Reproducibility of corticospinal diffusion tensor tractography in normal subjects and hemiparetic stroke patients

Prostatic and pelvic imaging parameters to predict post radical prostatectomy erectile function recovery: a systematic review

With radical prostatectomy for prostate cancer, there may be associated long-term postoperative sequalae: urinary incontinence and erectile dysfunction (ED). It is important to predict the functional recovery of erections for better patient counselling and timely treatment of ED. This systematic review looks at imaging parameters to predict the recovery of erectile function (EF) after laparoscopic or robotic prostatectomy. A systematic search was performed to capture publications from January 2000 up to December 2023 (PROSPERO; Registrations ID CRD 42022359557). The considered studies applied an imaging parameter obtained by any form of imaging modality and in any operative phase (pre- or intraoperative) to assess the potential impact on EF after surgery. An essential criterion was a formal EF assessment at both baseline and postoperatively, by means of a validated questionnaire. A total of 8 studies met our inclusion criteria. We categorised the studies based on the imaging modality into three groups: MRI (n = 4), diffusion tensor imaging (DTI) (n = 2), and intraoperative ultrasonography (n = 2). Preoperative MRI parameters were, firstly, dynamic contrast enhancement of prostatic tissue measured as ratio of change of contrast from baseline to 120 s (Ratio120) showing weak correlation to postoperative IIEF5 scores (r = 0.31; p = 0.044), and secondly, area of neurovascular bundle (NVB) was a predictor of EF recovery on univariate analysis (odds ratio = 1.30; P = 0.001). Bony pelvic dimensions, prostate surface area, and fascial thickness measured on MRI did not show correlation with EF scores. Two studies using DTI were included, with one showing the change in the number of periprostatic nerve fibres before and after surgery, which also demonstrated a correlation with the change in EF scores (r = 0.35; P < 0.05). While the other study using DTI showed the change direction of the periprostatic nerve fibres before and after surgery measured as a value of functional anistropy, it showed a weak negative correlation to postoperative EF scores on the left (r = -0.66120; p = 0.0006) and right (r = -0.420068; p = 0.0456). Additionally, intraoperative ultrasound assessment of the NVB, such as the number of visible vessels within the NVB, has also been shown to correlate (r = 0.34, p = 0.0001) with postoperative EF. Our systematic review could not identify an imaging parameter strongly correlated with EF recovery. Enhancement of the prostate on mpMRI and intraoperative ultrasound might be worth investigating through better-designed studies. More research is needed to establish which parameters can reliably predict EF post-prostatectomy to best inform the patient and mitigate the risk.

Concordance correlation coefficients estimated by modified variance components and generalized estimating equations for longitudinal overdispersed Poisson data

For longitudinal overdispersed Poisson data sets, estimators of the intra-, inter-, and total concordance correlation coefficient through variance components have been proposed. However, biased estimators of quadratic forms are used in concordance correlation coefficient estimation. In addition, the generalized estimating equations approach has been used in estimating agreement for longitudinal normal data and not for longitudinal overdispersed Poisson data. Therefore, this paper proposes a modified variance component approach to develop the unbiased estimators of the concordance correlation coefficient for longitudinal overdispersed Poisson data. Further, the indices of intra-, inter-, and total agreement through generalized estimating equations are also developed considering the correlation structure of longitudinal count repeated measurements. Simulation studies are conducted to compare the performance of the modified variance component and generalized estimating equation approaches for longitudinal Poisson and overdispersed Poisson data sets. An application of corticospinal diffusion tensor tractography study is used for illustration. In conclusion, the modified variance component approach performs outstandingly well with small mean square errors and nominal 95% coverage rates. The generalized estimating equation approach provides in model assumption flexibility of correlation structures for repeated measurements to produce satisfactory concordance correlation coefficient estimation results.

Prediction of Motor Recovery after Stroke by Assessment of Corticospinal Tract Wallerian Degeneration Using Diffusion Tensor Imaging

Aim of the Study To predict motor recovery after stroke by detection of diffusion tensor imaging (DTI) fractional anisotropy (FA) changes of corticospinal tract (CST) and correlate findings with clinical scores to provide more effective treatment and rehabilitation.

