IsotropicAnisotropic ROLE OF DIFFUSION TENSOR IMAGING (DTI) IN INTRACRANIAL MASSES Abstract Number: 117.

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Presentation transcript:

IsotropicAnisotropic ROLE OF DIFFUSION TENSOR IMAGING (DTI) IN INTRACRANIAL MASSES Abstract Number: 117

AIM & OBJECTIVES To obtain Fractional anisotropy & Mean diffusivity in various intracranial masses. To assess the usefulness of tractography

DIFFUSION TENSOR IMAGING The “diffusion tensor "is a matrix of numbers (mathematical model describing diffusion in 3D space) derived from diffusion measurements in several different directions (6+ directions for diffusion encoding).(1) DIFFUSION

REVIEW OF LITERATURE C.H.Toha, M.Castilloc et al. AJNR Am J Neuroradiology 2008 Mar ;29(3):471-5 Primary cerebral lymphoma and glioblastoma multiforme: differences in diffusion characteristics evaluated with diffusion tensor imaging. Cut off values to differentiate lymphoma and glioblastoma multiforme were for FA, 0.33 for FA ratio, for ADC and 1.06 for ADC ratio.

MATERIALS & METHODS FA & MD values were obtained &Tractography was performed. Three region of interest cursors were placed in the lesion, perilesional area and the normal appearing white matter(NAWM) respectively. 20 Patients with intracranial masses,proved histologically or by clinical follow up were subjected to DTI sequence. Prospective study

DTI MR ACQUISITION 1.5T Scanner GE Signa HDxt or Seimens Avanto Head And Neck Coil Pulse sequence: Single Shot Echo Planar Imaging Diffusion Directions: 25 Frequency and Phase Encoding: 128x128matrix ROI: 2x2x2 mm³ b-value: 1000 Techniques : Conventional plain MR, Diffusion tensor imaging & Contrast MR. Techniques : Conventional plain MR, Diffusion tensor imaging & Contrast MR.

GENDER

AGE DISTRIBUTION YEARS N O O F P T. S

INTRACRANIAL MASSES DISTRIBUTION (n=20)

FA IN VARIOUS TUMORS PATIENTS FAVALUEFAVALUE

FA IN VARIOUS TUMORS PATIENTS FAVALUEFAVALUE

MD IN VARIOUS TUMORS PATIENTS MDVALUEMDVALUE

MD IN VARIOUS TUMORS MDVALUEMDVALUE Patients

FA AND MD OF VARIOUS MASSES TUMORSFRACTIONAL ANISOTROPYMEAN DIFFUSIVITY ①(X10ˉ³mm²/s) LESIONPERILESI ONAL AREA NAWM⁺LEISONPERILESIO NAL AREA NAWM⁺ HIGH GRADE GLIOMAS LOW GRADE GLIOMAS MEDULLOBL ASTOMA MENINGIO MAS SCHWANNO MAS DEMYELINA TION NAWM⁺:- NORMAL APPEARING WHITE MATTER

HIGH GRADE GLIOMA T2 WEIGHTED TI POST CONTRAST

HIGH GRADE GLIOMA FA IN THE LESION: CONTROL FA: FA IN THE LESION: CONTROL FA: MD IN THE LESION: CONTROL MD: MD IN THE LESION: CONTROL MD:-0.730

HIGH GRADE GLIOMA TRACTOGRAPHY

LOW GRADE GLIOMA TI WEIGHTED T2 WEIGHTED

LOW GRADE GLIOMA FA IN THE LESION: CONTROL FA: FA IN THE LESION: CONTROL FA: MD IN THE LESION: CONTROL MD: MD IN THE LESION: CONTROL MD:-0.794

LOW GRADE GLIOMA TRACTOGRAPHY

LOW GRADE GLIOMA

MEDULLOBLASTOMA T2 WEIGHTED TI POST CONTRAST

MEDULLOBLASTOMA FA IN THE LESION: CONTROL FA: FA IN THE LESION: CONTROL FA: MD IN THE LESION: CONTROL MD: MD IN THE LESION: CONTROL MD:-0.782

MENINGIOMA T2 WEIGHTED TI POST CONTRAST

MENINGIOMA FA IN THE LESION: CONTROL FA: FA IN THE LESION: CONTROL FA: MD IN THE LESION: CONTROL MD: MD IN THE LESION: CONTROL MD:-0.803

DISCUSSION IN THIS STUDYSTUDY BY LEE et al FA IN HIGH GRADE GLIOMAS ↓↓ FA IN LOW GRADE GLIOMAS ↓↓ Lee et al 2008 Mar-Apr;32(2): doi: /RCT Diffusion-tensor imaging for glioma grading at 3-T magnetic resonance imaging: analysis of fractional anisotropy and mean diffusivity.

DISCUSSION FA IN PERILESIONAL AREA HIGH GR. GLIOMAS FA IN PERILESIONAL AREA IN MENINGIOMA MD IN PERILESIONAL AREA IN HIGH GR GLIOMA (10 -3 mm2/sec) MD IN PERILESIONAL AREA IN MENINGIOMA (10 -3 mm2/sec) IN THIS STUDY STUDY BY PROVENZALE JM et al Provenzale et al 2004 Aug;232(2): Epub 2004 Jun 23. Peritumoral brain regions in gliomas and meningiomas: investigation with isotropic diffusion-weighted MR imaging and diffusion-tensor MR imaging.

DISCUSSION FA-HIGH GR. GLIOMA FA - TDLsMD - HIGH GR.GLIOMA MD - TDLs IN THIS STUDY ↓↓0.151 ↓1.260 ↑↑0.985 ↑ STUDY BY C.H.TOHA et al ↓↓0.180 ↓1.237 ↑↑0.887 ↑ C.H Toh AJNR Am J Neuroradiol 33:846 –51 May 2012 Differentiation of Tumefactive Demyelinating Lesions from High-Grade Gliomas with the Use of Diffusion Tensor Imaging

CONCLUSION Diffusion tensor imaging is a complimentary tool and an important adjunct to the conventional MRI. FA and MD values are useful in grading of intracranial mass lesions Tractography is useful to assess whether the white matter tracts are destroyed or displaced.

REFERENCES *(₁)Diffusion Tensor Imaging of Cerebral White Matter: A Pictorial Review of Physics, Fiber Tract Anatomy, and Tumor Imaging Patterns by Brian J. Jellison et al. AJNR: 25, March 2004 *(2) Diffusion-tensor imaging for glioma grading at 3-T magnetic resonance imaging: analysis of fractional anisotropy and mean diffusivity. By Lee HY et al 2008 Mar- Apr;32(2): doi: /RCT. *(3)Peritumoral brain regions in gliomas and meningiomas: investigation with isotropic diffusion-weighted MR imaging and diffusion-tensor MR imaging. Provenzale JM et al 2004 Aug;232(2): Epub 2004 Jun 23. *(4) Differentiation of Tumefactive Demyelinating Lesions from High-Grade Gliomas with the Use of Diffusion Tensor Imaging C.H.Toha et al december 15, 2011,doi: /ajnr.A2871.AJNR /;