Clinical Use of DTI Guido Gerig MIDAGUNC Acknowledgments

Clinical Use of DTI Guido Gerig MIDAG@UNC

Acknowledgments Contributors: • Andy Alexander • Susumo Mori • The University of North Carolina Chapel Hill (UNC) National Alliance for Medical Image Computing (NIH U 54 EB 005149) Early Brain Development MIDAG@UNC

DTI Applications • Normal brain development and aging • Congenital anomalies and diseases of white matter • Traumatic brain injury • Encephalopathies – toxic, metabolic, infectious • Demyelinating and neurodegenerative diseases • Ischemia and stroke • Neoplasm, preoperative planning • Epilepsy • Dementia, schizophrenia, depression • Developmental disorders - fragile X, autism • Spinal Cord ASNR 2003 –Washington, DC DT-MRI Alexander 6

Normal Brain Development Courtesy J. Neil Washington St. Louis ASNR 2003 Univ. , –Washington, DC DT-MRI Alexander 7

WM Anisotropy Changes with Age Anterior . 8 genu FA frontal pericallosal Genu Left pericallosal Right pericallosal . 7. 6 Pfefferbaum et al. MRM 2000 centrum semiovale . 5. 4. 3 20 30 40 50 Age 60 70 Posterior 80 Splenium Left pericallosal Right pericallosal . 8. 7 FA parietal pericallosal . 44 . 38. 36 . 4 . 34 20 . 3 ASNR 2003 –Washington, DC . 46 . 40 . 5 20 Centrum Semiovale . 42 . 6 splenium . 48 30 40 50 Age 60 70 80 DT-MRI Alexander 30 40 50 Age 60 70 80 Courtesy K. Lim, Univ. Minn. 8

Multiple Sclerosis R. Bammer, F. Fazekas, Neuroim Clinics N Am, Feb. 2002. ASNR 2003 –Washington, DC DT-MRI Alexander STANFORD 9 S C H O O L OF M E D I C I N E Lucas MRS/I Center

DTI in Cerebral Neoplasms Deviated Infiltrated Edematous Destroyed ASNR 2003 –Washington, DC DT-MRI Alexander 12

Tract Displacement T 2 W ADC FA FA 1 ASNR 2003 –Washington, DC DT-MRI Alexander 13

Cerebral Palsy Courtesy of Susumu Mori

Fiber Tract-Oriented Statistics for Quantitative Diffusion Tensor MRI Analysis Isabelle Corouge 1, 2, P. Thomas Fletcher 4, Sarang Joshi 3, John H. Gilmore 2, Guido Gerig 1, 2 1 Depts of Computer Science, 2 Psychiatry, 3 Radiation Oncology, UNC-Chapel Hill, USA 4 Scientific Computing and Imaging Institute, University of Utah, USA MICCAI 2005 17 - October 27, 2005

Quantitative Tractography Tract ROIs FA along tracts Tensors statisics along spines FA motor tract MD motor tract - Tractography for ROI definition - Tensor-math. for statistics along tracts MICCAI 2005 18 - October 27, 2005

Fiber Tract Modeling and Analysis MICCAI 2005 19 - October 27, 2005

Experiments and Results • Data – 3 Tesla high resolution (2 x 2 x 2 mm 3) DT MRI database – 8 subjects: 4 neonates at 2 weeks-old, 4 one year-old – Fiber tracts: genu and splenium Neonate at 2 weeks-old MICCAI 2005 20 One year-old - 20 - October 27, 2005

Experiments and Results Splenium Genu • Average of diffusion tensors in cross-sections along tracts 2 weeks-old MICCAI 2005 21 One year-old - 21 - October 27, 2005

Experiments and Results 0 • Diffusion properties along fiber tracts Eigenvalues Fractional Anistropy Genu Mean Diffusivity 0 0 Splenium 0 MICCAI 2005 22 - October 27, 2005

Neonate Krabbe’s - Motor • • • Internal capsule from brain stem to superior cortex Left and right hemispheric bundles FA values on bundle Premotor cortex Prefrontal cortex Motor cortex VL thalamus corona radiata superior cerebellar peduncle Deep cerebellar nuc-dentate internal capsule cerebral peduncle Pontine nuclei Cerebellar cortex middle cerebellar peduncle Fallon MICCAI 2005 23 - October 27, 2005

Visualization - Left Bundle Controls FA seems to correlate with outcome • At 1. 5 y • Walks • Good motor MICCAI 2005 24 • At 3 m • Ok so far - 24 - • At 1 y • Weak trunk • Bad motor October 27, 2005

Visualization - Right Bundle Controls FA higher in Cnt than Krabbe • At 1. 5 y • Walks • Good motor MICCAI 2005 25 • At 3 m • Ok so far - 25 - • At 1 y • Weak trunk • Bad motor October 27, 2005

FA Statistics along Fibers • • • Lower FA across most of bundle for Krabbe Bad motor case has consistently lowest FA on left bundle Possible predictor for outcome? Controls good motor bad motor good motor MICCAI 2005 26 - October 27, 2005