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Shinohara Y, Ibaraki M, Matsubara K, Sato K, Yamamoto H, Kinoshita T. Visualization of small brain nuclei with a high-spatial resolution, clinically available whole-body PET scanner. Ann Nucl Med 2024; 38:154-161. [PMID: 37989801 PMCID: PMC10822807 DOI: 10.1007/s12149-023-01886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To verify the visibility of physiological 18F-fluorodeoxyglucose (18F-FDG) uptake in nuclei in and around the brainstem by a whole-body (WB) silicon photomultiplier positron emission tomography (SiPM-PET) scanner with point-spread function (PSF) reconstruction using various iteration numbers. METHODS Ten healthy subjects (5 men, 5 women; mean age, 56.0 ± 5.0 years) who underwent 18F-FDG PET/CT using a WB SiPM-PET scanner and magnetic resonance imaging (MRI) of the brain including a spin-echo three-dimensional sampling perfection with application-optimized contrasts using different flip angle evolutions fluid-attenuated inversion recovery (3D-FLAIR) and a 3D-T1 magnetization-prepared rapid gradient-echo (T1-MPRAGE) images were enrolled. Each acquired PET image was reconstructed using ordered-subset expectation maximization (OSEM) with iteration numbers of 4, 16, 64, and 256 (subset 5 fixed) + time-of-flight (TOF) + PSF. The reconstructed PET images and 3D-FLAIR images for each subject were registered to individual T1-MPRAGE volumes using normalized mutual information criteria. For each MR-coregistered individual PET image, the pattern of FDG uptake in the inferior olivary nuclei (ION), dentate nuclei (DN), midbrain raphe nuclei (MRN), inferior colliculi (IC), mammillary bodies (MB), red nuclei (RN), subthalamic nuclei (STN), lateral geniculate nuclei (LGN), medial geniculate nuclei (MGN), and superior colliculi (SC) was visually classified into the following three categories: good, clearly distinguishable FDG accumulation; fair, obscure contour of FDG accumulation; poor, FDG accumulation indistinguishable from surrounding uptake. RESULTS Among individual 18F-FDG PET images with OSEM iterations of 4, 16, 64, and 256 + TOF + PSF, the iteration numbers that showed the best visibility in each structure were as follows: ION, MRN, LGN, MGN, and SC, iteration 64; DN, iteration 16; IC, iterations 16, 64, and 256; MB, iterations 64 and 256; and RN and STN, iterations 16 and 64, respectively. Of the four iterations, the 18F-FDG PET image of iteration 64 visualized FDG accumulation in small structures in and around the brainstem most clearly (good, 98 structures; fair, 2 structures). CONCLUSIONS A clinically available WB SiPM-PET scanner is useful for visualizing physiological FDG uptake in small brain nuclei, using a sufficiently high number of iterations for OSEM with TOF and PSF reconstructions.
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Affiliation(s)
- Yuki Shinohara
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-kubota-machi, Akita, 010-0874, Japan.
