Name: dti of the visual pathway - white matter tracts and cerebral lesions
Uploaded: 2014-08-26T15:00:00
Description: Watch this Scientific Journal Video about DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions at JoVE.com

We would like to thank the whole Service of Neuroradiology. We would like to thank Lis Prussen for her work in the library.

NOTE: This protocol follows the guidelines of the Centre Hospitalier de Luxembourg in Luxembourg.
1. Preparation of Diffusion Tensor Imaging for the Visual Pathway for Neurosurgery and Follow Up
<ol style="margin-left: 40px;">
	<li>Perform an MRI-scan at least one day before surgery strictly axial using 32 gradient directions and one b0-image. Keep in close touch with the neuroradiology unit at any moment. 
	NOTE: Make clear to the neuroradiologist that the images after surgery are the ...

<ol>
	<li>Fernandez-Miranda, J. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High-Definition+Fiber+Tractography+of+the+Human+Brain:+Neuroanatomical+Validation+and+Neurosurgical+Applications.">High-Definition Fiber Tractography of the Human Brain: Neuroanatomical Validation and Neurosurgical Applications.</a> Neurosurgery. 71 (2), 430-453 (2012).</li><li>Alexander, D. C., Barker, G. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimal+imaging+parameters+for+fiber-orientation+estimation+in+diffusion+MRI.">Optimal imaging parameters for fiber-orientation estimation in diffusion MRI.</a> Neuroimage. 27 (2), 357-367 (2005).</li><li>Le Bihan, D., Poupon, C., Amadon, A., Lethimonnier, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Artifacts+and+pitfalls+in+diffusion+MRI.">Artifacts and pitfalls in diffusion MRI.</a> J Magn Reson Imaging. 24 (3), 478-488 (2006).</li><li>Abdullah, K. G., Lubelski, D., Nucifora, P. G., Brem, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+diffusion+tensor+imaging+in+glioma+resection.">Use of diffusion tensor imaging in glioma resection.</a> Neurosurg Focus. 34 (4), (2013).</li><li>Ota, T., Kawai, K., Kamada, K., Kin, T., Saito, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+monitoring+of+cortically+recorded+visual+response+for+posterior+visual+pathway.">Intraoperative monitoring of cortically recorded visual response for posterior visual pathway.</a> J Neurosurg. 112, 285-294 (2010).</li><li>Gras-Combe, G., Moritz-Gasser, S., Herbet, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+subcortical+electrical+mapping+of+optic+radiations+in+awake+surgery+for+glioma+involving+visual+pathways.">Intraoperative subcortical electrical mapping of optic radiations in awake surgery for glioma involving visual pathways.</a> J Neurosurg. 117 (3), 466-473 (2012).</li><li>Maruyama, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optic+radiation+tractography+integrated+into+simulated+treatment+planning+for+Gamma+Knife+surgery.">Optic radiation tractography integrated into simulated treatment planning for Gamma Knife surgery.</a> J Neurosurg. 107, 721-726 (2007).</li><li>Bérubé, J., McLaughlin, N., Bourgouin, P., Beaudoin, G., Bojanowski, M. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+tensor+imaging+analysis+of+long+association+bundles+in+the+presence+of+an+arteriovenous+malformation.">Diffusion tensor imaging analysis of long association bundles in the presence of an arteriovenous malformation.</a> J Neurosurg. 107 (3), 509-514 (2007).</li><li>Sun, G. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+High-Field+Magnetic+Resonance+Imaging+Combined+With+Fiber+Tract+Neuronavigation-Guided+Resection+of+Cerebral+Lesions+Involving+Optic+Radiation.">Intraoperative High-Field Magnetic Resonance Imaging Combined With Fiber Tract Neuronavigation-Guided Resection of Cerebral Lesions Involving Optic Radiation.</a> Neurosurgery. 69 (5), 1070-1084 (2011).</li><li>Kamada, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+Monitoring+For+Visual+Pathway+Using+Real-Time+Visual+Evoked+Potentials+Aand+Optic-Radiation+Tractography.">Functional Monitoring For Visual Pathway Using Real-Time Visual Evoked Potentials Aand Optic-Radiation Tractography.</a> Neurosurgery. 57 (1 Suppl), 121-127 (2005).</li><li>Wu, W., Rigolo, L., O'Donnell, L. J., Norton, I., Shriver, S., Golby, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Visual+Pathway+Study+Using+In+Vivo+Diffusion+Tensor+Imaging+Tractography+to+Complement+Classic+Anatomy.">Visual Pathway Study Using In Vivo Diffusion Tensor Imaging Tractography to Complement Classic Anatomy.</a> Neurosurgery. 70 (1 Suppl Operative), 145-156 (2012).</li><li>Stieglitz, L. H., L&#252;demann, W. O., Giordano, M., Raabe, A., Fahlbusch, R., Samii, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optic+Radiation+Fiber+Tracking+Using+Anteriorly+Angulated+Diffusion+Tensor+Imaging:+A+Tested+Algorithm+for+Quick+Application.">Optic Radiation Fiber Tracking Using Anteriorly Angulated Diffusion Tensor Imaging: A Tested Algorithm for Quick Application.</a> Neurosurgery. 68 (5), 1239-1251 (2011).</li><li>Hodaie, M., Quan, J., Chen, D. Q. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+Vivo+Visualization+of+Cranial+Nerve+Pathways+in+Humans+Using+Diffusion-Based+Tractography.">In Vivo Visualization of Cranial Nerve Pathways in Humans Using Diffusion-Based Tractography.</a> Neurosurgery. 66 (4), 788-795 (2010).