Pediatric Neuroscience Pathways Fall 2012 - Cleveland Clinic

cover story | diagNostic radiology
images. a third application of dti to pediatric neuroimaging regards
brain connectivity. many diseases may manifest themselves as
subtle alterations of diffusion properties along the pathways
between portions of the brain. In epilepsy, for example, in addition
to the primary epileptogenic focus, there is often a network of other
lesser epileptogenic regions in the brain (sometimes far away). dti
has the exciting potential application to measure the connectivity
between cortical regions in addition to determining the location of
the connecting pathway. an example of recent research at cleveland
Clinic is shown in Figure 6, in which high-resolution tractography is
compared with electrophysiological measurements obtained from an
epilepsy patient with multiple intracranial electrodes. Not only are
the connecting paths visualized in this sagittal image, but the color
of each path corresponds to the DWI connectivity, which modestly
correlates to the electrophysiological connectivity. the eventual goal
would be to obviate the need for extensive invasive intracranial
electrodes by using high-resolution DTI and tractography.
conclusion
mr tractography and dti are recently developed methods of
advanced neurological imaging, clinically used today mainly
for presurgical planning. However, a growing body of research
indicates the capabilities of DTI for identification of (1) deranged
white matter architecture subjacent to subtle MCD, (2) distal cortical
regions involved in an epileptogenic network and (3) abnormal brain
connectivity within epileptogenic zones.
suggested readiNg
Cauley KA, et al. Diffusion tensor imaging and tractography of
rasmussen encephalitis. Pediatr Radiol. 2009;39:727–730.
Hygino da Cruz LC Jr, ed. Clinical applications of diffusion imaging
of the brain. Neuroimag Clin N Am. 2011 Feb;21(1).
Jellison BJ, et al. Diffusion tensor imaging of cerebral white matter:
a pictorial review of physics, fiber tract anatomy, and tumor
imaging patterns. Am J Neuroradiol. 2004 Mar;25:356–369.
Kakisaka Y, So NK, Jones SE, et al. Intractable focal epilepsy
contralateral to the side of facial atrophy in Parry-Romberg
syndrome. Neurol Sci. 2012 Feb;33(1):165-168.
Robin M, et al. K-space and q-space: Combining ultra-high spatial
and angular resolution in diffusion imaging using ZooPPa at 7 t.
NeuroImage. 2012;60:967–978.
Stephen E. Jones, MD, PhD, is a neuroradiologist and physicist
whose specialty interests include advanced imaging, epilepsy,
functional neuroimaging, MRI, neuroradiology and traumatic brain
injury. He can be reached at 216.444.4454 or joness19@ccf.org.
visit clevelaNdcliNicchildreNs.org | 866.588.2264 5