The ralationship between fractional anisotropy value and tumor microarchitecture in late-stage rat glioma

Objective: To explore the magnetic resonance diffusion tensor imaging(MR-DTI) features of in the late stage of Wistar rat C6 brain glioma, and the relationship between fractional anisotropy value and tumor microarchitecture. Methods: The concentration of more than 1.0×伊 106/10 μL glioma cells and complete medium were injected stereotactically into the right caudate nucleus of the experimental group(n=35) and control group(n=10), respectively. Conventional MRI, DTI, and enhanced T1 WI scans were Performed using the GE Signa HD× 3.0T MRI scanner about 3-4 weeks after implantation for the rats. Postproeessing was done using the DTI specific software Function Tool to gain FA image. Many ROIs were drawn avoiding hemorrhage, necrosis areas in tumor parenchyma, the value of FA was recorded. Each surviving rat brain was examined histologically using HE and immunohistochemical staining for VEGF and CD34. Pearson correlation analysis was used to determine the relationships between FA values and VEGF, MVD, cell density, respectively. Results: A total of 35 tumor-bearing rats were confirmed the tumor formation by the subsequent MRI and pathological examination. The mean FA values of the tumor and the contralateral brain tissue were 0.17 ± 0.03 and 0.31 ± 0.05 respectively, and the difference was statistically significant(t = 12.80, P <0.05). The mean FA value of grade III glioma(n=12) was 0.16 ± 0.03, and the average FA value of grade IV glioma(n=23) was about 0.18 ± 0.04. There was no significant difference between the two groups(t= 1.92, P> 0.05). FA value in the late stage of Wistar rat C6 brain glioma has significant positive correlation to VEGF, MVD, cell density. The correlation coefficients between FA and VEGF, MVD, and cell density were 0.67, 0.65 and 0.71(P<0.05), respectively. Conclusions: The FA value of rat glioma tumor in the late stage can preoperatively provide an accurate, reliable and noninvasive imaging monitoring method to evaluate the microstructure of glioma( cell density, the extent of angiogenesis, fiber bundle integrity and tumor cell infiltration and so on), predict the biological behavior of the tumor and make out surgical plan.

Detecting dopaminergic neuronal degeneration using diffusion tensor imaging in a rotenone-induced rat model of Parkinson's disease: fractional anisotropy and mean diffusivity values

Dopamine content in the basal ganglia is strongly associated with the degree of dopaminergic neuron loss in the substantia nigra pars com- pacta. Symptoms of Parkinson＇s disease might not arise until more than 50% of the substantia nigra pars compacta is lost and the dopamine content in the basal ganglia is reduced by more than 80%. Greater diagnostic sensitivity and specificity would allow earlier detection of Parkinson＇s disease. Diffusion tensor imaging is a recently developed magnetic resonance imaging technique that measures mean diffusiv- ity and fractional anisotropy, and responds to changes in brain microstructure. When the microscopic barrier （including cell membranes, microtubules and other structures that interfere with the free diffusion of water） is destroyed and extracellular fluid volume accumulates, the mean diffusivity value increases; when the integrity of the microstructure （such as myelin） is destroyed, fractional anisotropy value decreases. However, there is no consensus as to whether these changes can reflect the early pathological alterations in Parkinson＇s disease. Here, we established a rat model of Parkinson＇s disease by injecting rotenone （or sunflower oil in controls） into the right suhstantia nigra. Diffusion tensor imaging results revealed that in the stages of disease, at 1, 2, 4, and 6 weeks after rotenone injection, fiactional anisotropy value decreased, but mean diffusivity values increased in the right substantia nigra in the experimental group. Fractional anisotropy values were lower at 4 weeks than at 6 weeks in the right substantia nigra of rats from the experimental group. Mean diffusivity values were mark- edly greater at 1 week than at 6 weeks in the right corpus striatum of rats from the experimental group. These findings suggest that mean diffusivity and fractional anisotropy values in the brain of rat models of Parkinson＇s disease 4 weeks after model establishment can reflect early degeneration of dopaminergic neurons. ＇The change in fractional anisotropy values after destruction of myelin integrity is likely to be of greater early diagnostic significance than the change in mean diffusivity values.

Diffusion tensor imaging study of fractional anisotropy values and the area of both cerebral peduncles in healthy adults

Diffusion tensor imaging was performed in 105 volunteers free of central nervous system lesions.No differences were found in fractional anisotropy between the left and right cerebral peduncles among subjects（P 0.05）.The lower limit value of fractional anisotropy was 0.36,and the asymmetry ratio was 0.77.The area and lower limit value of the cerebral peduncles were 0.90 cm2 and 0.83,respectively.These results will be useful in evaluating the diagnosis of Wallerian degeneration following cerebral infarction.