Subjects and Methods Thirty patients with cerebral stroke were enrolled and underwent conventional magnetic resonance imaging and DTI at admission and 1 month after stroke. Mean diffusivity (MD), FA, FA ratio (rFA), and fiber number (FN) values of CST were calculated at the pons at admission and after 1 month of stroke. Three-dimensional reconstruction of bilateral CST and the structural changes of fibrous bands were observed. Severity of limb weakness was assessed by using the motor sub-index scores of the National Institutes of Health Stroke Scale (NIHSS) at admission, and after 1, 6, and 9 months for severity of limb weakness.

Results The mean age of our patients was 61.32 ± 4.34 years, 17/30 (56.6%) were females, and 13/30 (43.4%) were males. In our study, 18/30 (60%) were hypertensive, 19/30 (63.3%) were diabetic, and 12/30 (40%) were smokers. A significant negative correlation was found between rFA and FN in the ipsilateral CST of the cerebral infarction at the rostral part of pons after 1 month of infarction and NIHSS score at 6 months ( r = 0.377, p = 0.04 and r = 0.237, p = 0.02, respectively). However, a positive insignificant correlation was found between MD and NIHSS ( r = 0.345, p = 0.635). The initial NIHSS score at the time of injury was 19.2 ± 4.3, which changed to 7.9 ± 2.4, 4.6 ± 1.9, and 3.3 ± 1.4 at 1, 6, and 9 months, respectively.

Conclusion DTI is a sensitive tool for early detection of Wallerian degeneration in the CST after stroke, and can predict motor performance to provide effective treatment and rehabilitation to improve quality of life.

Test-retest reliability and minimal detectable change of corticospinal tract integrity in chronic stroke

Diffusion tensor imaging (DTI) can be used to index white matter integrity of the corticospinal tract (CST) after stroke; however, the psychometric properties of DTI-based measures of white matter integrity are unknown. The purpose of this study was to examine test-retest reliability as determined by intraclass correlation coefficients (ICC) and calculate minimal detectable change (MDC) of DTI-based measures of CST integrity using three different approaches: a Cerebral Peduncle approach, a Probabilistic Tract approach, and a Tract Template approach. Eighteen participants with chronic stroke underwent DTI on the same magnetic resonance imaging scanner 4 days apart. For the Cerebral Peduncle approach, a researcher hand drew masks at the cerebral peduncle. For the Probabilistic Tract approach, tractography was seeded in motor areas of the cortex to the cerebral peduncle. For the Tract Template approach, a standard CST template was transformed into native space. For all approaches, the researcher performing analyses was blind to participant number and day of data collection. All three approaches had good to excellent test-retest reliability for fractional anisotropy (FA; ICCs >0.786). Mean diffusivity, axial diffusivity, and radial diffusivity were less reliable than FA. The ICC values were highest and MDC values were the smallest for the most automated approach (Tract Template), followed by the combined manual/automated approach (Probabilistic Tract) then the manual approach (Cerebral Peduncle). The results of this study may have implications for how DTI-based measures of CST integrity are used to define impairment, predict outcomes, and interpret change after stroke.

Test-retest reproducibility of white matter parcellation using diffusion MRI tractography fiber clustering

There are two popular approaches for automated white matter parcellation using diffusion MRI tractography, including fiber clustering strategies that group white matter fibers according to their geometric trajectories and cortical-parcellation-based strategies that focus on the structural connectivity among different brain regions of interest. While multiple studies have assessed test-retest reproducibility of automated white matter parcellations using cortical-parcellation-based strategies, there are no existing studies of test-retest reproducibility of fiber clustering parcellation. In this work, we perform what we believe is the first study of fiber clustering white matter parcellation test-retest reproducibility. The assessment is performed on three test-retest diffusion MRI datasets including a total of 255 subjects across genders, a broad age range (5-82 years), health conditions (autism, Parkinson's disease and healthy subjects), and imaging acquisition protocols (three different sites). A comprehensive evaluation is conducted for a fiber clustering method that leverages an anatomically curated fiber clustering white matter atlas, with comparison to a popular cortical-parcellation-based method. The two methods are compared for the two main white matter parcellation applications of dividing the entire white matter into parcels (i.e., whole brain white matter parcellation) and identifying particular anatomical fiber tracts (i.e., anatomical fiber tract parcellation). Test-retest reproducibility is measured using both geometric and diffusion features, including volumetric overlap (wDice) and relative difference of fractional anisotropy. Our experimental results in general indicate that the fiber clustering method produced more reproducible white matter parcellations than the cortical-parcellation-based method.

