Diffusion Tensor Imaging of Tract Involvement in Children with Pontine Tumors
K.J. Heltona,
N.S. Phillipsa,
R.B. Khana,
F.A. Boopc,d,
R.A. Sanfordc,d,
P. Zoua,
C.S. Lib,
J.W. Langstona and
R.J. Ogga
a Department of Radiological Sciences, St Jude Children’s Research Hospital, Memphis, Tenn
b Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tenn
c Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tenn
d Semmes-Murphy Clinic, Memphis, Tenn
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Fig 1. MR imaging and DTI of a 15-year-old patient with diffuse pontine tumor.
A, Sagittal T1-weighted image. The pontine tumor is diffusely infiltrative. B, Axial T2-weighted image. The pons appears expanded and hyperintense with an area of focal necrosis. C, Axial ADC map. The tumor demonstrates elevated diffusion, and the necrosis is extremely hyperintense. D, Axial FA map. The tumor demonstrates diminished fractional anisotropy, and necrosis is hypointense.
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Fig 2. Axial diffusion tensor color maps of the brain stem at the level of the middle cerebellar peduncles.
A, Image of patient with a pontine tumor showing destruction of the normal anisotropy of the corticospinal tracts and posterior displacement of the medial lemnisci.
B, Control image showing normal corticospinal tracts, transverse pontine fibers, and medial lemnisci.
C, Image of patient with a pontine tumor showing a diffusely infiltrating pattern.
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Fig 3. Axial diffusion tensor color maps demonstrating tract invasion.
A, Image of a 6-year-old patient with a diffusely infiltrating pontine tumor. The left corticospinal tract is enlarged, compared with the right, and tumor infiltration separates the corticospinal (anterior arrow) and corticobulbar (posterior arrow) components.
B, Image of an 8-year-old patient with a focally exophytic pontine tumor. Mild lateral expansion of the left corticospinal tract (medial arrow), with focally exophytic tumor (lateral arrow).
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Fig 4. Graphs show diffusion tensor imaging parameters for major white matter tracts in the brain stem.
A, Fractional anisotropy (FA). B, Apparent diffusion coefficient (ADC). Data are shown for the corticospinal (CS, blue bars), transverse pontine (TP, red bars), and medial lemnisci (ML, yellow bars). Subject groups included patients with pontine tumors, patient control (PAT), and healthy volunteer (VOL) groups.
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