Fractional anisotropy of the corticospinal tract in normal adults: Preliminary study using a diffusion tensor imaging technique

BACKGROUND： The corticospinal tract is an important tract for conducting motor function. The majority of studies focus on lesions of the corticospinal tract on appearance and function, whereas observation of normal corticospinal pathways can also improve understanding of lesion outcomes. OBJECTIVE： To observe the normal adult corticospinal tract using a diffusion tensor imaging technique to analyze fractional anisotropy （FA） in different levels of the brain. DESIGN, TIME AND SETTING： Neuroimaging observation was performed in the MRI Department, First Affiliated Hospital of Kunming Medical College in China, from October 2005 to October 2008. PARTICIPANTS： A total of 30 healthy adults were selected from the Department of MRI, First Affiliated Hospital of Kunming Medical College in China, from October 2005 to October 2008, and people with nervous system symptoms and signs were excluded. METHODS： Participants with normal conventional MRI results underwent diffusion tensor imaging examination in a 1.5 T GE MRI （slice thickness 4-5 mm, slice gap 0） for gradient data acquisition from 15 directions. The scanning involved the entire brain from the inferior medulla oblongata to the inferior cranial plate. Imaging post-processing was performed to obtain FA values; a paired t-test was applied for statistical analysis. MAIN OUTCOME MEASURES： FA values of the bilateral corticospinal tract in the medulla oblongata, pons, cerebral peduncle, basal ganglia, corona radiata, and centrum semiovale. RESULTS： FA values in the medulla oblongata and centrum semiovale were similar （P 〉 0.01）. FA values of left corticospinal tract were significantly greater than the right side in the pons, cerebral peduncle, basal ganglia and corona radiata （P 〈 0.01）. CONCLUSION： FA values vary by brain levels, including pons, cerebral peduncle, basal ganglia, and corona radiata. Moreover, FA values of the left corticospinal tract pathway were greater than the right side, which may relate to right handedness.

Fractional anisotropy for assessment of white matter tracts injury in methylmalonic acidemia

Background Methylmalonic acidemia （MMA） is a multifactorial autosomal recessive inborn error of organic acid metabolism, often presenting with neurological symptoms. As neurological disorders are often related to white matter injury, diffusion tensor imaging （DTI） is an excellent tool for assessment of white matter injury and possibly for diagnosing this disorder. Methods We retrospectively analyzed DTI images of 12 patients with MMA （7 males, 5 females, age range： 7-12 months, mean age： 9.25±1.70 months） with negative MRI findings. And another 12 age-matched and gender-matched infants were enrolled as control subjects. Fractional anisotropy （FA） of different white matter tracts of the brain was measured in both groups. Results For patients with negative MRI findings, compared with healthy infants, a statistically significant reduction in DTI FA value of the frontal white matter, temporal white matter, and occipital white matter was observed （P〈0.01）. Conclusions In addition to conventional TlW and T2W MR Image, Brain DTI presents a useful, sensitive and complementary tool for the assessment of brain damage in patients with MMA.

COMPARISON OF OPTICAL POLARIMETRY AND DIFFUSION TENSOR MR IMAGING FOR ASSESSING MYOCARDIAL ANISOTROPY

We have recently proposed an optical method for assessing heart structure that uses polarized light measurement of birefringence as an indicator of tissue anisotropy.The highly aligned nature of healthy cardiac muscle tissue has a detectable effect on the polarization of light,resulting in a measurable phase shift(“retardance”).When this organized tissue structure is perturbed,for example after cardiac infarction(heart attack),scar tissue containing disorganized collagen is formed,causing a decrease in the measured retardance values.However,these are dependent not only on tissue anisotropy,but also on the angle between the tissue’s optical anisotropy direction and the beam interrogating the sample.To remove this experimental ambiguity,we present a method that interrogates the sample at two different incident beam angles,thus yielding enough information to uniquely determine the true magnitude and orientation of the tissue optical anisotropy.We use an infarcted porcine heart model to compare these polarimetryderived anisotropy metrics with those obtained with diffusion tensor magnetic resonance imaging(DT-MRI).The latter yields the anisotropy and the direction of tissue water diffusivity,providing an independent measure of tissue anisotropy.The optical and MR results are thus directly compared in a common ex vivo biological model of interest,yielding reasonable agreement but also highlighting some technique-specific differences.

