Diffusion MRI: Clinical Correlation & Prediction

Room 713 A/B


Chairs: Alberto Bizzi and Roland G. Henry


Prog #

10:30 264. Representation of the NIH Stroke Scale with Probabilistic Diffusion Weighted Imaging Lesion Atlas

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.

10:42  265. Assessing Recovery in Comatose Cardiac Arrest Patients with Diffusion-Weighted MRI

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.

10:54  266. DTI Derived Metrics Correlate with Immunohistochemistry Obtained Matrix Metalloproteinase (MMP-9) Expression in Cellular Fraction of Brain Tuberculoma

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

11:06 267.  Voxel-Based DTI Analysis of White Matter Alterations in Parkinsonís Disease

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 Parkinsonís 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.

11:18 268. Predictive Value of Diffusion Tensor Imaging (DTI) Metrics and in Vivo Proton MR Spectroscopy (PMRS) in the Differential Diagnosis of Cystic Intracranial Mass Lesions

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.

11:30 269. Q-Space Diffusion Weighted Imaging (DWI) in the Spinal Cord: Comparison with Conventional DWI and Magnetization Transfer Imaging in Multiple Sclerosis

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 (ADCp), and quantitative magnetization transfer (MT) measurements.  Results from 8 controls and 4 patients show that, compared to ADCp, q-space DWI is more sensitive to abnormal diffusion and compares favorably with MTís sensitivity to WM damage.

11:42 270. Quantitative Fiber Tracking After Perinatal Hypoxic-Ischemia and Neurodevelopmental Outcome at 2 Years

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.

11:54 271. Apparent Diffusion Coefficient of the Superior Cerebellar Peduncle Differentiates Progressive Supranuclear Palsy from Parkinsonís Disease

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; 6Universitŗ 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 Parkinsonís 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.

12:06 272. Evaluation of Whole Brain and Regional DTI Parameters on Diffuse Axonal Injury Patients in the Sub-Acute Stage

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.

12:18  273. Peripheral Versus Central White Matter Damage in Chronic Traumatic Brain Injury :a Quantitative Tractography Study

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.