Evaluation of periprostatic neurovascular fibers before and after radical prostatectomy by means of 1.5 T MRI diffusion tensor imaging

OBJECTIVE

To evaluate if diffusion tensor imaging (DTI) is able to detect changes of periprostatic neurovascular fibers (PNFs) before and after radical prostatectomy (RP), and if these changes are related to post-surgical urinary incontinence and erectile dysfunction.

METHODS

22 patients (mean age 62.6 years) with biopsy-proven prostate cancer underwent 1.5 T DTI before and after RP. The number, fractional anisotropy (FA) values and length of PNFs before and after RP were compared using Student's t-test. Each patient filled out two questionnaires before and after RP, one for the evaluation of urinary continence (ICIQ-SF) and one for the evaluation of erectile function (IIEF-5). The ratios of the number, FA values and length of PNFs before and after RP (DTI B-A RATIOs) and the ratios between the scores obtained before and after RP for both ICIQ-SF and IIEF-2 (ICIQ-SF B-A RATIOs and IIEF-2 B-A RATIOs) were calculated to perform the Kendall's τ-test between them.

RESULTS

There was a statistically significant decrease of the number of PNFs after RP at base, midgland, and apex (p < 0.01) and of FA values at midgland (p < 0.05), with positive statistically significant correlation between the DTI B-A RATIOs of the number of PNFs and IIEF-2 B-A RATIOs (p < 0.05, ρ = 0.47).

CONCLUSION

DTI was able to detect that the decrease of the number of the PNFs after RP was statistically related to the post-surgical erectile dysfunction (p < 0.05). Advances in knowledge: This work demonstrates that: (1) 1.5 T MRI DTI is able to detect the decrease of the number and of the FA of PNFs after prostatectomy; (2) the decrease of the number of PNFs after prostatectomy is related with the post-surgical erectile dysfunction; (3) 1.5 T MRI DTI has demonstrated to be a reproducible technique in detecting the changes of the PNFs induced by RP, with high interobserver agreement.

Probing the reproducibility of quantitative estimates of structural connectivity derived from global tractography

As quantitative measures derived from fiber tractography are increasingly being used to characterize the structural connectivity of the brain, it is important to establish their reproducibility. However, no such information is as yet available for global tractography. Here we provide the first comprehensive analysis of the reproducibility of streamline counts derived from global tractography as quantitative estimates of structural connectivity. In a sample of healthy young adults scanned twice within one week, within-session and between-session test-retest reproducibility was estimated for streamline counts of connections based on regions of the AAL atlas using the intraclass correlation coefficient (ICC) for absolute agreement. We further evaluated the influence of the type of head-coil (12 versus 32 channels) and the number of reconstruction repetitions (reconstructing streamlines once or aggregated over ten repetitions). Factorial analyses demonstrated that reproducibility was significantly greater for within- than between-session reproducibility and significantly increased by aggregating streamline counts over ten reconstruction repetitions. Using a high-resolution head-coil incurred only small beneficial effects. Overall, ICC values were positively correlated with the streamline count of a connection. Additional analyses assessed the influence of different selection variants (defining fuzzy versus no fuzzy borders of the seed mask; selecting streamlines that end in versus pass through a seed) showing that an endpoint-based variant using fuzzy selection provides the best compromise between reproducibility and anatomical specificity. In sum, aggregating quantitative indices over repeated estimations and higher numbers of streamlines are important determinants of test-retest reproducibility. If these factors are taken into account, streamline counts derived from global tractography provide an adequately reproducible quantitative measure that can be used to gauge the structural connectivity of the brain in health and disease.

Utility of Fractional Anisotropy in Cerebral Peduncle for Stroke Outcome Prediction: Comparison of Hemorrhagic and Ischemic Strokes

BACKGROUND

Diffusion-tensor fractional anisotropy (FA) has been used for predicting stroke outcome. However, most previous studies focused on patients with either hemorrhagic or ischemic stroke. The aim of this study was to assess the correlation between FA and outcome for patients with hemorrhagic stroke and those with ischemic stroke, and then compare their correlation patterns.