Diffusion tensor imaging assesses white matter injury in neonates with hypoxic-ischemic encephalopathy

With improvements in care of at-risk neonates, more and more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. Computed tomography, ultrasound, and conventional magnetic resonance imaging are helpful to diagnose brain injury, but cannot quantify white matter damage. In this study, ten full-term infants without brain injury and twenty-two full-term neonates with hypoxic-ischemic encephalopathy （14 moderate cases and 8 severe cases） underwent diffusion tensor imaging to assess its feasibility in evaluating white matter damage in this condition. Results demonstrated that fractional anisotropy, voxel volume, and number of fiber bundles were different in some brain areas between infants with brain injury and those without brain injury. The correlation between fractional anisotropy values and neonatal behavioral neurological assessment scores was closest in the posterior limbs of the internal capsule. We conclude that diffusion tensor imaging can quantify white matter injury in neonates with hypoxic-ischemic encephalopathy.

Diffusion tensor imaging detects Wallerian degeneration of the corticospinal tract early after cerebral infarction

To investigate the feasibility and time window of early detection of Wallerian degeneration in the corticospinal tract after middle cerebral artery infarction, 23 patients were assessed using magnetic resonance diffusion tensor imaging at 3.0T within 14 days after the infarction. The fractional anisotropy values of the affected corticospinal tract began to decrease at 3 days after onset and decreased in all cases at 7 days. The diffusion coefficient remained unchanged. Experimental findings indicate that diffusion tensor imaging can detect the changes associated with Wallerian degeneration of the corticospinal tract as early as 3 days after cerebral infarction.

Mild hypothermia for treatment of diffuse axonal injury: a quantitative analysis of diffusion tensor imaging

Fractional anisotropy values in diffusion tensor imaging can quantitatively reflect the consistency of nerve fibers after brain damage, where higher values generally indicate less damage to nerve fibers. Therefore, we hypothesized that diffusion tensor imaging could be used to evaluate the effect of mild hypothermia on diffuse axona[ injury. A total of 102 patients with diffuse axonal injury were randomly divided into two groups： normothermic and mild hypothermic treatment groups. Patient＇s modified Rankin scale scores 2 months after mild hypothermia were significant- ly lower than those for the normothermia group. The difference in average fractional anisotropy value for each region of interest before and after mild hypothermia was 1.32-1.36 times higher than the value in the normothermia group. Quantitative assessment of diffusion tensor imaging indicates that mild hypothermia therapy may be beneficial for patients with diffuse axonal injury.

Feasibility of 3.0 T diffusion-weighted nuclear magnetic resonance imaging in the evaluation of functional recovery of rats with complete spinal cord injury

Diffusion tensor imaging is a sensitive way to reflect axonal necrosis and degeneration, glial cell regeneration and demyelination following spinal cord injury, and to display microstructure changes in the spinal cord in vivo. Diffusion tensor imaging technology is a sensitive method to diagnose spinal cord injury; fiber tractography visualizes the white matter fibers, and directly displays the structural integrity and resultant damage of the fiber bundle. At present, diffusion tensor imaging is restricted to brain examinations, and is rarely applied in the evaluation of spinal cord injury. This study aimed to explore the fractional anisotropy and apparent diffusion coefficient of diffusion tensor magnetic resonance imaging and the feasibility of diffusion tensor tractography in the evaluation of complete spinal cord injury in rats. The results showed that the average combined scores were obviously decreased after spinal cord transection in rats, and then began to increase over time. The fractional anisotropy scores after spinal cord transection in rats were significantly lower than those in normal rats （P 〈 0.05）; the apparent diffusion coefficient was significantly increased compared with the normal group （P 〈 0.05）. Following spinal cord transection, fractional anisotropy scores were negatively correlated with apparent diffusion coefficient values （r = -0.856, P 〈 0.01）, and positively correlated with the average combined scores （r = 0.943, P 〈 0.01）, while apparent diffusion coefficient values had a negative correlation with the average combined scores （r = -0.949, P 〈 0.01）. Experimental findings suggest that, as a non-invasive examination, diffusion tensor magnetic resonance imaging can provide qualita- tive and quantitative information about spinal cord injury. The fractional anisotropy score and apparent diffusion coefficient have a good correlation with the average combined scores, which reflect functional recovery after spinal cord injury.