| | - Masanobu Ibaraki
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-kubota-machi, Akita, 010-0874, Japan
| | - Keisuke Matsubara
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-kubota-machi, Akita, 010-0874, Japan
- Department of Management Science and Engineering, Faculty of System Science and Technology, Akita Prefectural University, Yurihonjo, Japan
| | - Kaoru Sato
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-kubota-machi, Akita, 010-0874, Japan
| | - Hiroyuki Yamamoto
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-kubota-machi, Akita, 010-0874, Japan
| | - Toshibumi Kinoshita
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-kubota-machi, Akita, 010-0874, Japan
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Donatelli G, Emmi A, Costagli M, Cecchi P, Macchi V, Biagi L, Lancione M, Tosetti M, Porzionato A, De Caro R, Cosottini M. Brainstem anatomy with 7-T MRI: in vivo assessment and ex vivo comparison. Eur Radiol Exp 2023; 7:71. [PMID: 37968363 PMCID: PMC10651583 DOI: 10.1186/s41747-023-00389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/01/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The brainstem contains grey matter nuclei and white matter tracts to be identified in clinical practice. The small size and the low contrast among them make their in vivo visualisation challenging using conventional magnetic resonance imaging (MRI) sequences at high magnetic field strengths. Combining higher spatial resolution, signal- and contrast-to-noise ratio and sensitivity to magnetic susceptibility (χ), susceptibility-weighted 7-T imaging could improve the assessment of brainstem anatomy. METHODS We acquired high-resolution 7-T MRI of the brainstem in a 46-year-old female healthy volunteer (using a three-dimensional multi-echo gradient-recalled-echo sequence; spatial resolution 0.3 × 0.3 × 1.2 mm3) and in a brainstem sample from a 48-year-old female body donor that was sectioned and stained. Images were visually assessed; nuclei and tracts were labelled and named according to the official nomenclature. RESULTS This in vivo imaging revealed structures usually evaluated through light microscopy, such as the accessory olivary nuclei, oculomotor nucleus and the medial longitudinal fasciculus. Some fibre tracts, such as the medial lemniscus, were visible for most of their course. Overall, in in vivo acquisitions, χ and frequency maps performed better than T2*-weighted imaging and allowed for the evaluation of a greater number of anatomical structures. All the structures identified in vivo were confirmed by the ex vivo imaging and histology. CONCLUSIONS The use of multi-echo GRE sequences at 7 T allowed the visualisation of brainstem structures that are not visible in detail at conventional magnetic field and opens new perspectives in the diagnostic and therapeutical approach to brain disorders. RELEVANCE STATEMENT In vivo MR imaging at UHF provides detailed anatomy of CNS substructures comparable to that obtained with histology. Anatomical details are fundamentals for diagnostic purposes but also to plan a direct targeting for a minimally invasive brain stimulation or ablation. KEY POINTS • The in vivo brainstem anatomy was explored with ultrahigh field MRI (7 T). • In vivo T2*-weighted magnitude, χ, and frequency images revealed many brainstem structures. • Ex vivo imaging and histology confirmed all the structures identified in vivo. • χ and frequency imaging revealed more brainstem structures than magnitude imaging.
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Affiliation(s)
- Graziella Donatelli
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Imago7 Research Foundation, Pisa, Italy
| | - Aron Emmi
- Department of Neuroscience, Institute of Human Anatomy, University of Padua, Padua, Italy
- Center for Neurodegenerative Disease Research (CESNE), University of Padova, Padua, Italy
| | - Mauro Costagli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
- Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris, Pisa, Italy
| | - Paolo Cecchi
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Imago7 Research Foundation, Pisa, Italy
| | - Veronica Macchi
- Department of Neuroscience, Institute of Human Anatomy, University of Padua, Padua, Italy
- Center for Neurodegenerative Disease Research (CESNE), University of Padova, Padua, Italy
| | - Laura Biagi
- Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris, Pisa, Italy
| | - Marta Lancione
- Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris, Pisa, Italy
| | - Michela Tosetti
- Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris, Pisa, Italy
| | - Andrea Porzionato
- Department of Neuroscience, Institute of Human Anatomy, University of Padua, Padua, Italy
- Center for Neurodegenerative Disease Research (CESNE), University of Padova, Padua, Italy
| | - Raffaele De Caro
- Department of Neuroscience, Institute of Human Anatomy, University of Padua, Padua, Italy
- Center for Neurodegenerative Disease Research (CESNE), University of Padova, Padua, Italy
| | - Mirco Cosottini
- Department of Translational Research On New Technologies in Medicine and Surgery, Neuroradiology Unit, University of Pisa, 56124, Pisa, Italy.
