1. Clinical Use of DTI
Guido Gerig

2. Early Brain Development
Acknowledgments
Contributors:
Andy Alexander
Susumo Mori
The University of North Carolina Chapel Hill (UNC)
National Alliance for Medical Image Computing
(NIH U54EB005149)
Early Brain Development

3. Early Brain Development
Example 1
Cerebral Cortex 2005: White Matter Development During Childhood and Adolescence: A Cross-sectional Diffusion Tensor Imaging Study.
Barnea-Goraly N, Menon V, Eckert M, Tamm L, Bammer R, Karchemskiy A, Dant CC, Reiss AL. Department of Psychiatry and Behavioral Sciences, Stanford University
Voxel-by-voxel analysis of FA
During childhood and adolescence, white matter anisotropy measured by FA changes in brain regions that are important for attention, motor skills, cognitive ability, and memory.
With increasing age, FA values increased in prefrontal regions, in the internal capsule as well as in basal ganglia and thalamic pathways, the ventral visual pathways, and the corpus callosum.
This typical developmental trajectory may be altered in individuals with disorders of development, cognition and behavior.
Early Brain Development

4. Early Brain Development
Example 2
Acad Radiol. 2005: Age-related structural changes in the young adult brain shown by magnetic resonance diffusion tensor imaging
Yoshiura T, Mihara F, Tanaka A, Togao O, Taniwaki T, Nakagawa A, Nakao T, Noguchi T, Kuwabara Y, Honda H.
Department of Clinical Radiology, Kyushu University Japan
Histogram analysis of Mean diffusivity + FA
Overall histogram analysis revealed increase in mean FA and a decrease in max FA with increasing age.
No age-related changes in mean diffusivity.
Early Brain Development

5. Early Brain Development
Example 3
Arch Gen Psychiatry Pathways that make voices: white matter changes in auditory hallucinations.
Hubl D, Koenig T, Strik W, Federspiel A, Kreis R, Boesch C, Maier SE, Schroth G, Lovblad K, Dierks T.
Department of Psychiatric Neurophysiology, University Hospital of Bern, Switzerland.
FA histogram analysis measurements in DTI covering the Sylvian fissure
Region of interest analysis in selected regions.
Patients with hallucinations had higher FA in the lateral parts of the temporoparietal section of the arcuate fasciculus and in parts of the anterior corpus callosum compared with control subjects and patients without hallucinations.
Patients with hallucinations had higher FA in the left hemispheric fiber tracts, including the cingulate bundle compared with patients without hallucinations.
Early Brain Development

6. DTI Applications Normal brain development and aging
Congenital anomalies and diseases of white matter
Traumatic brain injury
Encephalopathies – toxic, metabolic, infectious
Demyelinating and neurodegenerative diseases
Ischemia and stroke
Neoplasm, preoperative planning
Epilepsy
Dementia, schizophrenia, depression
Developmental disorders - fragile X, autism
Spinal Cord
ASNR 2003 –Washington,DC
DT-MRI Alexander

7. Normal Brain Development
Significant changes in anisotropy values of the white matter of the centrum semiovale take place well before changes in T1 and T2 relaxation detected by standard imaging methods. Cerebral cortex in infants less than 32 weeks gestational age (GA) has nonzero anisotropy values. Cortical A values decrease with increasing GA (r = 0.81, p < 0.05) and are consistent with zero after 35 weeks GA. The major axis of the diffusion ellipsoid is oriented radially, as would be expected if anisotropy were due to the radial orientation of apical dendrites of pyramidal cells.
Courtesy J. Neil Washington Univ., St. Louis
ASNR 2003 –Washington,DC
DT-MRI Alexander

8. WM Anisotropy Changes with Age
Pfefferbaum et al.
MRM 2000
genu
frontal
pericallosal
centrum
semiovale
Genu
Left pericallosal
Right pericallosal .3 .4 .5 .6 .7 .8 20 30 40 50 60 70 80
Age
Anterior FA
Splenium
Posterior
.34
.36
.38
.40
.42
.44
.46
.48
Centrum Semiovale
parietal
splenium
Courtesy K. Lim, Univ. Minn.
ASNR 2003 –Washington,DC
DT-MRI Alexander

9. Multiple Sclerosis ASNR 2003 –Washington,DC DT-MRI Alexander
R. Bammer, F. Fazekas, Neuroim Clinics N Am, Feb
S T A N F O R D
S C H O O L OF M E D I C I N E
Lucas MRS/I Center
ASNR 2003 –Washington,DC
DT-MRI Alexander

