DTI fiber tracking to differentiate demyelinating diseases from diffuse brain stem glioma
DTI fiber tracking to differentiate demyelinating diseases from diffuse brain stem glioma
复制标题
DOI：
10.1016/j.neuroimage.2010.03.079
复制
发表时间：
2010-08-01
期刊：
影响因子：
5.7
通讯作者：
Ojemann, Jeffrey G.
中科院分区：
文献类型：
--
作者：
Giussani, Carlo;Poliakov, Andrew;Ojemann, Jeffrey G.
Object.原发性弥漫性脑干肿瘤和主要影响脑干的脱髓鞘疾病具有共同的临床和放射学特征，有时使得诊断困难，特别是在首次临床表现的时候。为了探索新的MRI序列，特别是扩散张量成像纤维追踪在区分这两种病理实体中的潜在有用性，我们回顾了一系列脑干肿瘤和脱髓鞘疾病的治疗在我们的机构材料和方法的临床病史，包括体征和症状和MRI表现的三个连续的脱髓鞘疾病涉及脑干，提出了诊断不确定性和三个弥漫性回顾性分析了脑干内源性肿瘤，沿着与一个幕上肿瘤的儿童进行比较。对每个患者在就诊时进行了DTI研究，对锥体束进行了纤维追踪。另外，计算了每个患者在脑桥和延髓的各向异性分数值。回顾性DTI纤维追踪清楚地区分了病理学，在脑干内肿瘤的情况下显示锥体束向后和侧向偏转，而在脱髓鞘疾病的情况下，显示不佳和截断的纤维。结论在常规MRI和临床资料均不明确的情况下，疑有脑干肿瘤或脱髓鞘疾病的患者的锥体束DTI纤维追踪表现出两种明显不同的模式，有助于鉴别这两种病理。(C)2010爱思唯尔公司版权所有
Object. Intrinsic diffuse brainstem tumors and demyelinating diseases primarily affecting the brainstem can share common clinical and radiological features, sometimes making the diagnosis difficult especially at the rime of first clinical presentation To explore the potential usefulness of new MRI sequences in particular diffusion tensor imaging fiber tracking in differentiating these two pathological entities, we review a series of brainstem tumors and demyelinating diseases treated at our institutionMaterial and methods The clinical history including signs and symptoms and MRI findings of three consecutive demyelinating diseases involving the brainstem that presented with diagnostic uncertainty and three diffuse intrinsic brainstem tumors were reviewed, along with a child with a supratentorial tumor for comparison Fiber tracking of the pyramidal tracts was performed for each patient using a DTI study at the time of presentation Additionally Fractional Anisotropy values were calculated for each patient in the pons and the medulla oblongataResults Routine MR imaging was unhelpful in differentiating between intrinsic tumor and demyelination In contrast. retrospective DTI fiber tracking clearly differentiated the pathology showing deflection of the pyramidal tracts posteriorly and laterally in the case of intrinsic brainstem tumors and, in the case of demyelinating disease, poorly represented and truncated fibers. Regionalized FA values were variable and of themselves were not predictive either pathologyConclusion DTI fiber tracking of the pyramid tracts in patients with suspected intrinsic brainstem tumor or demyelinating disease presents two clearly different patterns that may help in differentiating between these two pathologies when conventional MRI and clinical data are inconclusive. (C) 2010 Elsevier Inc All rights reserved