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Klein J, Gerken A, Agethen N, Rothlübbers S, Upadhyay N, Purrer V, Schmeel C, Borger V, Kovalevsky M, Rachmilevitch I, Shapira Y, Wüllner U, Jenne J. Automatic planning of MR-guided transcranial focused ultrasound treatment for essential tremor. FRONTIERS IN NEUROIMAGING 2023; 2:1272061. [PMID: 37953746 PMCID: PMC10637361 DOI: 10.3389/fnimg.2023.1272061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023]
Abstract
Introduction Transcranial focused ultrasound therapy (tcFUS) offers precise thermal ablation for treating Parkinson's disease and essential tremor. However, the manual fine-tuning of fiber tracking and segmentation required for accurate treatment planning is time-consuming and demands expert knowledge of complex neuroimaging tools. This raises the question of whether a fully automated pipeline is feasible or if manual intervention remains necessary. Methods We investigate the dependence on fiber tractography algorithms, segmentation approaches, and degrees of automation, specifically for essential tremor therapy planning. For that purpose, we compare an automatic pipeline with a manual approach that requires the manual definition of the target point and is based on FMRIB software library (FSL) and other open-source tools. Results Our findings demonstrate the high feasibility of automatic fiber tracking and the automated determination of standard treatment coordinates. Employing an automatic fiber tracking approach and deep learning (DL)-supported standard coordinate calculation, we achieve anatomically meaningful results comparable to a manually performed FSL-based pipeline. Individual cases may still exhibit variations, often stemming from differences in region of interest (ROI) segmentation. Notably, the DL-based approach outperforms registration-based methods in producing accurate segmentations. Precise ROI segmentation proves crucial, surpassing the importance of fine-tuning parameters or selecting algorithms. Correct thalamus and red nucleus segmentation play vital roles in ensuring accurate pathway computation. Conclusion This study highlights the potential for automation in fiber tracking algorithms for tcFUS therapy, but acknowledges the ongoing need for expert verification and integration of anatomical expertise in treatment planning.
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Affiliation(s)
- Jan Klein
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Annika Gerken
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Niklas Agethen
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Sven Rothlübbers
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Neeraj Upadhyay
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Veronika Purrer
- Clinic and Policlinic for Neurology, University Hospital Bonn, Bonn, Germany
| | - Carsten Schmeel
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Clinic and Policlinic for Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | | | | | - Ullrich Wüllner
- Clinic and Policlinic for Neurology, University Hospital Bonn, Bonn, Germany
| | - Jürgen Jenne
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
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Schmidbauer VU, Yildirim MS, Dovjak GO, Weber M, Diogo MC, Milos RI, Giordano V, Prayer F, Stuempflen M, Goeral K, Buchmayer J, Klebermass-Schrehof K, Berger A, Prayer D, Kasprian G. Synthetic MR Imaging-Based WM Signal Suppression Identifies Neonatal Brainstem Pathways in Vivo. AJNR Am J Neuroradiol 2022; 43:1817-1823. [PMID: 36396336 DOI: 10.3174/ajnr.a7710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Multidynamic multiecho sequence-based imaging enables investigators to reconstruct multiple MR imaging contrasts on the basis of a single scan. This study investigated the feasibility of synthetic MRI-based WM signal suppression (syWMSS), a synthetic inversion recovery approach in which a short TI suppresses myelin-related signals, for the identification of early myelinating brainstem pathways. MATERIALS AND METHODS Thirty-one cases of neonatal MR imaging, which included multidynamic multiecho data and conventionally acquired T1- and T2-weighted sequences, were analyzed. The multidynamic multiecho postprocessing software SyMRI was used to generate syWMSS data (TR/TE/TI = 3000/5/410 ms). Two raters discriminated early myelinating brainstem pathways (decussation of the superior cerebellar peduncle, medial lemniscus, central tegmental tract, and medial longitudinal fascicle [the latter 3 assessed at the level of the pons]) on syWMSS data and reference standard contrasts. RESULTS On the basis of syWMSS data, the decussation of the superior cerebellar peduncle (31/31); left/right medial lemniscus (31/31; 30/31); left/right central tegmental tract (19/31; 20/31); and left/right medial longitudinal fascicle (30/31) were reliably identified by both raters. On the basis of T1-weighted contrasts, the decussation of the superior cerebellar peduncle (14/31); left/right medial lemniscus (22/31; 16/31); left/right central tegmental tract (1/31); and left/right medial longitudinal fascicle (9/31; 8/31) were reliably identified by both raters. On the basis of T2-weighted contrasts, the decussation of the superior cerebellar peduncle (28/31); left/right medial lemniscus (16/31; 12/31); left/right central tegmental tract (23/31; 18/31); and left/right medial longitudinal fascicle (15/31; 14/31) were reliably identified by both raters. CONCLUSIONS syWMSS data provide a feasible imaging technique with which to study early myelinating brainstem pathways. MR imaging approaches that use myelin signal suppression contribute to a more sensitive assessment of myelination patterns at early stages of cerebral development.
