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AJNR - American Journal of Neuroradiology

Published ahead of print on September 20, 2007
doi: 10.3174/ajnr.A0640

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Multitensor Tractography Enables Better Depiction of Motor Pathways: Initial Clinical Experience Using Diffusion-Weighted MR Imaging with Standard b-Value

K. Yamada^a, K. Sakai^c, F.G.C. Hoogenraad^d, R. Holthuizen^d, K. Akazawa^a, H. Ito^a, H. Oouchi^a, S. Matsushima^a, T. Kubota^a, H. Sasajima^b, K. Mineura^b and T. Nishimura^a

^a Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto City, Kyoto, Japan
^b Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto City, Kyoto, Japan
^c Center for Promotion of Excellence in Higher Education, Kyoto University, Kyoto City, Kyoto, Japan
^d MR Clinical Science, Neuro, Philips Medical Systems, Best, the Netherlands

View larger version (67K): [in this window] [in a new window]   Fig 1. ROIs were placed at 5 different locations along the primary motor cortex to depict the different fiber tracts of the pyramidal tract. The brain stem ROI is indicated by the arrows.

View larger version (45K): [in this window] [in a new window]   Fig 2. The relative number of points constituting each fiber bundle in the contralesional hemisphere are shown. For example, by using tensor-based tractography, case 1 had mostly trunk fibers depicted (97%) and a low percentage (3%) of LE fibers. On the other hand, by using the multitensor technique, the fibers from other parts are also depicted, and, in this particular case, the trunk fibers constitute only 23% of all fibers. Of note, in general the multitensor approach is able to depict fibers from various locations, whereas the single-tensor approach is limited to the depiction of the trunk and hand regions.

View larger version (40K): [in this window] [in a new window]   Fig 3. The relative number of points constituting each fiber bundle in the lesional hemisphere is shown. Of note, the depiction of the fibers in this hemisphere is largely limited to the trunk fibers when the single-tensor approach is used. The difference between the single-tensor technique and the multitensor technique becomes obvious in the lesional hemisphere.

View larger version (44K): [in this window] [in a new window]   Fig 4. A 55-year-old man (case 4) presented to the hospital with a Jacksonian seizure starting in his right fingers. On MR imaging, a large left frontal lobe tumor was depicted. Of note, the multitensor technique is able to depict fibers from various locations and is able to reveal the relationship between the vital fiber tracts and the dorsal edge of the tumor. On the transaxial view, note that single-tensor tractography is able to show that the trunk fibers (purple) are located within the tumor. Using the multitensor approach, one can see that the hand fibers (green) are involved. Facial fibers (blue) are also seen in close proximity to the tumor.

View larger version (59K): [in this window] [in a new window]   Fig 5. A 58-year-old woman with glioblastoma multiforme (case 1) is illustrated. A large right parietal lobe tumor is noted with surrounding vasogenic edema. Note that the pyramidal fibers of lesional side (right) are not depicted using single-tensor tractography, whereas they are well shown by using multitensor tractography. These fibers are noted to have substantial anterior displacement.