Dynamic correlation of diffusion tensor imaging and neurological function scores in beagles with spinal cord injury

Exploring the relationship between different structure of the spinal cord and functional assessment after spinal cord injury is important. Quantitative diffusion tensor imaging can provide information about the microstructure of nerve tissue and can quantify the pathological damage of spinal cord white matter and gray matter. In this study, a custom-designed spinal cord contusion-impactor was used to damage the T_（10） spinal cord of beagles. Diffusion tensor imaging was used to observe changes in the whole spinal cord, white matter, and gray matter, and the Texas Spinal Cord Injury Score was used to assess changes in neurological function at 3 hours, 24 hours, 6 weeks, and 12 weeks after injury. With time, fractional anisotropy values after spinal cord injury showed a downward trend, and the apparent diffusion coefficient, mean diffusivity, and radial diffusivity first decreased and then increased. The apparent diffusion-coefficient value was highly associated with the Texas Spinal Cord Injury Score for the whole spinal cord（R = 0.919, P = 0.027）, white matter（R = 0.932, P = 0.021）, and gray matter（R = 0.882, P = 0.048）. Additionally, the other parameters had almost no correlation with the score（P 〉 0.05）. In conclusion, the highest and most significant correlation between diffusion parameters and neurological function was the apparent diffusion-coefficient value for white matter, indicating that it could be used to predict the recovery of neurological function accurately after spinal cord injury.

Magnetic resonance diffusion tensor imaging of optic nerve and optic radiation in healthy adults at 3T

AIM:To investigate the diffusion characteristics of water of optic nerve and optic radiation in healthy adults and its related factors by diffusion tensor imaging（DTI）at3T.METHODS:A total of 107 healthy volunteers performed head conventional MRI and bilateral optic nerve and optic radiation DTI.The primary data of DTI was processed by post-processing software of DTI studio 2.3,obtaining fractional anisotropy value,mean diffusivity value,principal engine value,orthogonal engine value by measuring,and analyzed by the SPSS13.0 statistical software.RESULTS:The bilateral optic nerve and optic radiation fibers presented green color in directional encoded color（DEC）maps and presented high signal in fractional anisotropy（FA）maps.The FA value of the left optic nerve was 0.598±0.069 and the right was 0.593±0.065;the mean diffusivity（MD）value of the left optic nerve was（1.324±0.349）×10-3mm2/s and the right was（1.312±0.350）x10-3mm2/s;the principal engine value(λ?)of the left optic nerve was（2.297±0.522）×10-4mm2/s and the right was（2.277±0.526）×10-3mm2/s;the orthogonal engine value（λ⊥）of the left optic nerve was（0.838±0.285）×10-3mm2/s and the right was（0.830±0.280）×10-3mm2/s;the FA value of the left optic radiation was 0.636±0.057 and the right was0.628±0.056;the mean diffusivity（MD）value of the left optic radiation was（0.907±0.103）×10-3mm2/s and the right was（0.889±0.125）×10-3mm2/s;the principal eigenvalue(λⅡ)of the left optic radiation was（1.655±0.210）×10-3mm2/s and the right was（1.614±0.171）×10-3mn2/s;the orthogonal enginvalue（λ⊥）of the left optic radiation was（0.531±0.103）×10-3mm2/s and the right was（0.524±0.152）×10-3mm2/s.There was no obvious difference between the FA,MD,λ‖,λ⊥of the bilateral optic radiation and the bilateral optic nerve（P】0.05）and no obvious differencebetween male and female group.The FA,MO,λ‖,λ⊥of the bilateral optic radiation and the bilateral optic nerve had no obvious correlations to the age.CONCLUSION:DTI is sensitive to the optic nerve and radiation and the relevant DTI parameters of the optic nerve and radiation are established preliminarily in this study.

DTI and pathological changes in a rabbit model of radiation injury to the spinal cord after ^(125)I radioactive seed implantation

Excessive radiation exposure may lead to edema of the spinal cord and deterioration of the nervous system. Magnetic resonance imaging can be used to judge and assess the extent of edema and to evaluate pathological changes and thus may be used for the evaluation of spinal cord injuries caused by radiation therapy. Radioactive ^125I seeds to irradiate 90% of the spinal cord tissue at doses of 40–100 Gy （D90） were implanted in rabbits at T10 to induce radiation injury, and we evaluated their safety for use in the spinal cord. Diffusion tensor imaging showed that with increased D90, the apparent diffusion coefficient and fractional anisotropy values were increased. Moreover, pathological damage of neurons and microvessels in the gray matter and white matter was aggravated. At 2 months after implantation, obvious pathological injury was visible in the spinal cords of each group. Magnetic resonance diffusion tensor imaging revealed the radiation injury to the spinal cord, and we quantified the degree of spinal cord injury through apparent diffusion coefficient and fractional anisotropy.