METHODS

This study sampled 40 hemorrhagic and 40 ischemic stroke patients from our previously published reports. Diffusion-tensor images were obtained on days 14-21, and FA images were generated, after which the ratio of FA within the cerebral peduncles of the affected and unaffected hemispheres (rFA) was calculated. Outcome was assessed using Brunnstrom stage (BRS), motor component of the functional independence measure (FIM-motor), and total length of hospital stay (LOS) at discharge from our affiliated rehabilitation hospital. The data were then compared between the hemorrhage and the infarct groups. Correlation analyses between rFA and outcome assessments were performed separately for both groups and then were compared between the groups.

RESULTS

The hemorrhage group exhibited significantly more severe BRS, longer LOS, and lower rFA than the infarct group. The correlations between rFA and outcome measures were all statistically significant for both the hemorrhage and the infarct groups. The correlation patterns for BRS and LOS were very similar between the hemorrhage and the infarct groups. However, such similarity was not evident for FIM-motor.

CONCLUSIONS

FA in the cerebral peduncles may be used to predict extremity functions and LOS for both types of stroke.

A pilot study of pre-operative motor dysfunction from gliomas in the region of corticospinal tract: Evaluation with diffusion tensor imaging

BACKGROUND AND PURPOSE

Brain tumors in the corticospinal tract (CST) region are more likely to cause motor dysfunction. The aim of this study is to evaluate the effect of gliomas located in the CST region on motor function with diffusion tensor imaging (DTI) preoperatively.

MATERIALS AND METHODS

Forty-five patients with histopathologically confirmed gliomas were included in this pilot study, in all cases (low-grade n = 13, high-grade n = 32) CST but not the motor cortex were involved by the tumor. DTI image were acquired and the posterior limb of the internal capsule fractional anisotropy (FA) and relative FA (rFA = affected FA/contralateral FA) were measured. Injury of the CST from tumor was divided into three grades (grade 1: displacement, grade 2: displacement and infiltration, grade 3: displacement and disruption). The fiber density index (FDi) and relative FDi (rFDi = affected FDi/contralateral FDi) of the injured and contralateral CST were measured. The correlations between muscle strength and the CST injury grade and the rFA, affected FDi, rFDi values were calculated using Spearman rank correlation analysis. rFA and rFDi values of muscle strength groups (MMT2-5) were compared with one-way analysis of variance (ANOVA). The difference of muscle strength between low- and high-grade glioma groups were analysed with the Mann-Whitney U-test.

RESULTS

Muscle strength was negatively correlated with the injury grade of the CST (r = -0.840, P<0.001). Muscle strength was positively correlated with rFA, FDi and rFDi (correlation coefficients (r) were 0.615, 0.643 and 0.567 for rFA, FDi and rFDi, respectively). The rFA values between grades (2&3, 2&4, 2&5, 3&5, 4&5) of muscle strength were significantly different (P<0.05), the rFDi values between grades (2&4, 2&5, 3&4, 3&5) of muscle strength were significantly different (P<0.05), while the rFA and rFDi values in the remaining groups of muscle strength grades showed no significant differences(P>0.05).

CONCLUSIONS

Preoperative DTI and diffusion tensor tractography may quantify the injury degrees of CST and the extent of motor dysfunction in patients with brain glioma.

Investigation of Motor Cortical Plasticity and Corticospinal Tract Diffusion Tensor Imaging in Patients with Parkinsons Disease and Essential Tremor

Parkinson's disease (PD) and essential tremor (ET) are characterized with motor dysfunctions. Motor circuit dysfunctions can be complementarily investigated by paired associative stimulation (PAS)-induced long-term potentiation (LTP)-like plasticity and diffusion tensor imaging (DTI) of the corticospinal tract (CST). Three groups of twelve subjects with moderate severity PD, ET with intention tremor and healthy controls (HC) were studied. The primary motor cortex (M1) excitability, measured by motor evoked potential (MEP) amplitude and by short-interval and long-interval intracortical inhibition (SICI and LICI) was compared between the three groups before and after PAS. The DTI measures of fractional anisotropy (FA) and mean diffusivity (MD) were acquired. PAS effects and DTI data were simultaneously examined between groups. PAS increased MEP amplitude in HC but not in PD and ET. SICI and LICI were significantly reduced after PAS irrespective of groups. No significant differences of the mean FA and MD were found between groups. There was no significant correlation between the PAS effects and the DTI measures. Findings suggest that both PD and ET with intention tremor have impairment of the associative LTP-like corticospinal excitability change in M1. The microstructure of the CST is not relevant to the deficiency of M1 associative plasticity in PD and ET.

