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Advanced Diffusion Imaging

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Title: Advanced Diffusion Imaging


1
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

2
Advanced Diffusion Imaging
  • Spine and spinal cord
  • High B values
  • Diffusion tensor imaging and tractography

3
Diffusion imagingspine indications
  • cord lesions
  • demyelinating disease
  • infarction

Pusan 2000
4
Diffusion imagingspine indications
  • cord lesions
  • demyelinating disease
  • infarction
  • vertebral lesion characterization

Pusan 2000
5
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
34
High SNR DWI 1.5 T
35
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

36
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

37
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

38
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

39
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
40
fractional anisotropy
41
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

42
real-time fMRI sensorimotor Cortex 35
seconds NVi / CVi
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Tensor imaging anisotropy study -- 55 directions
44
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
59
Superior Longitudinal Fasciculus
Anterior Commissure
Cingulum
Uncinate Fasciculus
Inferior Fronto-Occipital Fasciculus
Fornix
Derek Jones, Institute of Psychiatry, UK
60
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

61
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

63
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
64
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
65
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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
68
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
70
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
71
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
75
superior longitudinal f. (SLF)
76
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
79
projection fibers
  • corticospinal tracts
  • corticobulbar tracts
  • corticopontine tracts
  • geniculocalcarine tracts (optic radiations)

80
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
81
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
82
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
84
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
85
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
87
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
88
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

89
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

90
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
91
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
96
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
98
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
99
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
101
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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
103
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Jellison, et.al. AJNR 25356-369, March 2004
105
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
106
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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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