Imagerie en tenseur de diffusion et tractographie de l’encéphale et de la moelle

doi:10.1016/S0221-0363(07)89850-7

Journal de Radiologie

Volume 88, Issue 3, Part 2, March 2007, Pages 510-520

https://doi.org/10.1016/S0221-0363(07)89850-7 Get rights and content

Résumé

L’imagerie en tenseur de diffusion est une technique d’IRM qui permet la cartographie in vivo de la microstructure et de l’organisation des tissus. Elle offre la possibilité de détecter et de quantifier des anomalies de la substance blanche non visibles en imagerie conventionnelle dans des pathologies cérébrales variées, est fréquemment intégrée aux protocoles IRM d’exploration de l’encéphale, et plus récemment de la moelle. L’objectif de ce document est de rappeler les principes de l’imagerie de diffusion et de la tractographie de fibres, d’en préciser l’apport pour l’exploration du système nerveux central dans les pathologies suivantes : maladie d’Alzheimer, affections psychiatriques, ischémie cérébrale, pathologies inflammatoires, tumorales, et épilepsies pharmacorésistantes. Enfin, les applications émergentes pour l’étude de la pathologie médullaire sont également abordées.

Abstract

Diffusion tensor imaging is a magnetic resonance imaging technique that provides details on tissue microstructure and organization well beyond the usual image resolution. With diffusion tensor imaging, diffusion anisotropy can be quantified and subtle white matter changes not normally seen on conventional MRI can be detected. The aim of this article is to review the principles of diffusion tensor imaging and fiber tracking and their applications to the study of the brain, including Alzheimer disease, neuropsychiatric disorders, strokes, multiple sclerosis, brain tumors, and intractable seizures. Emerging applications to spinal cord disorders are also presented.

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Cited by (19)