Comparison of Diffusion Tensor Tractography and Motor Evoked Potentials for the Estimation of Clinical Status in Subacute Stroke

Objective

To compare diffusion tensor tractography (DTT) and motor evoked potentials (MEPs) for estimation of clinical status in patients in the subacute stage of stroke.

Methods

Patients with hemiplegia due to stroke who were evaluated using both DTT and MEPs between May 2012 and April 2015 were recruited. Clinical assessments investigated upper extremity motor and functional status. Motor status was evaluated using Medical Research Council grading and the Fugl-Meyer Assessment of upper limb and hand (FMA-U and FMA-H). Functional status was measured using the Modified Barthel Index (MBI). Patients were classified into subgroups according to DTT findings, MEP presence, fractional anisotropy (FA) value, FA ratio (rFA), and central motor conduction time (CMCT). Correlations of clinical assessments with DTT parameters and MEPs were estimated.

Results

Fifty-five patients with hemiplegia were recruited. In motor assessments (FMA-U), MEPs had the highest sensitivity and negative predictive value (NPV) as well as the second highest specificity and positive predictive value (PPV). CMCT showed the highest specificity and PPV. Regarding functional status (MBI), FA showed the highest sensitivity and NPV, whereas CMCT had the highest specificity and PPV. Correlation analysis showed that the resting motor threshold (RMT) ratio was strongly associated with motor status of the upper limb, and MEP parameters were not associated with MBI.

Conclusion

DTT and MEPs could be suitable complementary modalities for analyzing the motor and functional status of patients in the subacute stage of stroke. The RMT ratio was strongly correlated with motor status.

Topographic organization of motor fibre tracts in the human brain: findings in multiple locations using magnetic resonance diffusion tensor tractography

OBJECTIVES

To identify the hand and foot fibre tracts of the corticospinal tract (CST), and to evaluate the relative locations, angles, and distances of two fibre tracts using diffusion tensor tractography (DTT).

METHODS

Twelve healthy subjects were enrolled. The regions of interests (ROIs) were drawn in the functional magnetic resonance imaging (fMRI) activation areas and pons in each subject for fibre tracking. We evaluated fibre tract distributions using distances and angles between two fibre tracts starting from the location of a hand fibre tract in multiple brain regions.

RESULTS

The measured angles and distances were 96.43-150°/2.69-9.93 mm (upper CR), 91.86-180°/1.63-7.42 mm (lower CR), 54.47-75°/0.75-4.45 mm (PLIC), and 3.65-90°/0.11-2.36 mm (pons), respectively. The distributions between CR and other sections, such as PLIC and pons, were statistically significant (p < 0.05). There were no significant differences between the upper and lower CR\ or between the PLIC and pons.

CONCLUSIONS

This study showed that the somatotopic arrangement of the hand fibre tract was located at the anterolateral portion in CR and at the anteromedial portion in PLIC and pons, based on the foot fibre. Our methods and results seem to be helpful in motor control neurological research.

KEY POINTS

• We evaluated somatotopic arrangement of CST at multiple anatomical locations. • Somatotopic arrangements and fibre tract distributions were evaluated based on hand fibre location. • Relative angles, locations, and distances between two fibres vary according to their anatomical locations.

A note on the mapping and quantification of the human brain corticospinal tract

Several diffusion tensor imaging tractography (DTT) have been adopted to construct the living human brain corticospinal tract. In this Note, we applied method "A" as recently described and used by "Lin CC, Tsai MY, Lo YC, et al. Reproducibility of corticospinal diffusion tensor tractography innormal subjects and hemiparetic stroke patients. Eur J Radiol 2013;82: e610-6." We compared the results obtained with method "A" with those obtained using an anatomy-guided method "B" on two healthy adults. We also quantified the results using tract volume, and corresponding fractional anisotropy, mean, and radial diffusivities. We demonstrate that accurate mapping and quantification of CST requires at least two regions of interest one at the level of the medulla oblongata, a second at the level of pons, this assures termination at the motor spine and contamination with cerebellar and sensory pathways.