Plasticity of language pathways in patients with low-grade glioma A diffusion tensor imaging study

Knowledge of the plasticity of language pathways neurosurgeons to achieve maximum resection wh n patients with low-grade glioma is important for e preserving neurological function. The current study sought to investigate changes in the ventral language pathways in patients with low-grade glioma located in regions likely to affect the dorsal language pathways. The results revealed no significant difference in fractional anisotropy values in the arcuate fasciculus between groups or between hemispheres. However, fractional anisotropy and lateralization index values in the left inferior longitudinal fasciculus and lateralization index values in the left inferior fronto-occpital fasciculus were higher in patients than in healthy subjects. These results indicate plasticity of language pathways in patients with low-grade glioma. The ventral language pathways may perform more functions in patients than in healthy subjects. As such, it is important to protect the ventral language pathways intraoperatively.

Changes in lumbosacral spinal nerve roots on diffusion tensor imaging in spinal stenosis

Lumbosacral degenerative disc disease is a common cause of lower back and leg pain. Conventional T1-weighted imaging（T1WI） and T2-weighted imaging（T2WI） scans are commonly used to image spinal cord degeneration. However, these modalities are unable to image the entire lumbosacral spinal nerve roots. Thus, in the present study, we assessed the potential of diffusion tensor imaging（DTI） for quantitative assessment of compressed lumbosacral spinal nerve roots. Subjects were 20 young healthy volunteers and 31 patients with lumbosacral stenosis. T2 WI showed that the residual dural sac area was less than two-thirds that of the corresponding normal area in patients from L3 to S1 stenosis. On T1 WI and T2 WI, 74 lumbosacral spinal nerve roots from 31 patients showed compression changes. DTI showed thinning and distortion in 36 lumbosacral spinal nerve roots（49%） and abruption in 17 lumbosacral spinal nerve roots（23%）. Moreover, fractional anisotropy values were reduced in the lumbosacral spinal nerve roots of patients with lumbosacral stenosis. These findings suggest that DTI can objectively and quantitatively evaluate the severity of lumbosacral spinal nerve root compression.

Diffusion tensor imaging of the hippocampus reflects the severity of hippocampal injury induced by global cerebral ischemia/reperfusion injury

At present,predicting the severity of brain injury caused by global cerebral ischemia/reperfusion injury(GCI/RI)is a clinical problem.After such an injury,clinical indicators that can directly reflect neurological dysfunction are lacking.The change in hippocampal microstructure is the key to memory formation and consolidation.Diffusion tensor imaging is a highly sensitive tool for visualizing injury to hippocampal microstructure.Although hippocampal microstructure,brain-derived neurotrophic factor(BDNF),and tropomyosin-related kinase B(Trk B)levels are closely related to nerve injury and the repair process after GCI/RI,whether these indicators can reflect the severity of such hippocampal injury remains unknown.To address this issue,we established rat models of GCI/RI using the four-vessel occlusion method.Diffusion tensor imaging parameters,BDNF,and Trk B levels were correlated with modified neurological severity scores.The results revealed that after GCI/RI,while neurological function was not related to BDNF and Trk B levels,it was related to hippocampal fractional anisotropy.These findings suggest that hippocampal fractional anisotropy can reflect the severity of hippocampal injury after global GCI/RI.The study was approved by the Institutional Animal Care and Use Committee of Capital Medical University,China(approval No.AEEI-2015-139)on November 9,2015.

Intraoperative diffusion tensor imaging predicts the recovery of motor dysfunction after insular lesions

Insular lesions remain surgically challenging because of the need to balance aggressive resection and functional protection. Motor function deficits due to corticospinal tract injury are a common complication of surgery for lesions adjacent to the internal capsule and it is therefore essential to evaluate the corticospinal tract adjacent to the lesion. We used diffusion tensor imaging to evaluate the corticospinal tract in 89 patients with insular lobe lesions who underwent surgery in Chinese PLA General Hospital from February 2009 to May 2011. Postoperative motor function evaluation revealed that 57 patients had no changes in motor function, and 32 patients suffered motor dysfunction or aggravated motor dysfunction. Of the affected patients, 20 recovered motor function during the 6-12-month follow-up, and an additional 12 patients did not recover over more than 12 months of follow-up. Following reconstruction of the corticospinal tract, fractional anisotropy comparison demonstrated that preoperative, intraoperative and follow-up normalized fractional anisotropy in the stable group was higher than in the transient deficits group or the long-term deficits group. Compared with the transient deficits group, intraoperative normalized fractional anisotropy significantly decreased in the long-term deficits group. We conclude that intraoperative fractional anisotropy values of the corticospinal tracts can be used as a prognostic indicator of motor function outcome.

