TY - JOUR T1 - Recovery of White Matter Tracts in Regions of Peritumoral FLAIR Hyperintensity with Use of Restriction Spectrum Imaging JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 1157 LP - 1163 DO - 10.3174/ajnr.A3372 VL - 34 IS - 6 AU - C.R. McDonald AU - N.S. White AU - N. Farid AU - G. Lai AU - J.M. Kuperman AU - H. Bartsch AU - D.J. Hagler AU - S. Kesari AU - B.S. Carter AU - C.C. Chen AU - A.M. Dale Y1 - 2013/06/01 UR - http://www.ajnr.org/content/34/6/1157.abstract N2 - BACKGROUND AND PURPOSE: DTI is being increasingly used to visualize critical white matter tracts adjacent to brain tumors before neurosurgical resection. However, brain tumors, particularly high-grade gliomas, are typically surrounded by regions of FLAIR hyperintensity that include edema, which increase isotropic diffusion, degrading the ability of standard DTI to uncover orientation estimates within these regions. We introduce a new technique, RSI, which overcomes this limitation by removing the spherical, fast diffusion component introduced by edema, providing better analysis of white matter architecture. MATERIALS AND METHODS: A total of 10 patients with high-grade gliomas surrounded by FLAIR-HI that at least partially resolved on follow-up imaging were included. All patients underwent RSI and DTI at baseline (FLAIR-HI present) and at follow-up (FLAIR-HI partially resolved). FA values obtained with RSI and DTI were compared within regions of FLAIR-HI and NAWM at both time points. RESULTS: RSI showed higher FA in regions of FLAIR-HI and NAWM relative to DTI, reflecting the ability of RSI to specifically measure the slow, restricted volume fraction in regions of edema and NAWM. Furthermore, a method by time interaction revealed that FA estimates increased when the FLAIR-HI resolved by use of standard DTI but remained stable with RSI. Tractography performed within the region of FLAIR-HI revealed the superior ability of RSI to track fibers through severe edema relative to standard DTI. CONCLUSIONS: RSI improves the quantification and visualization of white matter tracts in regions of peritumoral FLAIR-HI associated with edema relative to standard DTI and may provide a valuable tool for neurosurgical planning. CSTcorticospinal tractFAfractional anisotropyHIhyperintensityNAWMnormal-appearing white matterRSIrestriction spectrum imagingSLFsuperior longitudinal fasciculus ER -