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Affiliation(s)
- V U Schmidbauer
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - M S Yildirim
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - G O Dovjak
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - M Weber
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - M C Diogo
- Department of Neuroradiology (M.C.D.), Hospital Garcia de Orta, Almada, Portugal
| | - R-I Milos
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - V Giordano
- Comprehensive Center for Pediatrics (V.G., K.G., J.B., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - F Prayer
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - M Stuempflen
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - K Goeral
- Comprehensive Center for Pediatrics (V.G., K.G., J.B., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - J Buchmayer
- Comprehensive Center for Pediatrics (V.G., K.G., J.B., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - K Klebermass-Schrehof
- Comprehensive Center for Pediatrics (V.G., K.G., J.B., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - A Berger
- Comprehensive Center for Pediatrics (V.G., K.G., J.B., K.K.-S., A.B.), Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - D Prayer
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
| | - G Kasprian
- From the Department of Biomedical Imaging and Image-Guided Therapy (V.U.S., M.S.Y., G.O.D., M.W., R.-I.M., F.P., M.S., D.P., G.K.)
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Shepherd TM, Hoch MJ. MRI-Visible Anatomy of the Brainstem. Neuroimaging Clin N Am 2022; 32:553-564. [PMID: 35843662 DOI: 10.1016/j.nic.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human brainstem internal anatomy is intricate, complex, and essential to normal brain function. The brainstem is affected by stroke, multiple sclerosis, and most neurodegenerative diseases-a 1-mm focus of pathologic condition can have profound clinical consequences. Unfortunately, detailed internal brainstem anatomy is difficult to see with conventional MRI sequences. We review normal brainstem anatomy visualized on widely available clinical 3-T MRI scanners using fast gray matter acquisition T1 inversion recovery, probabilistic diffusion tractography, neuromelanin, and susceptibility-weighted imaging. Better anatomic localization using these recent innovations improves our ability to diagnose, localize, and treat brainstem diseases. We aim to provide an accessible review of the most clinically relevant brainstem neuroanatomy.
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Affiliation(s)
- Timothy M Shepherd
- Department of Radiology, New York University Langone School of Medicine, 660 First Avenue, Room 230D, New York, NY 10016, USA.
| | - Michael J Hoch
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Suite 130, Philadelphia, PA 19104, USA. https://twitter.com/RVUhound
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Nguyen TH, Vaussy A, Le Gaudu V, Aboab J, Espinoza S, Curajos I, Heron E, Habas C. The brainstem in multiple sclerosis: MR identification of tracts and nuclei damage. Insights Imaging 2021; 12:151. [PMID: 34674050 PMCID: PMC8531176 DOI: 10.1186/s13244-021-01101-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/23/2021] [Indexed: 01/04/2023] Open
Abstract
Objective To evaluate the 3D Fast Gray Acquisition T1 Inversion Recovery (FGATIR) sequence for MRI identification of brainstem tracts and nuclei damage in multiple sclerosis (MS) patients. Methods From april to december 2020, 10 healthy volunteers and 50 patients with remitted-relapsing MS (58% female, mean age 36) underwent MR imaging in the Neuro-imaging department of the C.H.N.O. des Quinze-Vingts, Paris, France. MRI was achieved on a 3 T system (MAGNETOM Skyra) using a 64-channel coil. 3D FGATIR sequence was first performed on healthy volunteers to classify macroscopically identifiable brainstem structures. Then, FGATIR was assessed in MS patients to locate brainstem lesions detected with Proton Density/T2w (PD/T2w) sequence. Results In healthy volunteers, FGATIR allowed a precise visualization of tracts and nuclei according to their myelin density. Including FGATIR in MR follow-up of MS patients helped to identify structures frequently involved in the inflammatory process. Most damaged tracts were the superior cerebellar peduncle and the transverse fibers of the pons. Most frequently affected nuclei were the vestibular nuclei, the trigeminal tract, the facial nerve and the solitary tract. Conclusion Combination of FGATIR and PD/T2w sequences opened prospects to define MS elective injury in brainstem tracts and nuclei, with particular lesion features suggesting variations of the inflammatory process within brainstem structures. In a further study, hypersignal quantification and microstructure information should be evaluated using relaxometry and diffusion tractography. Technical improvements would bring novel parameters to train an artificial neural network for accurate automated labeling of MS lesions within the brainstem.