</li><li>Perrin, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fiber+tracking+in+Q-ball+fields+using+regularized+particle+trajectories.">Fiber tracking in Q-ball fields using regularized particle trajectories.</a> Inf Process Med Imaging. 19, 52-63 (2005).</li><li>Wedeen, V. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+spectrum+magnetic+resonance+imaging+(DSI)+tractography+of+crossing+fibers.">Diffusion spectrum magnetic resonance imaging (DSI) tractography of crossing fibers.</a> Neuroimage. 41 (4), 1267-1277 (2008).</li><li>Yamamoto, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+Tensor+Fiber+Tractography+of+the+Optic+Radiation:+Analysis+with+6-,+12-,+40-,+and+81-+Directional+Motion-Probing+Gradients,+a+Preliminary+Study.">Diffusion Tensor Fiber Tractography of the Optic Radiation: Analysis with 6-, 12-, 40-, and 81- Directional Motion-Probing Gradients, a Preliminary Study.</a> AJNR Am J Neuroradiol. 28 (1), 92-96 (2007).</li><li>Okada, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diffusion+Tensor+Fiber+Tractography+for+Arteriovenous+Malformations:+Quantitative+Analyses+to+Evaluate+the+Corticospinal+Tract+and+Optic+Radiation.">Diffusion Tensor Fiber Tractography for Arteriovenous Malformations: Quantitative Analyses to Evaluate the Corticospinal Tract and Optic Radiation.</a> AJNR Am J Neuroradiol. 28 (6), 1107-1113 (2007).</li><li>Kuhnt, D., Bauer, M. H., Sommer, J., Merhof, D., Nimsky, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optic+Radiation+Fiber+Tractography+in+Glioma+Patients+Based+on+High+Angular+Resolution+Diffusion+Imaging+with+Compressed+Sensing+Compared+with+Diffusion+Tensor+Imaging+-+Initial+Experience.">Optic Radiation Fiber Tractography in Glioma Patients Based on High Angular Resolution Diffusion Imaging with Compressed Sensing Compared with Diffusion Tensor Imaging - Initial Experience.</a> PLoS One. 8 (7), e70973 (2013).</li><li>Basser, P. J., Pajevic, S., Pierpaoli, C., Duda, J., Aldroubi, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vivo+fiber+tractography+using+DT-MRI+data.">In vivo fiber tractography using DT-MRI data.</a> Magn Reson Med. 44 (4), 625-632 (2000).</li><li>Friman, O., Farneback, G., Westin, C. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Bayesian+approach+for+stochastic+white+matter+tractography.">A Bayesian approach for stochastic white matter tractography.</a> IEEE Trans Med Imaging. 25 (8), 965-978 (2006).</li><li>Mori, S., van Zijl, P. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fiber+tracking:+principles+and+strategies+-+a+technical+review.">Fiber tracking: principles and strategies - a technical review.</a> NMR Biomed. 15 (7-8), 468-480 (2002).</li><li>Alexander, D. C., Barker, G. J., Arridge, S. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+and+modeling+of+non-Gaussian+apparent+diffusion+coefficient+profiles+in+human+brain+data.">Detection and modeling of non-Gaussian apparent diffusion coefficient profiles in human brain data.</a> Magn Reson Med. 48 (2), 331-340 (2002).</li><li>Mori, S., Crain, B. J., Chacko, V. P., van Zijl, P. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-dimensional+tracking+of+axonal+projections+in+the+brain+by+magnetic+resonance+imaging.">Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging.</a> Ann Neurol. 45, 265-269 (1999).</li><li>Conturo, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tracking+neuronal+fiber+pathways+in+the+living+human+brain.">Tracking neuronal fiber pathways in the living human brain.</a> Proc Natl Acad Sci U S A. 96, 10422-10427 (1999).</li><li>Poupon, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regularization+of+diffusion-based+direction+maps+for+the+tracking+of+brain+white+matter+fascicles.">Regularization of diffusion-based direction maps for the tracking of brain white matter fascicles.</a> Neuroimage. 12, 184-195 (2000).</li><li>Parker, G. J., Haroon, H. A., Wheeler-Kingshott, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+framework+for+a+streamline-based+probabilistic+index+of+connectivity+(PICo)+using+a+structural+interpretation+of+MRI+diffusion+measurements.">A framework for a streamline-based probabilistic index of connectivity (PICo) using a structural interpretation of MRI diffusion measurements.</a> J Magn Reson Imaging. 18, 242-254 (2003).</li><li>Behrens, T. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-invasive+mapping+of+connections+between+human+thalamus+and+cortex+using+diffusion+imaging.">Non-invasive mapping of connections between human thalamus and cortex using diffusion imaging.</a> Nat Neurosci. 6, 750-757 (2003).</li><li>Reinges, M. H., Schoth, F., Coenen, V. A., Krings, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Imaging+of+postthalamic+visual+fiber+tracts+by+anisotropic+diffusion+weighted+MRI+and+diffusion+tensor+imaging:+principles+and+applications.">Imaging of postthalamic visual fiber tracts by anisotropic diffusion weighted MRI and diffusion tensor imaging: principles and applications.</a> European Journal of Radiology. 49, 91-104 (2004).</li><li>Sherbondy, A. J., Dougherty, R. F., Napel, S., Wandell, B. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identifying+the+human+optic+radiation+using+diffusion+imaging+and+fiber.">Identifying the human optic radiation using diffusion imaging and fiber.</a> J. Vis. 8 (10), (2008).</li></ol>

