Advertisement

Neuroradiology

, Volume 48, Issue 6, pp 434–437 | Cite as

Oculomotor nerve palsy evaluated by diffusion-tensor tractography

  • Kei YamadaEmail author
  • Kensuke Shiga
  • Osamu Kizu
  • Hirotoshi Ito
  • Katsuhisa Akiyama
  • Masanori Nakagawa
  • Tsunehiko Nishimura
Functional Neuroradiology

Abstract

Introduction

The aim of the study was to test the feasibility of the tractography technique based on diffusion-tensor imaging (DTI) for the assessment of small infarcts involving the brainstem.

Methods

A patient who presented with an isolated left third cranial nerve palsy underwent magnetic resonance examination. Images were obtained by use of a whole-body, 1.5-T imager. Data were transferred to an off-line workstation for fiber tracking.

Results

The conventional diffusion-weighted imaging (DWI) performed using a 5 mm slice thickness could only depict an equivocal hyperintensity lesion located at the left paramedian midbrain. An additional thin-slice DTI was performed immediately after the initial DWI using a 3 mm slice thickness and was able to delineate the lesion more clearly. Image postprocessing of thin-slice DTI data revealed that the lesion location involved the course of the third cranial nerve tract, corresponding with the patient’s clinical symptoms.

Conclusion

The tractography technique can be applied to assess fine neuronal structures of the brainstem, enabling direct clinicoradiological correlation of small infarcts involving this region.

