and Peter C. M. van
Zijl1,2 AJR 2002 1783-16
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Jellison, et.al. AJNR 25356-369, March 2004
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Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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HD MRI 3T
.21 mm in plane
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HD Prop MRI 3T
.21 mm in plane
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Residual glioma
Perfusion
DWI B1000
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Diffusion Tensor Imaging of Cerebral White
Matter A Pictorial Review of Physics, Fiber
Tract Anatomy, and Tumor Imaging Patterns Brian
J. Jellison, et.al. American Journal of
Neuroradiology 25356-369, March 2004
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redL-R greenA-P blueS-I
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anterior limb int capsule
posterior limb int capsule
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cortico spinal fibers
sup long fasciculus
inf long fasciculus
post limb int cap
cortico spinal fibers
post limb int cap
post limb int cap
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Glioma
Perfusion
DWI B1000
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cingulum
Inf longitudinal f.
optic radiations
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U fibers
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optic radiations and inferior longitudinal f.
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Tensor Diffusion
2
Scott Atlas, M.D.
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Mesial temporal sclerosis 3.0 T
K. Thulborn MD
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Hippocampal sclerosis
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Hippocampal sclerosis
3 mm 55 dirns 5 min
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Alzheimer disease

• loss of tract count and reduced FA within counts
  in fronto-occipital and thalamo-frontal tracts in
  early AD
• corresponds to quantitative EEG findings of a
  loss of coherence between the occipital and
  frontal lobes
• reduced FA in corpus callosum

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www. drtmasters .com
JFK Medical Center
Mardi Gras NO 2001
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www.drtmasters.com
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For further information contact the CMRS at
888-350-CMRS or visit www.cmrs.org.
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www.drtmasters.com
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