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Kyle W. Singleton¹, Timothy J. Schaewe², W John Boscardin³, Marie Luby¹, Steven Warach¹, Chelsea S. Kidwell⁴, Jeffry R. Alger²

¹National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA; ²David Geffen School of Medicine at UCLA, Los Angeles, California , USA; ³School of Public Health, UCLA, Los Angeles, California , USA; ⁴Georgetown University, Washington, District Of Columbia, USA

The hypothesis is that probabilistic brain atlas techniques can be used to formulate statistically significant relationships between functional deficits as measured with the NIH Stroke Scale (NIHSS) and diffusion weighted imaging lesion characteristics in acute stroke patients. We have developed the first neuroanatomic atlas to combine acute infarct location and volume information with clinical deficit measured with the NIHSS.  We show that lesion overlap measures derived from this atlas may be used to detect individual NIHSS item deficits with a high degree of accuracy.

Ona Wu¹, A Gregory Sorensen¹, Thomas Benner¹, Aneesh Singhal², Karen L. Furie², David M. Greer²

¹Massachusetts General Hospital, Charlestown, Massachusetts, USA; ²Massachusetts General Hospital, Boston, Massachusetts, USA

Imaging data from comatose cardiac arrest patients who received diffusion-weighted MRI (N=72) were retrospectively analyzed to determine whether changes in the apparent diffusion coefficient (ADC) values can be used to predict good recovery. Recovery was based upon either eye opening or the six-month modified Rankin Scale (mRS) score. Patients with poor outcomes (mRS >3) or with no eye opening had significantly lower whole brain median ADC values compared to patients with good recovery or eye opening, respectively. Whole brain ADC measurements may play an important role in assessing recovery and patient management decisions in comatose cardiac arrest patients.

Rakesh K. Gupta¹, Mohd Haris¹, Nuzhat Husain², Sona Saksena¹, Mazhar Husain², Sanjay Behari¹, Ram Kishore Singh Rathore³

¹Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; ²CSM Medical University, Lucknow, India; ³Indian Institute of Technology, Kanpur, India

Elevated Matrix Metalloproteinase (MMP-9) activity in cerebrospinal fluid from patients with central nervous system tuberculosis is associated with signs of local tissue destruction. Diffusion tensor imaging (DTI) derived indices are known to provide information about the tissue microstructural integrity in various disease conditions. In current study, MMP-9 in cellular fraction of brain tuberculoma showed significant correlation with DTI derived metrics suggesting that the DTI metrics may be used as surrogate marker of MMP-9 in vivo

Wang Zhan¹, Gail A. Kang², Graham A. Glass², William J. Marks², Yu Zhang¹, Marzieh Nezamzadeh¹, Andreas Ebel¹, Xiaoping Zhu¹, Rachel Millin¹, Daniel McCoy¹, Michael W. Weiner¹, Norbert Schuff¹

¹University of California San Francisco, San Francisco, California , USA; ²VA Medical Center San Francisco, San Francisco, California , USA

Diffusion tensor imaging (DTI) at 4T was applied to analyze the alterations of white matter (WM) integrity on a voxel-wise basis in patients with Parkinson’s disease (PD). Tract-based spatial statistics (TBSS) technique was used to ensure robust co-registration of the DTI data and to perform non-parametric statistical testing. PD patients had reduced fractional anisotropy (FA) in regions known to be associated with PD pathology compared to age-matched control subjects. Furthermore, significant correlations were found between PD severity, as measured by the UPDRS motor scores, and the DTI indexes, supporting the hypothesis that movement impairment in PD is associated with regionally selective microscopic degeneration of WM.

Rakesh Kumar Gupta¹, Monika Agarwal¹, Mazhar Husain², Nuzhat Husain², Kashi Nath Prasad¹, Chandra Mohan Pandey¹, Ram Kishore Singh Rathore³

¹Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; ²CSMM University, Lucknow, India; ³Indian Institute of Technology, Kanpur, India

In-vivo PMRS and DTI were performed in 53 patients of intracranial cystic mass lesions prospectively and were classified based on defined criteria of PMRS (a), mean diffusivity (MD, b), and fractional anisotropy (FA, c). Amongst 40 brain abscesses, 25 were confirmed on all three indices (a,b,c); 12 by two indices [(n=7; a,c) and (n=5; b,c)]; 3 by one index (c); while in cystic tumors (n=13), 10 were diagnosed on all three indices (a,b,c) and 3 by two indices (a,b). Findings indicate that FA is more sensitive (sensitivity, 1) while PMRS and MD are more specific (specificity, 1) for differentiating abscesses from tumors. We conclude that combining PMRS with DTI helps in better tissue characterization of cystic mass lesions.

