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Reliability of the corticospinal tract and arcuate fasciculus reconstructed with DTI-based tractography: implications for clinical practice

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Abstract

Objectives

To assess the reliability of diffusion tensor imaging (DTI)-based fibre tractography (FT), which is a prerequisite for clinical applications of this technique. Here we assess the test–retest reproducibility of the architectural and microstructural features of two clinically relevant tracts reconstructed with DTI-FT.

Methods

The corticospinal tract (CST), arcuate fasciculus (AF) and its long segment (AFl) were reconstructed in 17 healthy subjects imaged twice using a deterministic approach. Coefficients of variation (CVs) of diffusion-derived tract values were used to assess the microstructural reproducibility. Spatial correlation and fibre overlap were used to assess the architectural reproducibility.

Results

Spatial correlation was 68 % for the CST and AF, and 69 % for the AFl. Overlap was 69 % for the CST, 61 % for the AF, and 59 % for the AFl. This was comparable to 2-mm tract shift variability. CVs of diffusion-derived tract values were at most 3.4 %.

Conclusions

The results showed low architectural and microstructural variability for the reconstruction of the tracts. The architectural reproducibility results encourage the further investigation of the use of DTI-FT for neurosurgical planning. The high microstructural reproducibility results are promising for using DTI-FT in neurology to assess or predict functional recovery.

Key Points

• Magnetic resonance diffusion tensor fibre tractography is increasingly used in the neurosciences.

• The architectural reproducibility of fibre pathways can be up to 69 %.

• However the microstructural variability of fibre pathways is only 3.4 % at most.

• The architectural reproducibility results encourage the use of DTI-FT for neurosurgery.

• The microstructural reproducibility results support the use of DTI-FT in neurology.

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Authors and Affiliations

  1. Department of Medical Psychology and Neuropsychology, University of Tilburg, Tilburg, The Netherlands

    Gert Kristo & Beatrice de Gelder

  2. Department of Neurosurgery, St. Elisabeth Hospital, Tilburg, The Netherlands

    Gert Kristo & Geert-Jan Rutten

  3. Rudolf Magnus Institute of Neuroscience, and Department of Neurology and Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, mail stop G.03.124, 3584 CX, Utrecht, The Netherlands

    Gert Kristo, Mathijs Raemaekers & Nick Ramsey

  4. Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands

    Alexander Leemans

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  1. Gert Kristo
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Correspondence to Gert Kristo.

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Fig. A

Overlap values for the corticospinal tract (CST) (red open circles), the arcuate fasciculus (AF) (blue open squares) and its long segment (AFl) (green open triangles) for different tract visitation thresholds (10 to 50 %, in steps of 10 %) (GIF 8 KB)

High resolution image (EPS 5272 kb)

Appendix

Appendix

Fibre tractography procedure

First, whole brain tractography was performed for all individuals and imaging sessions. FA thresholds were set to 0.20 to initiate and continue tracking and the angle threshold was set to 30° for both tracts. Only fibres with a minimum length of 50 mm were considered.

Next, the CST, the AF and AFl were extracted for each individual from regions of interest (ROIs) according to a priori information of tract location [50, 51]. The tracts of interest were only delineated in the left hemisphere considering the left hemisphere lateralisation of these tracts when subjects are strongly right-handed [52, 53]. The ROI sets of all tracts of interest were manually placed only by the first author (G.K.) as a previous study reported a high interobserver reliability in tract-specific analysis [54]. This was done following the guidelines and protocols described in previous studies, where figures showing the ROI placement are also present [9, 32, 33, 51]. The CST was extracted by placing two ROIs on axial slices. The first ROI included the cerebral peduncle at the level of the decussation of the superior cerebellar peduncle. The second ROI was drawn right after the bifurcation to the motor and sensory cortex to include only primary motor cortex, and not sensory tracts [51]. The AF was extracted by placing two ROIs on coronal slices. The first ROI was selected where the AF, appearing as a green triangular shape on coronal images (indicating anterior/posterior orientation), was seen to be largest. The second ROI was selected at the level of the splenium of the corpus callosum, where the AF makes a sharp turn towards the temporal lobe [9, 32]. The AFl was defined by using the first ROI used for the delineation of the AF, and by placing a second ROI on an axial slice through which the AF passes in the superior/inferior direction [33].

The ROI sets of all tracts of interest were per individual the same for both imaging sessions. In doing so, the variability in ROI designation introduced by the operator is eliminated and does not affect the reliability results. However, we did not underestimate reliability because the protocol followed for tract delineation already reduced the variability in ROI designation to a minimum. All ROIs were placed subcortically [51] and were large enough to encompass all possible fibres belonging to the tracts of interest [33]. The subcortical placement of ROIs ensures proper delineation of tracts, such as the CST, that are known to substantially differ in volume among individuals. The large size of the ROIs ensures similar tractography results for different operators.

For each tract (corticospinal and AF) per subject and imaging session, the following parameters were calculated: average FA, average MD, average λ1, average λ┴, average length of tracts, and volume of tracts [24–26]. FA, MD, λ1 and λ┴ values were obtained by averaging across all voxels in the tract and each voxel was counted only once.

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Kristo, G., Leemans, A., de Gelder, B. et al. Reliability of the corticospinal tract and arcuate fasciculus reconstructed with DTI-based tractography: implications for clinical practice. Eur Radiol 23, 28–36 (2013). https://doi.org/10.1007/s00330-012-2589-9

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