Keywords

MRI Brain Infarction Diffusion tensor imaging Tractography 

References

  1. 1.
    Warach S, Gaa J, Siewert B, Wielopolski P, Edelman RR (1995) Acute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging. Ann Neurol 37:231–241PubMedCrossRefGoogle Scholar
  2. 2.
    Sorensen AG, Buonanno FS, Gonzalez RG et al (1996) Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging. Radiology 199:391–401PubMedGoogle Scholar
  3. 3.
    Schwamm LH, Koroshetz WJ, Sorensen AG et al (1998) Time course of lesion development in patients with acute stroke: serial diffusion- and hemodynamic-weighted magnetic resonance imaging. Stroke 29:2268–2276PubMedGoogle Scholar
  4. 4.
    Basser PJ, Mattiello J, LeBihan D (1994) Estimation of the effective self-diffusion tensor from the NMR spin echo. J Magn Reson B 103:247–254PubMedCrossRefGoogle Scholar
  5. 5.
    Pierpaoli C, Basser PJ (1996) Toward a quantitative assessment of diffusion anisotropy. Magn Reson Med 36:893–906PubMedCrossRefGoogle Scholar
  6. 6.
    Pajevic S, Pierpaoli C (1999) Color schemes to represent the orientation of anisotropic tissues from diffusion tensor data: application to white matter fiber tract mapping in the human brain. Magn Reson Med 42:526–540PubMedCrossRefGoogle Scholar
  7. 7.
    Moseley ME, Cohen Y, Kucharczyk J et al (1990) Diffusion-weighted MR imaging of anisotropic water diffusion in cat central nervous system. Radiology 176:439–445PubMedGoogle Scholar
  8. 8.
    Chenevert TL, Brunberg JA, Pipe JG (1990) Anisotropic diffusion in human white matter: demonstration with MR technique in vivo. Radiology 177:401–405PubMedGoogle Scholar
  9. 9.
    Melhem ER, Mori S, Mukundan G et al (2002) Diffusion tensor MR imaging of the brain and white matter tractography. AJR Am J Roentgenol 178:3–16PubMedGoogle Scholar
  10. 10.
    Mori S, Crain BJ, Chacko VP, van Zijl PCM (1999) Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol 45:265–269PubMedCrossRefGoogle Scholar
  11. 11.
    Xue R, van Zijl PCM, Crain BJ et al (1999) In vivo three-dimensional reconstruction of rat brain axonal projections by diffusion tensor imaging. Magn Reson Med 42:1123–1127PubMedCrossRefGoogle Scholar
  12. 12.
    Stieltjes B, Kaufmann WE, van Zijl PCM et al (2001) Diffusion tensor imaging and axonal tracking in the human brainstem. Neuroimage 14:723–735PubMedCrossRefGoogle Scholar
  13. 13.
    Conturo TE, Lori NF, Cull TS et al (1999) Tracking neuronal fiber pathways in the living human brain. Proc Natl Acad Sci U S A 96:10422–10427PubMedCrossRefGoogle Scholar
  14. 14.
    Guye M, Parker GJ, Symms M et al (2003) Combined functional MRI and tractography to demonstrate the connectivity of the human primary motor cortex in vivo. Neuroimage 19:1349–1360PubMedCrossRefGoogle Scholar
  15. 15.
    Yang Q, Tress BM, Barber PA et al (1999) Serial study of apparent diffusion coefficient and anisotropy in patients with acute stroke. Stroke 30:2382–2390PubMedGoogle Scholar
  16. 16.
    Green HA, Pena A, Price CJ et al (2002) Increased anisotropy in acute stroke: a possible explanation. Stroke 33:1517–1521PubMedCrossRefGoogle Scholar
  17. 17.
    Nagae-Poetscher LM, Jiang H, Wakana S et al (2004) High-resolution diffusion tensor imaging of the brain stem at 3 T. AJNR Am J Neuroradiol 25:1325–1330PubMedGoogle Scholar
  18. 18.
    Collard M, Saint-Val C, Mohr M, Kiesmann M (1990) Isolated paralysis of the ocular motor nerve caused by infarction of fascicular fibers. Rev Neurol (Paris) 146:128–132Google Scholar
  19. 19.
    Kim JS, Kim J (2005) Pure midbrain infarction: clinical, radiologic, and pathophysiologic findings. Neurology 64:1227–1232PubMedGoogle Scholar
  20. 20.
    Yamada K, Kizu O, Mori S et al (2003) Brain fiber tracking with clinically feasible diffusion-tensor MR imaging: initial experience. Radiology 227:295–301PubMedCrossRefGoogle Scholar
  21. 21.
    Nimsky C, Ganslandt O, Hastreiter P et al (2005) Preoperative and intraoperative diffusion tensor imaging-based fiber tracking in glioma surgery. Neurosurgery 2005 56:130–137PubMedGoogle Scholar
  22. 22.
    Kunimatsu A, Aoki S, Masutani Y et al (2003) Three dimensional white matter tractography by diffusion tensor imaging in ischaemic stroke involving the corticospinal tract. Neuroradiology 45:532–535PubMedCrossRefGoogle Scholar
  23. 23.
    Yamada K, Mori S, Nakamura H et al (2003) Fiber-tracking method reveals sensorimotor pathway involvement in stroke patients. Stroke 34:E159–E162PubMedCrossRefGoogle Scholar
  24. 24.
    Mukherjee P (2005) Diffusion tensor imaging and fiber tractography in acute stroke. Neuroimaging Clin N Am 15:655–665PubMedCrossRefGoogle Scholar
  25. 25.
    Konishi J, Yamada K, Kizu O et al (2005) MR tractography for the evaluation of the functional recovery from lenticulostriate infarct. Neurology 64:108–113PubMedGoogle Scholar
  26. 26.
    Nakamura H, Yamada K, Kizu O et al (2005) Effect of thin-section diffusion-weighted MR imaging on stroke diagnosis. AJNR Am J Neuroradiol 26:560–565PubMedGoogle Scholar
  27. 27.
    Okada T, Miki Y, Fushimi Y et al (2006) Diffusion-tensor fiber tractography: intraindividual comparison of 3.0-T and 1.5-T MR imaging. Radiology 253 238:668–678PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Kei Yamada
    • 1
    Email author
  • Kensuke Shiga
    • 2
  • Osamu Kizu
    • 1
  • Hirotoshi Ito
    • 1
  • Katsuhisa Akiyama
    • 2
  • Masanori Nakagawa
    • 2
  • Tsunehiko Nishimura
    • 1
  1. 1.Department of RadiologyKyoto Prefectural University of MedicineKyotoJapan
  2. 2.Department of NeurologyKyoto Prefectural University of MedicineKyotoJapan

Personalised recommendations