Contribution of tractography to peripheral nerve imaging
2023, Journal d'imagerie diagnostique et interventionnelle
L’émergence des IRM à haut champ 1,5 et surtout 3 T a facilité le développement de nouvelles séquences 3D permettant une meilleure visualisation des plexus nerveux. Nous disposons à l’heure actuelle d’une technique IRM particulière, l’imagerie de tenseur de diffusion, qui permet d’étudier les grands faisceaux des nerfs périphériques. Cette technique est déjà connue et réalisée depuis longtemps pour l’étude des fibres nerveuses intracrâniennes. Cet article traite des nerfs des membres supérieurs et inférieurs uniquement.
Dans les pathologies inflammatoires, tumorales ou traumatologiques des nerfs, le tenseur de diffusion permet d’étudier, en plus de la zone d’intérêt, la totalité des fibres nerveuses en question. Il permet de mettre en évidence les anomalies structurales et de continuité des nerfs. L’examen IRM est composé de séquences anatomiques sur le nerf à étudier et d’une séquence de tractographie (la séquence de tenseur de diffusion), suivi d’un post-traitement minutieux : le fiber tracking. Il s’agit de fusionner les séquences anatomiques avec la séquence de tractographie, puis de repérer manuellement le nerf à étudier. Le logiciel permet de suivre l’ensemble des fibres nerveuses sélectionnées, en les matérialisant par différentes couleurs. On peut ensuite réaliser des animations en 3D et créer des films.
L’IRM est l’imagerie incontournable, en complément de l’échographie, dans l’imagerie des nerfs périphériques.
The introduction of 1.5 T and especially 3 T in particular high-field MRIs has facilitated the development of new 3D sequences allowing a better visualization of nerve plexuses. Currently, the MRI technique enables to observe peripheral nerves’ large bundles. This technique is known and has been used for a long time to study Fibers intracranial nerves’ studies. However, this article will only deal with nerves in the upper and lower limbs.
In inflammatory, tumor or traumatological pathologies of the nerves, the diffusion makes it possible to study, the totality of the nerve fibers in question in addition to the area of interest. It allows putting highlights structural and continuity anomalies of Nerves. The MRI's exam is composed of several anatomic sequences on the nerve to be studied and a tractography sequence (the diffusion tensor sequence), followed by a meticulous post processing called the fiber tracking. It's about fusing anatomic sequences with tractography analysis, before spotting manually the studied nerve. The software makes it possible to track all the nervous selected fibers, materializing them with different colors. Then, we are able to make 3D animations and create movies.
MRI is essential, in addition to ultrasound, for imaging peripheral nerves.
Role of tractography in stereotactic radiosurgery and brain stereotactic radiotherapy
2022, Cancer/Radiotherapie
La radiothérapie stéréotaxique hypofractionnée et la radiochirurgie sont des armes thérapeutiques majeures au niveau cérébral, que ce soit à visée tumorale, vasculaire ou fonctionnelle. Elles tendent de plus en plus à se démocratiser et à devenir des traitements standard. Or, l’anatomie du cerveau est très complexe et ne se résume pas aux organes à risque actuellement décrits en radiothérapie. La tractographie par imagerie en tenseur de diffusion (DTI) est un outil simple qui permet d’identifier de façon reproductible les gros faisceaux de fibres de substance blanche. Non seulement la tractographie permet une redéfinition des organes à risque dans le cerveau, mais c’est également une des techniques qui permettrait également l’identification anatomique en IRM de nouvelle cibles stéréotaxiques, comme le noyau ventral intermédiaire (Vim) au sein du thalamus pour les traitements de tremblements essentiels ou liés à la maladie de Parkinson. Nous présentons dans cette revue de la littérature l’intérêt de la tractographie et reviendrons sur l’anatomie, la fonction et les relations dose–effet actuellement décrites des faisceaux de fibres de substance blanche ayant un impact fonctionnel majeur : le faisceau pyramidal pour la motricité, les radiations optiques pour la vision et le faisceau arqué pour le langage.
Hypofractionated stereotactic radiotherapy and stereotactic radiosurgery are major therapeutic weapons in the brain, whether for tumor, vascular or functional treatments. They tend increasingly to democratize and to become standard treatments. However, human brain anatomy is very complex and not limited to the currently described organs at risk. Diffusion tensor imaging (DTI) tractography is a simple tool that enables to identify reproducibly big white matter fiber tracts. Not only does tractography allow a redefinition of organs at risk in the brain, but it would also allow the identification of new targets, such as the ventral intermediate nucleus (Vim) within the thalamus for treatment of movement disorders. We present here a review of the role of tractography and the anatomy, function and currently described dose-effect relationships of white matter fiber tracts with a major functional impact: the pyramidal tract for motor ability, the optic radiation for vision and the arcuate fasciculus for language.
Predicting Current Thresholds for Pyramidal Tract Activation Using Volume of Activated Tissue Modeling in Patients Undergoing Deep Brain Stimulation Surgery
2018, World Neurosurgery
Citation Excerpt :
These ROIs must be correctly positioned if only the white substance tracts are to be visualized. For this purpose, it is necessary to position at least 2 ROIs according to known anatomic landmarks within the tract of interest.22 Finally, the use of the tractography requires that the DTI data be matched with reference imaging data, which can sometimes lead to errors in the estimated position of the fiber tract.
The volume of activated tissue (VTA) model attempts to represent in 3 dimensions the diffusion of the current provided by the deep brain stimulation lead on brain structures. The objective of the present study was to assess the correlations among the VTA, activation of the corticospinal tract, and the intraoperative side effect (ISE) threshold.
This double-blind, single-center study was performed between September 2016 and July 2017. We identified 2 groups for statistical analysis: the entire study population and a subset of patients with additional diffusion tensor imaging (DTI) data for determining the location of the pyramidal tract. We determined the intensity threshold at which the VTA reached the border of the target nucleus (referred to as the VTAn) and the intensity threshold when the VTA reached the pyramidal tract (VTAndti). In each group of patients, we studied the correlations between the ISE threshold and the VTAn or VTAndti threshold.
Fifteen patients were included in the study. In both groups, there was a significant correlation between the VTA intensity threshold and the ISE threshold (P = 0.018; r = 0.31 for VTAn in the entire study population). The correlation was stronger in the subset of patients with valid tractography data (P = 0.002; r = 0.5 for VTAndti).