10. (Lim et al., Arch Gen Psychiatry 1999)
Schizophrenia
Structural Volume (FSE)
100
200
300
400
500
CSF
Gray
White
Fractional Anisotropy **
Median FA
SZ (N=10)
NC (N=10)
** p < .005
20000
40000
60000
80000
Number of pixels
CSF
Gray
White
This is a summary of the structural and FA data.
On the left are the pixel counts for the CSF, gray and white matter.
There was a slight but not significant increase in CSF, no difference in WM and a significant deficit in GM.
On the right are the FA values for each of the three compartments.
For FA, no difference in CSF or Gray, but a significant difference in WM.
(Lim et al., Arch Gen Psychiatry 1999)
ASNR 2003 –Washington,DC
DT-MRI Alexander

11. Negative Symptoms in Schizophrenia
No significant correlations found with mean diffusivity
Only significant correlations for FA found at AC-5
Courtesy K. Lim
Univ. Minnesota
ASNR 2003 –Washington,DC
DT-MRI Alexander
Wolkin et al., AJP, in press

12. DTI in Cerebral Neoplasms
Deviated
Infiltrated
Edematous
Destroyed
ASNR 2003 –Washington,DC
DT-MRI Alexander

13. Tract Displacement T2W ADC FA FA  1 ASNR 2003 –Washington,DC
Anaplastic astrocytoma
ASNR 2003 –Washington,DC
DT-MRI Alexander

14. Tract Infiltration Edema Oligo T2W ADC FA FA  1 T2W ADC FA FA  1
Grade 3 astro
ASNR 2003 –Washington,DC
DT-MRI Alexander

15. Pilocytic Astrocytoma
Preop
Postop
T2W
ADC
T2W
ADC FA
FA  1 FA
FA  1
ASNR 2003 –Washington,DC
DT-MRI Alexander

16. Cerebral Palsy
Courtesy of Susumu Mori

17. Fiber Tract-Oriented Statistics for Quantitative Diffusion Tensor MRI Analysis
Isabelle Corouge1,2,
P. Thomas Fletcher4,
Sarang Joshi3,
John H. Gilmore2,
Guido Gerig1,2
1Depts of Computer Science, 2Psychiatry, 3Radiation Oncology, UNC-Chapel Hill, USA
4Scientific Computing and Imaging Institute, University of Utah, USA
MICCAI 2005
October 27, 2005

18. Quantitative Tractography
Tract ROIs
FA along tracts
Tensors statisics along spines
FA motor tract
MD motor tract
- Tractography for ROI definition
- Tensor-math. for statistics along tracts
MICCAI 2005
October 27, 2005

19. Fiber Tract Modeling and Analysis
MICCAI 2005
October 27, 2005

20. Experiments and Results
Data
3Tesla high resolution (2x2x2 mm3) DT MRI database
8 subjects: 4 neonates at 2 weeks-old, 4 one year-old
Fiber tracts: genu and splenium
Neonate at 2 weeks-old
One year-old
MICCAI 2005
October 27, 2005

21. Experiments and Results
Average of diffusion tensors in cross-sections along tracts
Genu
Splenium
2 weeks-old
One year-old
MICCAI 2005
October 27, 2005

22. Experiments and Results
Diffusion properties along fiber tracts
Eigenvalues
Mean Diffusivity
Fractional Anistropy
Genu
Splenium
MICCAI 2005
October 27, 2005

23. Neonate Krabbe’s - Motor
Internal capsule from brain stem to superior cortex
Left and right hemispheric bundles
FA values on bundle
Motor
cortex
VL thalamus
Pontine nuclei
Cerebellar cortex
Deep cerebellar
nuc-dentate
middle cerebellar
peduncle
superior cerebellar
corona
radiata
internal
capsule
cerebral
Fallon
Premotor
Prefrontal
MICCAI 2005
October 27, 2005

24. Visualization - Left Bundle
Controls
FA seems to correlate with outcome
At 1y
Weak trunk
Bad motor
At 1.5y
Walks
Good motor
At 3m
Ok so far
MICCAI 2005
October 27, 2005

25. Visualization - Right Bundle
Controls
FA higher in Cnt than Krabbe
At 1y
Weak trunk
Bad motor
At 1.5y
Walks
Good motor
At 3m
Ok so far
MICCAI 2005
October 27, 2005

26. FA Statistics along Fibers
Lower FA across most of bundle for Krabbe
Bad motor case has consistently lowest FA on left bundle
Possible predictor for outcome?
Controls
good motor
bad motor
MICCAI 2005
October 27, 2005