Jonathan A.D. Farrell¹, ², Seth A. Smith¹, ², Eliza M. Gordon-Lipkin¹, Daniel S. Reich¹, Peter A. Calabresi¹, Peter C. van Zijl¹, ²

¹Johns Hopkins University School of Medicine, Baltimore, USA; ²Kennedy Krieger Institute, Baltimore, USA

Water diffusion perpendicular to the spinal cord should be sensitive to loss of axonal and/or myelin barriers. Diffusion-weighted imaging (DWI) analyzed with the q-space technique provides a probability density function for diffusion.  We demonstrate the feasibility of the technique in vivo in human cervical cord and, with respect to the detection of multiple sclerosis lesions, compare q-space contrasts to the perpendicular apparent diffusion constant (ADC_p), and quantitative magnetization transfer (MT) measurements.  Results from 8 controls and 4 patients show that, compared to ADC_p, q-space DWI is more sensitive to abnormal diffusion and compares favorably with MT’s sensitivity to WM damage.

Roel L.F. van der Palen¹, Jan Buijs¹, Anna Vilanova, F George Roos, Carola van Pul

¹Maxima Medical Center, Veldhoven, Netherlands

Perinatal HI is an important cause of neuromotor disability in childhood. We used DTI and quantitative fibertracking to investigate the Corticospinal Tract in neonates with perinatal HI. Fiber volume of the CST at 0 and 3 months correlate with neuromotor outcome at 2 years. The normal outcome group has a higher volume at 0 and 3 months. In severe outcome, ADC and FA of the fibers are higher and lower at 0 and 3 months compared to a normal outcome, respectively. This suggests that in the severe group, edema and membrane disruption are more important contributing factors.

Caterina Tonon¹, Raffaele Lodi¹, David Neil Manners¹, Giuseppe Nicoletti², Francesca Condino², Emil Malucelli¹, Maurizio Morelli³, Fabiana Novellino³, Sandra Paglionico³, Pierluigi Lanza², Demetrio Messina², Paolo Barone⁴, Letterio Morgante⁵, Mario Zappia⁶, Aldo Quattrone², Bruno Barbiroli¹

¹University of Bologna, Bologna, Italy; ²Institute of Neurological Sciences, Piano Lago di Mangone, Cosenza, Italy; ³University Magna Graecia, Catanzaro, Italy; ⁴University Federico II, Napoli, Italy; ⁵University of Messina, Messina, Italy; ⁶Università di Catania, Catania, Italy

The early diagnosis of progressive supranuclear palsy (PSP), a sporadic neurodegenerative disorder, may be challenging, because of clinical overlapping features with Parkinson’s disease (PD) and other parkinsonian syndromes. In our study an increase in mean superior cerebellar peduncle (SCP) ADC values in PSP but not in PD patients was detected, showing a diagnostic accuracy of 100% in differentiating between PSP and PD. The higher ADC values in SCP of PSP patients indicate microstructural changes reflecting the atrophy in this structure. These results provide an accurate MR diagnostic marker in differentiating parkinsonian syndromes.

Jiachen Zhuo¹, Andrew Rosenkrantz¹, Steven Roys¹, Kathirkamanthan Shanmuganathan¹, Stuart Mirvis¹, Rao Gullapalli¹

¹University of Maryland School of Medicine, Baltimore, Maryland, USA

Diffuse axonal injury (DAI) represents the most common primary intra-axial form of traumatic brain injury (TBI). We evaluated 73 DAI patients at a sub-acute stage following injury using whole-brain (WB), whole-brain-white-matter (WBWM) and regional DTI parameters. Compared to normal controls, a widespread ADC increase throughout the brain was observed from both the global and regional measures. Globally FA also increased in patients while regional FA change only reached significance in the corpus callosum. Both WB and WBWM provided similar results.  Among all parameters, peak ADC showed the strongest correlation with GCS suggesting it as a useful clinical marker for DAI.

Virginia Felicity Jane Newcombe¹, Doris A. Chatfield¹, Joanne G. Outtrim¹, Jonathan P. Coles¹, M G. Abate¹, Sally G. Harding¹, John D. Pickard¹, Peter J. Huchinson¹, T Adrian Carpenter¹, Guy B. Williams¹, David K. Menon¹

¹Cambridge University, Cambridge, UK

Diffuse axonal injury is classically observed in the more central white matter (WM) areas. However, microscopic lesions may also occur peripherally at the gray/white matter junction and in the subcortical white matter. This study used diffusion tensor imaging and quantitative tractography to assess the extent of central and peripheral white matter damage in patients with chronic traumatic brain injury which may explain some of the morbidity seen after injury. The damage seen appears to be more dominant in the central than peripheral white matter.