Pediatric Neuroscience Pathways Fall 2012 - Cleveland Clinic

cover story | diagNostic radiology
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Figure 3
Figure 3. Example of DTI tractography. A single tract is produced from connecting the directions of maximal water
diffusion in multiple voxels, starting from the corticospinal tract in the pons. It is essential to understand that the
visualized tracts primarily represent the diffusion of water and secondarily may represent the underlying white
matter pathways.
Figure 4. Utility of DTI for presurgical planning. This young patient has a tumor in the right temporal-occipital
lobe, near the expected location of the optic tracts. DTI tractography more accurately shows the location of the
optic tracts and influenced the pathway for surgical resection.
Figure 5. Deterministic tracking of bilateral corticospinal tracts in a patient with Parry-Romberg syndrome, which
causes a progressive hemifacial atrophy with associated hemi-degenerative changes in the brain. Qualitatively, the
image shows fewer DTI tracts on the patient’s right than on the left, which corresponds to the affected side.
Figure 6. Sagittal view of the brain of an epilepsy patient who had numerous intracranial electrodes implanted after
high-resolution DTI. The lines show tractography from an electrode in Broca’s area, connecting a subset of electrode
contacts. The colors of the lines represent the magnitude of electrophysiological connectivity, as produced by
cortico-cortical evoked potentials (CCEP). Such knowledge could reduce the degree of invasive evaluations for
intractable epilepsy.
4 Pediatric NeuroscieNce Pathways | 2012 – 2013
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