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

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

3. 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

4. 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 0.192 for FA, 0.33 for FA ratio, 0.818 for ADC and 1.06 for ADC ratio.

5. 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

6. 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.

7. GENDER

8. AGE DISTRIBUTION YEARS N O O F P T. S

9. INTRACRANIAL MASSES DISTRIBUTION (n=20)

10. FA IN VARIOUS TUMORS PATIENTS FAVALUEFAVALUE

11. FA IN VARIOUS TUMORS PATIENTS FAVALUEFAVALUE

12. MD IN VARIOUS TUMORS PATIENTS MDVALUEMDVALUE

13. MD IN VARIOUS TUMORS MDVALUEMDVALUE Patients

14. FA AND MD OF VARIOUS MASSES TUMORSFRACTIONAL ANISOTROPYMEAN DIFFUSIVITY ①(X10ˉ³mm²/s) LESIONPERILESI ONAL AREA NAWM⁺LEISONPERILESIO NAL AREA NAWM⁺ HIGH GRADE GLIOMAS 0.1350.2540.3121.2601.1430.774 LOW GRADE GLIOMAS 0.2080.3520.3161.2581.1760.817 MEDULLOBL ASTOMA 0.2370.2730.3320.8370.8150.826 MENINGIO MAS 0.1580.2160.2970.8600.8470.803 SCHWANNO MAS 0.1620.2330.3311.3521.2240.805 DEMYELINA TION 0.1510.2540.3730.9850.8280.952 NAWM⁺:- NORMAL APPEARING WHITE MATTER

15. HIGH GRADE GLIOMA T2 WEIGHTED TI POST CONTRAST

16. HIGH GRADE GLIOMA FA IN THE LESION: 0.150 CONTROL FA: 0.290 FA IN THE LESION: 0.150 CONTROL FA: 0.290 MD IN THE LESION:-1.120 CONTROL MD:-0.730 MD IN THE LESION:-1.120 CONTROL MD:-0.730

17. HIGH GRADE GLIOMA TRACTOGRAPHY

18. LOW GRADE GLIOMA TI WEIGHTED T2 WEIGHTED

19. LOW GRADE GLIOMA FA IN THE LESION:-0.146 CONTROL FA:-0.413 FA IN THE LESION:-0.146 CONTROL FA:-0.413 MD IN THE LESION:-1.014 CONTROL MD:-0.794 MD IN THE LESION:-1.014 CONTROL MD:-0.794

20. LOW GRADE GLIOMA TRACTOGRAPHY

21. LOW GRADE GLIOMA

22. MEDULLOBLASTOMA T2 WEIGHTED TI POST CONTRAST

23. MEDULLOBLASTOMA FA IN THE LESION:-0.287 CONTROL FA:-0.232 FA IN THE LESION:-0.287 CONTROL FA:-0.232 MD IN THE LESION:-1.014 CONTROL MD:-0.782 MD IN THE LESION:-1.014 CONTROL MD:-0.782

24. MENINGIOMA T2 WEIGHTED TI POST CONTRAST

25. MENINGIOMA FA IN THE LESION:-0.101 CONTROL FA:-0.297 FA IN THE LESION:-0.101 CONTROL FA:-0.297 MD IN THE LESION:-0.997 CONTROL MD:-0.803 MD IN THE LESION:-0.997 CONTROL MD:-0.803

26. 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):298-303. doi: 10.1097/RCT Diffusion-tensor imaging for glioma grading at 3-T magnetic resonance imaging: analysis of fractional anisotropy and mean diffusivity.

27. 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 STUDY0.2540.2161.1431.176 STUDY BY PROVENZALE JM et al 0.1780.2241.3091.427 Provenzale et al 2004 Aug;232(2):451-60. Epub 2004 Jun 23. Peritumoral brain regions in gliomas and meningiomas: investigation with isotropic diffusion-weighted MR imaging and diffusion-tensor MR imaging.

28. DISCUSSION FA-HIGH GR. GLIOMA FA - TDLsMD - HIGH GR.GLIOMA MD - TDLs IN THIS STUDY 0.135 ↓↓0.151 ↓1.260 ↑↑0.985 ↑ STUDY BY C.H.TOHA et al 0.120 ↓↓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

29. 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.

30. 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):298-303.doi: 10.1097/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):451-60. 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: 10.3174/ajnr.A2871.AJNR 2012 33/;846-851.