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Affiliation(s)
- Thien Huong Nguyen
- Department of Neuro Imaging, C.H.N.O. des Quinze- Vingts, Paris, France.
| | | | - Violette Le Gaudu
- Department of Neuro Imaging, C.H.N.O. des Quinze- Vingts, Paris, France
| | - Jennifer Aboab
- Department of Internal Medicine, C.H.N.O. des Quinze-Vingts, Paris, France
| | - Sophie Espinoza
- Department of Neuro Imaging, C.H.N.O. des Quinze- Vingts, Paris, France
| | - Irina Curajos
- Department of Neuro Imaging, C.H.N.O. des Quinze- Vingts, Paris, France
| | - Emmanuel Heron
- Department of Internal Medicine, C.H.N.O. des Quinze-Vingts, Paris, France
| | - Christophe Habas
- Department of Neuro Imaging, C.H.N.O. des Quinze- Vingts, Paris, France
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Purrer V, Upadhyay N, Borger V, Pieper CC, Kindler C, Grötz S, Keil VC, Stöcker T, Boecker H, Wüllner U. Lesions of the cerebello-thalamic tract rather than the ventral intermediate nucleus determine the outcome of focused ultrasound therapy in essential tremor: A 3T and 7T MRI-study. Parkinsonism Relat Disord 2021; 91:105-108. [PMID: 34562715 DOI: 10.1016/j.parkreldis.2021.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The ventral intermediate nucleus of the thalamus (VIM) is an important relay station receiving cerebellar and pallidal fiber tracts. Data on structural visualization of the VIM however is limited and uncertainty prevails to what extent lesional approaches to treat tremor affect the VIM itself or passing tracts. The aim of the study was to analyze the localization of individual lesions with respect to the VIM and the cerebello-thalamic tract (CTT). METHODS We employed ultrahigh resolution (7 Tesla) MRI to delineate the VIM and performed 3 T-DTI-imaging pre- and post-interventional in seven ET patients undergoing transcranial magnetic resonance guided focused ultrasound (tcMRgFUS). Tremor improvement was measured using a modified subscore of the Clinical Rating Scale for Tremor. RESULTS All subjects showed substantial tremor improvement (88.5%, range 80.7%-94,8%) after tcMRgFUS. We found only a minor overlap of the lesions with the VIM (4%, range 1%-7%) but a larger overlap with the CTT (43%, range 23%-60%) in all subjects. CONCLUSIONS Lesions within the CTT rather than the VIM seem to drive the tremorlytic response and clinical improvement in tcMRgFUS.
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Affiliation(s)
- Veronika Purrer
- Department of Neurology, University Hospital Bonn, Germany; German Centre of Neurodegenerative Diseases (DZNE), Bonn, Germany.