Brain imaging of mild cognitive impairment and Alzheimer's disease

The rapidly increasing prevalence of cognitive impairment and Alzheimer＇s disease has the potential to create a major worldwide healthcare crisis. Structural MRI studies in patients with Alzheimer＇s disease and mild cognitive impairment are currently attracting considerable interest. It is extremely important to study early structural and metabolic changes, such as those in the hippocampus, entorhinal cortex, and gray matter structures in the medial temporal lobe, to allow the early detection of mild cognitive impairment and AIzheimer＇s disease. The microstructural integrity of white matter can be studied with diffusion tensor imaging. Increased mean diffusivity and decreased fractional anisotropy are found in subjects with white matter damage. Functional imaging studies with positron emission tomography tracer compounds enable detection of amyloid plaques in the living brain in patients with Alzheimer＇s disease. In this review, we will focus on key findings from brain imaging studies in mild cognitive impairment and Alzheimer＇s disease, including structural brain changes studied with MRI and white matter changes seen with diffusion tensor imaging, and other specific imaging methodologies will also be discussed.

Correlation between white matter damage and gray matter lesions in multiple sclerosis patients

We observed the characteristics of white matter fibers and gray matter in multiple sclerosis patients, to identify changes in diffusion tensor imaging fractional anisotropy values following white matter fiber injury. We analyzed the correlation between fractional anisotropy values and changes in whole-brain gray matter volume. The participants included 20 patients with relapsing-remitting multiple sclerosis and 20 healthy volunteers as controls. All subjects underwent head magnetic resonance imaging and diffusion tensor imaging. Our results revealed that fractional anisotropy values decreased and gray matter volumes were reduced in the genu and splenium of corpus callosum, left anterior thalamic radiation, hippocampus, uncinate fasciculus, right corticospinal tract, bilateral cingulate gyri, and inferior longitudinal fasciculus in multiple sclerosis patients. Gray matter volumes were significantly different between the two groups in the right frontal lobe（superior frontal, middle frontal, precentral, and orbital gyri）, right parietal lobe（postcentral and inferior parietal gyri）, right temporal lobe（caudate nucleus）, right occipital lobe（middle occipital gyrus）, right insula, right parahippocampal gyrus, and left cingulate gyrus. The voxel sizes of atrophic gray matter positively correlated with fractional anisotropy values in white matter association fibers in the patient group. These findings suggest that white matter fiber bundles are extensively injured in multiple sclerosis patients. The main areas of gray matter atrophy in multiple sclerosis are the frontal lobe, parietal lobe, caudate nucleus, parahippocampal gyrus, and cingulate gyrus. Gray matter atrophy is strongly associated with white matter injury in multiple sclerosis patients, particularly with injury to association fibers.

Changes in a cerebellar peduncle lesion in a patient with Dandy-Walker malformation A diffusion tensor imaging study

We report a patient with severe ataxia due to Dandy-Walker malformation, who showed functional recovery over 10 months corresponding to a change in a cerebellar peduncle lesion. A 20-month-old female patient who was diagnosed with Dandy-Walker syndrome and six age- and sex-matched healthy control subjects were enrolled. The superior cerebellar peduncle, the middle cerebellar peduncle, and the inferior cerebellar peduncle were evaluated using fractional anisotropy and the apparent diffusion coefficient. The patients＇ functional ambulation category was 0 at the initial visit, but improved to 2 at the follow-up evaluation, and Berg＇s balance scale score also improved from 0 to 7. Initial diffusion tensor tractography revealed that the inferior cerebellar peduncle was not detected, that the fractional anisotropy of the superior cerebellar peduncle and middle cerebellar peduncle decreased by two standard deviations below, and that the apparent diffusion coefficient increased by two standard deviations over normal control values. However, on follow-up diffusion tensor tractography, both inferior cerebellar peduncles could be detected, and the fractional anisotropy of superior cerebellar peduncle increased to within two standard deviations of normal controls. The functional improvement in this patient appeared to correspond to changes in these cerebellar peduncles. We believe that evaluating cerebellar peduncles using diffusion tensor imaging is useful in cases when a cerebellar peduncle lesion is suspected.