DTI is a technique enabling the neurosurgeon to visualize white matter tracts in vivo8. The visual pathway is one of these tracts. Although this method provides physicians with new possibilities regarding the treatment of patients with lesions concerning eloquent regions of the brain we have to say that some limitations of this technique do still exist. The first and most obvious challenge is brain shift, which remains an issue under investigation4. After opening the dura mater and after ma...

Diffusion tensor imaging (DTI) is used to portray WMT non-invasively in the human brain1. It has been used in the past decade to reduce the risk of harming eloquent areas of the brain during surgery1.
DTI was performed in fifty patients between March 2012 and January 2014 to portray the visual pathway. DTI might improve preservation of eloquent areas of the brain during surgery by providing important information about the anatomical location of white matter tracts. It has been incorporated into strategic planning for resection of complex brain lesions1. However, the portrayal of the visual pathway remains a challenge because there is no standard for the parameters of DTI, the placement of the seed volumes and interpretation of results12.
Different algorithms have been implemented so far 19-21. Some approaches concentrated on deterministic methods 19, 22-25. Others were using probabilistic methods,26,27,29. More recently, techniques using Q-ball tensor fields, diffusion spectral imaging and High Angular Resolution Diffusion Imaging (HARDI) are being used to depict white matter tracts among others the visual pathway 1,13-15,18 . Nevertheless, the necessary time for HARDI is significantly longer with 45 min, the software is not commercially available and emphasizes scientific applications18. The teaching period for HARDI seems to be longer than for DTI18.
The presented protocol is easy feasible and can be used for everyday routine in neurosurgical operations in order to avoid morbidity and improve the postoperative outcome. The additional time for this protocol is less than 9 min which is significantly faster than other protocols1,9,12,16. Acknowledging the fact that many sophisticated algorithms have been developed recently the paper restricts itself to the use of a commercially available and FDA approved software. However it is mandatory to take into account the limitations of this technique which are mentioned above.