| | - Neeraj Upadhyay
- German Centre of Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Germany
| | - Claus Christian Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Christine Kindler
- Department of Neurology, University Hospital Bonn, Germany; German Centre of Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Simon Grötz
- Department of Neuroradiology, University Hospital Bonn, Germany
| | - Vera Catharina Keil
- Department of Neuroradiology, University Hospital Bonn, Germany; Department of Radiology, Amsterdam University Medical Center (AUMC), VUmc, Amsterdam, the Netherlands
| | - Tony Stöcker
- Department of Physics and Astronomy, University of Bonn, Bonn, Germany
| | - Henning Boecker
- German Centre of Neurodegenerative Diseases (DZNE), Bonn, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Germany
| | - Ullrich Wüllner
- Department of Neurology, University Hospital Bonn, Germany; German Centre of Neurodegenerative Diseases (DZNE), Bonn, Germany
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8
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Chung SJ, Cho KH, Lee YH, Yoo HS, Baik K, Jung JH, Ye BS, Sohn YH, Cha J, Lee PH. Diffusion tensor imaging-based pontine damage as a degeneration marker in synucleinopathy. J Neurosci Res 2021; 99:2922-2931. [PMID: 34521154 DOI: 10.1002/jnr.24926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/25/2021] [Accepted: 07/02/2021] [Indexed: 11/08/2022]
Abstract
The pons is one of the earliest affected regions in patients with synucleinopathies. We aimed to investigate the diagnostic value of measuring pontine damage using diffusion tensor imaging (DTI) in these patients. We enrolled 49 patients with Parkinson's disease (PD), 16 patients with idiopathic rapid eye movement sleep behavior disorder (iRBD), 23 patients with multiple system atrophy (MSA), and 39 healthy controls in this study. All the participants underwent high-resolution T1-weighted imaging and DTI. Mean diffusivity (MD) and fraction anisotropy (FA) values in the pons were calculated to characterize structural damage. The discriminatory power of pontine MD and FA values to differentiate patients with synucleinopathies from healthy controls was examined using receiver operating characteristics (ROC) analyses. Compared to healthy controls, patients with PD, iRBD, and MSA had increased MD values and decreased FA values in the pons, although no correlation was observed between these DTI measures and disease severity. The ROC analyses showed that MD values in the pons had a fair discriminatory power to differentiate healthy controls from patients with PD (area under the curve [AUC], 0.813), iRBD (AUC, 0.779), and MSA (AUC, 0.951). The AUC for pontine FA values was smaller than that for pontine MD values when differentiating healthy controls from patients with PD (AUC, 0.713; p = 0.054) and iRBD (AUC, 0.686; p = 0.045). Our results suggest that MD values in the pons may be a useful marker of brain stem neurodegeneration in patients with synucleinopathies.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Kyoo Ho Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Cha
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Samara A, Lugar HM, Hershey T, Shimony JS. Longitudinal Assessment of Neuroradiologic Features in Wolfram Syndrome. AJNR Am J Neuroradiol 2020; 41:2364-2369. [PMID: 33122205 DOI: 10.3174/ajnr.a6831] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Wolfram syndrome is a rare genetic disease with characteristic brain involvement. We reviewed the brain MR images of patients with Wolfram syndrome to determine the frequency and characteristics of common neuroradiologic findings. MATERIALS AND METHODS We retrospectively reviewed the imaging data of patients with genetically-confirmed Wolfram syndrome who had been recruited to the Washington University Wolfram Syndrome Research Clinic. These patients were evaluated between 2010 and 2019 with annual MRIs, along with other measures. MR images were assessed for clinical neuroradiologic signs at each individual's first and last follow-up visits to characterize the frequency, rate of progression, and clinical correlations of these signs. RESULTS We included 30 patients (13 males/17 females; average age at first visit, 14 years; average age at last visit, 19 years). The median duration of follow-up was 5 years (range, 2-9 years). The most common findings were an absent or diminished posterior pituitary bright spot (first, 53%; last, 70%), T1/T2 pons signal abnormalities (first, 53%; last, 67%), optic nerve atrophy (first, 30%; last, 80%), white matter T2 hyperintensities (first, 27%; last, 35%), and cerebellar atrophy (first, 23%; last, 70%). CONCLUSIONS Patients with Wolfram syndrome present characteristic neuroradiologic findings that involve the posterior pituitary gland, optic nerves, white matter, brain stem, and cerebellum. These abnormal findings appear at an early age and tend to increase in frequency with time. However, the neurologic significance and neuropathologic mechanisms of each sign require more investigation. Neuroradiologists should be aware of the pattern of these features in Wolfram syndrome.
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Affiliation(s)
- A Samara
- From the Department of Psychiatry (A.S., H.M.L.)
| | - H M Lugar
- From the Department of Psychiatry (A.S., H.M.L.)
| | - T Hershey
- From the Department of Psychiatry (A.S., H.M.L.) .,Neurology (T.H.).,Mallinckrodt Institute of Radiology (T.H., J.S.S.), Washington University School of Medicine, St. Louis, Missouri
| | - J S Shimony
- Mallinckrodt Institute of Radiology (T.H., J.S.S.), Washington University School of Medicine, St. Louis, Missouri
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