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Research ArticleHEAD & NECK

Multishell Diffusion MRI–Based Tractography of the Facial Nerve in Vestibular Schwannoma

M. Castellaro, M. Moretto, V. Baro, S. Brigadoi, E. Zanoletti, M. Anglani, L. Denaro, R. Dell’Acqua, A. Landi, F. Causin, D. d’Avella and A. Bertoldo
American Journal of Neuroradiology July 2020, DOI: https://doi.org/10.3174/ajnr.A6706
M. Castellaro
aFrom the Padova Neuroscience Center (M.C., M.M., R.D., A.L., D.d., A.B.)
bDepartment of Information Engineering (M.C., M.M., S.B., A.B.)
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M. Moretto
aFrom the Padova Neuroscience Center (M.C., M.M., R.D., A.L., D.d., A.B.)
bDepartment of Information Engineering (M.C., M.M., S.B., A.B.)
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V. Baro
cAcademic Neurosurgery, Department of Neurosciences (V.B., L.D., A.L., D.d.)
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S. Brigadoi
bDepartment of Information Engineering (M.C., M.M., S.B., A.B.)
dDepartment of Developmental Psychology (S.B., R.D.)
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E. Zanoletti
eOtolaryngology Unit, Department of Neurosciences (E.Z.)
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M. Anglani
fNeuroradiology Unit (M.A., F.C.,) University of Padova, Padova, Italy.
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L. Denaro
cAcademic Neurosurgery, Department of Neurosciences (V.B., L.D., A.L., D.d.)
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R. Dell’Acqua
aFrom the Padova Neuroscience Center (M.C., M.M., R.D., A.L., D.d., A.B.)
dDepartment of Developmental Psychology (S.B., R.D.)
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A. Landi
aFrom the Padova Neuroscience Center (M.C., M.M., R.D., A.L., D.d., A.B.)
cAcademic Neurosurgery, Department of Neurosciences (V.B., L.D., A.L., D.d.)
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F. Causin
fNeuroradiology Unit (M.A., F.C.,) University of Padova, Padova, Italy.
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D. d’Avella
aFrom the Padova Neuroscience Center (M.C., M.M., R.D., A.L., D.d., A.B.)
cAcademic Neurosurgery, Department of Neurosciences (V.B., L.D., A.L., D.d.)
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A. Bertoldo
aFrom the Padova Neuroscience Center (M.C., M.M., R.D., A.L., D.d., A.B.)
bDepartment of Information Engineering (M.C., M.M., S.B., A.B.)
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Abstract

BACKGROUND AND PURPOSE: Tractography of the facial nerve based on single-shell diffusion MR imaging is thought to be helpful before surgery for resection of vestibular schwannoma. However, this paradigm can be vitiated by the isotropic diffusion of the CSF, the convoluted path of the facial nerve, and its crossing with other bundles. Here we propose a multishell diffusion MR imaging acquisition scheme combined with probabilistic tractography that has the potential to provide a presurgical facial nerve reconstruction uncontaminated by such effects.

MATERIALS AND METHODS: Five patients scheduled for vestibular schwannoma resection underwent multishell diffusion MR imaging (b-values = 0, 300, 1000, 2000 s/mm2). Facial nerve tractography was performed with a probabilistic algorithm and anatomic seeds located in the brain stem, cerebellopontine cistern, and internal auditory canal. A single-shell diffusion MR imaging (b-value = 0, 1000 s/mm2) subset was extrapolated from the multishell diffusion MR imaging data. The quality of the facial nerve reconstruction based on both multishell diffusion MR imaging and single-shell diffusion MR imaging sequences was assessed against intraoperative videos recorded during the operation.

RESULTS: Single-shell diffusion MR imaging–based tractography was characterized by failures in facial nerve tracking (2/5 cases) and inaccurate facial nerve reconstructions displaying false-positives and partial volume effects. In contrast, multishell diffusion MR imaging–based tractography provided accurate facial nerve reconstructions (4/5 cases), even in the presence of ostensibly complex patterns.

CONCLUSIONS: In comparison with single-shell diffusion MR imaging, the combination of multishell diffusion MR imaging–based tractography and probabilistic algorithms is a more valuable aid for surgeons before vestibular schwannoma resection, providing more accurate facial nerve reconstructions, which may ultimately improve the postsurgical patient’s outcome.

ABBREVIATIONS:

dMRI
diffusion MRI
FN
facial nerve
iFOD2
second-order integration over fiber orientation distributions
MS
multishell
PVE
partial volume effect
SD-STREAM
streamlines tractography based on spherical deconvolution
SS
single-shell
VS
vestibular schwannoma

Footnotes

  • M. Castellaro and M. Moretto contributed equally to this work.

  • M. Castellaro and M. Moretto contributed equally to this work.

  • © 2020 by American Journal of Neuroradiology
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Multishell Diffusion MRI–Based Tractography of the Facial Nerve in Vestibular Schwannoma
M. Castellaro, M. Moretto, V. Baro, S. Brigadoi, E. Zanoletti, M. Anglani, L. Denaro, R. Dell’Acqua, A. Landi, F. Causin, D. d’Avella, A. Bertoldo
American Journal of Neuroradiology Jul 2020, DOI: 10.3174/ajnr.A6706

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Multishell Diffusion MRI–Based Tractography of the Facial Nerve in Vestibular Schwannoma
M. Castellaro, M. Moretto, V. Baro, S. Brigadoi, E. Zanoletti, M. Anglani, L. Denaro, R. Dell’Acqua, A. Landi, F. Causin, D. d’Avella, A. Bertoldo
American Journal of Neuroradiology Jul 2020, DOI: 10.3174/ajnr.A6706
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