Oculomotor nerve palsy evaluated by diffusion-tensor tractography

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

[1]  Sinisa Pajevic,et al.  Color schemes to represent the orientation of anisotropic tissues from diffusion tensor data: Application to white matter fiber tract mapping in the human brain , 1999, Magnetic resonance in medicine.

[2]  M. Solaiyappan,et al.  In vivo three‐dimensional reconstruction of rat brain axonal projections by diffusion tensor imaging , 1999, Magnetic resonance in medicine.

[3]  Pratik Mukherjee,et al.  Diffusion tensor imaging and fiber tractography in acute stroke. , 2005, Neuroimaging clinics of North America.

[4]  Susumu Mori,et al.  Brain fiber tracking with clinically feasible diffusion-tensor MR imaging: initial experience. , 2003, Radiology.

[5]  Takashi Hanakawa,et al.  Diffusion-tensor fiber tractography: intraindividual comparison of 3.0-T and 1.5-T MR imaging. , 2006, Radiology.

[6]  John S. Duncan,et al.  Combined functional MRI and tractography to demonstrate the connectivity of the human primary motor cortex in vivo , 2003, NeuroImage.

[7]  M. Collard,et al.  [Isolated paralysis of the ocular motor nerve caused by infarction of fascicular fibers]. , 1990, Revue neurologique (Paris).

[8]  P. Basser,et al.  Estimation of the effective self-diffusion tensor from the NMR spin echo. , 1994, Journal of magnetic resonance. Series B.

[9]  M. Kraut,et al.  Diffusion tensor MR imaging of the brain and white matter tractography. , 2002, AJR. American journal of roentgenology.

[10]  M Nakagawa,et al.  MR tractography for the evaluation of functional recovery from lenticulostriate infarcts , 2005, Neurology.

[11]  K. Yoshikawa,et al.  Effect of thin-section diffusion-weighted MR imaging on stroke diagnosis. , 2005, AJNR. American journal of neuroradiology.

[12]  T. L. Davis,et al.  Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging. , 1996, Radiology.

[13]  T. Chenevert,et al.  Anisotropic diffusion in human white matter: demonstration with MR techniques in vivo. , 1990, Radiology.

[14]  L H Schwamm,et al.  Time course of lesion development in patients with acute stroke: serial diffusion- and hemodynamic-weighted magnetic resonance imaging. , 1998, Stroke.

[15]  J. Tsuruda,et al.  Diffusion-weighted MR imaging of anisotropic water diffusion in cat central nervous system. , 1990, Radiology.

[16]  P. V. van Zijl,et al.  Three‐dimensional tracking of axonal projections in the brain by magnetic resonance imaging , 1999, Annals of neurology.

[17]  P. Basser,et al.  Toward a quantitative assessment of diffusion anisotropy , 1996, Magnetic resonance in medicine.

[18]  Y. Masutani,et al.  Three-dimensional white matter tractography by diffusion tensor imaging in ischaemic stroke involving the corticospinal tract , 2003, Neuroradiology.

[19]  G. Pearlson,et al.  Diffusion Tensor Imaging and Axonal Tracking in the Human Brainstem , 2001, NeuroImage.

[20]  John D Pickard,et al.  Increased Anisotropy in Acute Stroke: A Possible Explanation , 2002, Stroke.

[21]  小西 淳也.  MR tractography for the evaluation of the functional recovery from lenticulostriate infarcts , 2005 .

[22]  Jeeyeon Kim,et al.  Pure midbrain infarction , 2005, Neurology.

[23]  S M Davis,et al.  Serial study of apparent diffusion coefficient and anisotropy in patients with acute stroke. , 1999, Stroke.

[24]  M. Mohr,et al.  Paralysie isolée du nerf moteur oculaire commun par infarctus de ses fibres fasciculaires. , 1990 .

[25]  M. Raichle,et al.  Tracking neuronal fiber pathways in the living human brain. , 1999, Proceedings of the National Academy of Sciences of the United States of America.

[26]  Hangyi Jiang,et al.  High-Resolution Diffusion Tensor Imaging of the Brain Stem at 3 T , 2003 .

[27]  Susumu Mori,et al.  Fiber-tracking method reveals sensorimotor pathway involvement in stroke patients. , 2003, Stroke.

[28]  B. Siewert,et al.  Acute human stroke studied by whole brain echo planar diffusion‐weighted magnetic resonance imaging , 1995, Annals of neurology.