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			<td height="42" style="height:42px;width:216px;">Name of Material/ Equipment</td>
			<td style="width:71px;">Company</td>
			<td style="width:173px;">Catalog Number</td>
			<td style="width:167px;">Comments/Description</td>
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			<td height="42" style="height:42px;width:216px;">3-Tesla-MRI</td>
			<td style="width:71px;">General Electric</td>
			<td style="width:173px;">&#160;Signa LX version 9.1</td>
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			<td height="42" style="height:42px;width:216px;">Surgical Navigation System Srogram</td>
			<td style="width:71px;">Medtronic</td>
			<td align="right" style="width:173px;">9734478</td>
			<td></td>
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			<td height="42" style="height:42px;width:216px;">Surgical Navigation System Srogram</td>
			<td style="width:71px;">Medtronic</td>
			<td style="width:173px;">4500810331&#160; 20016318</td>
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dti of the visual pathway - white matter tracts and cerebral lesions

DTI is a technique that identifies white matter tracts (WMT) non-invasively in healthy and non-healthy patients using diffusion measurements. Similar to visual pathways (VP), WMT are not visible with classical MRI or intra-operatively with microscope. DTI will help neurosurgeons to prevent destruction of the VP while removing lesions adjacent to this WMT. We have performed DTI on fifty patients before and after surgery between March 2012 to January 2014. To navigate we used a 3DT1-weighted sequence. Additionally, we performed a T2-weighted and DTI-sequences. The parameters used were, FOV: 200 x 200 mm, slice thickness: 2 mm, and acquisition matrix: 96 x 96 yielding nearly isotropic voxels of 2 x 2 x 2 mm. Axial MRI was carried out using a 32 gradient direction and one b0-image. We used Echo-Planar-Imaging (EPI) and ASSET parallel imaging with an acceleration factor of 2 and b-value of 800 s/mm&#178;. The scanning time was less than 9 min.
The DTI-data obtained were processed using a FDA approved surgical navigation system program which uses a straightforward fiber-tracking approach known as fiber assignment by continuous tracking (FACT). This is based on the propagation of lines between regions of interest (ROI) which is defined by a physician. A maximum angle of 50, FA start value of 0.10 and ADC stop value of 0.20 mm&#178;/s were the parameters used for tractography.
There are some limitations to this technique. The limited acquisition time frame enforces trade-offs in the image quality. Another important point not to be neglected is the brain shift during surgery. As for the latter intra-operative MRI might be helpful. Furthermore the risk of false positive or false negative tracts needs to be taken into account which might compromise the final results.

This protocol enables the physician to portray adequately the major parts of the VP. It can be used with a little amount of time in order to prevent damages in patients with cerebral lesions next to eloquent areas. Postoperative controls show also good results. VP is portrayed in Figure 7 after the patient was operated from a glioblastoma. Figure 2 shows the VP after recurrence of a glioblastoma. The authors recognize the fact of the difficulties presented by this protocol to depict the ...

Watch this Scientific Journal Video about DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions at JoVE.com

DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions

Diffusion tensor imaging (DTI) was performed to try to depict the major parts of the visual pathway. The goal was to use an FDA approved standard commercial workstation which could be used for everyday routine in order to try to reduce postoperative damage of the visual pathway in the patients.

DTI is a technique that identifies white matter tracts (WMT) non-invasively in healthy and non-healthy patients using diffusion measurements. Similar to ...

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