Advanced

AJNR - American Journal of Neuroradiology

Published ahead of print on December 13, 2007
doi: 10.3174/ajnr.A0855

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Nelles, M. Articles by Urbach, H. Search for Related Content PubMed PubMed Citation Articles by Nelles, M. Articles by Urbach, H.

Diffusion Tensor Pyramidal Tractography in Patients With Anterior Choroidal Artery Infarcts

M. Nelles^a, J. Gieseke^a, S. Flacke^a, L. Lachenmayer^b, H.H. Schild^a and H. Urbach^a

^a Department of Radiology, University of Bonn Medical Center, Bonn, Germany
^b Department of Neurology, University of Bonn Medical Center, Bonn, Germany

View larger version (65K): [in this window] [in a new window]   Fig 1. Sample patient, group I (favorable outcome), scanned on day 3 after symptom onset. IS indicates involvement scale. Stroke onset zones are marked with arrows. A, 3D volume rendering (50% opacity) of DWI and superimposed bilateral CSTs. B, FiberTracking coregistered with coronal 2D DWI sections. C, Axial ADC map; D and E, axial DWI; F, axial FA map coregistered with 2D overlay of CST fibers (*, C and D). In this case, the ischemic lesion is lateral of the CST to its major extent; there is no CST involvement (IS = 0) and no fiber disruption. This 46-year-old man suffered from dysarthria and decreased fine motor skills of his right hand at the time of admittance. He was hospitalized for 5 days and symptom free in re-evaluation after 3 months.

View larger version (52K): [in this window] [in a new window]   Fig 2. AchoA stroke with partial CST involvement (IS = 1, arrow) and partial fiber disruption (*). IS indicates involvement scale. A 56-year-old woman scanned on day 5 after symptom onset (initially with dysarthria and weakness of the cranial nerve VII [facial] buccal branch) who developed hemiparesis of the right arm and leg during her 10-day hospital course. After 3 months, she still had a lower extremity MS of 4 ("moderate" outcome, group II).

View larger version (50K): [in this window] [in a new window]   Fig 3. A 61-year-old man with left-sided hemiparesis (MS 4+) at hospital admittance. Paresis was progressive in the course of his 12-day stay ("unfavorable" outcome, group III). He was examined with DTI on the third day after symptom onset and had a complete CST disruption in DTT (open arrow).

View larger version (22K): [in this window] [in a new window]   Fig 4. Median AchoA infarct sizes (millimeters squared) for patient subgroups, measured at the level of the largest stroke extents, resided closely together. There were no statistically significant differences between stroke dimensions of patients with more favorable versus patients with unfavorable functional outcome.

View larger version (16K): [in this window] [in a new window]   Fig 5. Whisker plots of FA (A) and ADCs (B) illustrate that there is higher FA asymmetry (P = .03) between the affected and unaffected sides in AchoA stroke in patients with unfavorable outcome (III). B, ADC is reduced in all of the cases with no significant difference between single subgroups (see text).

View larger version (15K): [in this window] [in a new window]   Fig 6. Case numbers of different subgroups regarding complete/partial/no CST involvement (A) or CST fiber disruption (B). There is complete CST involvement and complete fiber disruption in group III only.