The present study is the first to show a relationship between the intensity threshold as determined by the use of the VTA and the ISE threshold. The correlation between the clinical features and the VTA appears to be stronger in the model based on a combination of high-resolution anatomic data and interpretable DTI data.
Tumor pathology of the spinal cord and its envelopes in adults and children
2016, Feuillets de Radiologie
Les tumeurs intracanalaires sont des tumeurs rares dont l’évolution est lente, et la symptomatologie clinique variée et peu spécifique. Les tumeurs extra-médullaires sont principalement développées aux dépens des gaines nerveuses et de la méninge (schwannome et méningiome respectivement). Les tumeurs intra-médullaires les plus fréquentes sont les tumeurs gliales (l’astrocytome chez l’enfant et l’épendymome chez l’adulte), mais il y a de nombreuses autres tumeurs qui ne sont pas si rares. Le diagnostic se fait essentiellement par l’imagerie par résonance magnétique (IRM). L’intérêt de l’imagerie est de déterminer le siège de la lésion. La localisation tumorale à un espace anatomique (épidural, intradural et intramédullaire) permet la meilleure approche diagnostique. Le suivi thérapeutique par IRM permet un diagnostic précoce des récidives ou l’évaluation de reliquat.
Intraductal tumors are rare tumors exhibiting slow progression and varied and nonspecific clinical symptoms. Tumors affecting the cord envelopes mainly develop from nerve sheaths and meninges (meningioma and schwannoma respectively). The most frequent intramedullary tumors are gliomas (astrocytoma in children and ependymoma in adults), but there are many other tumors that are not so rare. The diagnosis is made primarily by magnetic resonance imaging (MRI). Imaging is useful to determine the location of the injury. Tumor location to an anatomical space (epidural and intradural intramedullary) provides the best diagnostic approach. Therapeutic monitoring with MRI allows early diagnosis of recurrence or surveillance of residual tumor tissue.
Pain and spinal cord imaging measures in children with demyelinating disease
2015, NeuroImage: Clinical
Citation Excerpt :
Recent work has used functional imaging to demonstrate connectivity between rostral brain centers (Sprenger et al., 2015). A similar approach using functional white matter tractography (seeding rostral regions with known function as part of ascending pain pathways) may also be employed in patients with myelitis to map out brain regions associated with pain and other functions that are affected (Agosta et al., 2007; Oppenheim et al., 2007). Furthermore, in the future, by combining spinal cord with brain functional imaging, regions of the brain known to be affected in neuropathic pain in other conditions may be used to dissect the contribution of alterations in white matter tracts and the evolution of pain, a defined and necessary brain function (Garcia-Larrea and Peyron, 2013).
Pain is a significant problem in diseases affecting the spinal cord, including demyelinating disease. To date, studies have examined the reliability of clinical measures for assessing and classifying the severity of spinal cord injury (SCI) and also to evaluate SCI-related pain. Most of this research has focused on adult populations and patients with traumatic injuries. Little research exists regarding pediatric spinal cord demyelinating disease. One reason for this is the lack of reliable and useful approaches to measuring spinal cord changes since currently used diagnostic imaging has limited specificity for quantitative measures of demyelination. No single imaging technique demonstrates sufficiently high sensitivity or specificity to myelin, and strong correlation with clinical measures. However, recent advances in diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) measures are considered promising in providing increasingly useful and specific information on spinal cord damage. Findings from these quantitative imaging modalities correlate with the extent of demyelination and remyelination. These techniques may be of potential use for defining the evolution of the disease state, how it may affect specific spinal cord pathways, and contribute to the management of pediatric demyelination syndromes. Since pain is a major presenting symptom in patients with transverse myelitis, the disease is an ideal model to evaluate imaging methods to define these regional changes within the spinal cord. In this review we summarize (1) pediatric demyelinating conditions affecting the spinal cord; (2) their distinguishing features; and (3) current diagnostic and classification methods with particular focus on pain pathways. We also focus on concepts that are essential in developing strategies for the detection, monitoring, treatment and repair of pediatric myelitis.
New imaging in neurology: Clinical applications
2010, Medecine et Longevite
Les techniques d’imagerie en neurologie connaissent un progrès récent considérable. Nous présentons dans cet article les principales techniques, leur évolution et leurs applications cliniques : le scanner hélicoïdal pour les mesures de volume (critères Recist) et l’étude de la microvascularisation ; l’IRM de diffusion et l’angio-IRM pour l’étude cellulaire et vasculaire ; la spectroscopie pour la composition moléculaire ; le Pet-scanner pour le métabolisme cellulaire. L’imagerie actuelle anatomique et fonctionnelle améliore le diagnostic précoce et spécifique, aide à anticiper l’avènement des maladies neurodégénératives, à cibler les traitements pour les optimiser et à les personnaliser et à mieux comprendre la physiopathologie des maladies neurologiques. Les techniques présentées sont pour certaines d’entre elles encore en cours d’évaluation et constituent des voies de recherche. Leur étude est multicentrique. Le domaine de la neuro-imagerie en est le plus prometteur.
New-Imaging technics in Neurology is actually in a constant and important progress. We present in this article the new essential techniques, their evolution and clinical applications: helical CT for volume measurement (Recist criteria) and microvascularisation study; diffusion MRI and Angio-MR for cellular and vascular study; spectroscopy for molecular composition; Tep-Scanner for cellular metabolism. This actual anatomical and functional Imaging increases the specific and precocious diagnosis, helps to anticipate the appearance of neuro-degenerative disease, targets the treatments for their optimization and personalisation for each patient and helps also to better understanding neurological diseases physiopathology.

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Le point sur…Imagerie en tenseur de diffusion et tractographie de l’encéphale et de la moelleDiffusion tensor imaging and tractography of the brain and spinal cord

Résumé

Abstract

Surg Neurol

J Radiol

Neuroimage

Neuroimage

Psychiatry Res

Eur J Radiol

Schizophr Res

Neuroimage

Neuroimage

J Neuroradiol

Neuroimaging Clin N Am

Neuroimage

Clin Radiol

Neuroimage

Diffusion-weighted MR imaging of intracerebral masses: comparison with conventional MR imaging and histologic findings

AJNR Am J Neuroradiol

Diffusion-weighted imaging: basic concepts and application in cerebral stroke and head trauma

Eur Radiol

Le point sur…
Imagerie en tenseur de diffusion et tractographie de l’encéphale et de la moelleDiffusion tensor imaging and tractography of the brain and spinal cord