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DTI as a promising tool for a deeper understanding of white matter pathology

DTI as a promising tool for a deeper understanding of white matter pathology. Ansgar Furst, Ph.D. Director of Neuroimaging Laboratory, WRIISC VA Palo Alto, CA Clinical Assistant Professor (Affiliated) of Psychiatry and Behavioral Sciences and of Neurology and Neurological Sciences

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DTI as a promising tool for a deeper understanding of white matter pathology

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  1. DTI as a promising tool for a deeper understanding of white matter pathology Ansgar Furst, Ph.D. Director of Neuroimaging Laboratory, WRIISC VA Palo Alto, CA Clinical Assistant Professor (Affiliated) of Psychiatry and Behavioral Sciences and of Neurology and Neurological Sciences Stanford University School of Medicine, CA

  2. Neuroimaging- What else? • Diffusion Tensor Imaging (DTI) • F-MRI • Diffusion-Weighted Imaging • Diffusion-Spectrum Imaging • Magnetic Resonance Spectroscopy • Magnetization Transfer Imaging • Magnetic Source Imaging

  3. Neuroimaging- What else? • Diffusion Tensor Imaging (DTI) • F-MRI • Diffusion-Weighted Imaging • Diffusion-Spectrum Imaging • Magnetic Resonance Spectroscopy • Magnetization Transfer Imaging • Magnetic Source Imaging

  4. Too many imaging sequences ?

  5. Broad classification scheme Structure Function T1-weighted T2-weighted T2-FLAIR T2*-GRE SWI DTI fMRI PET

  6. Broad classification scheme Structure Function Mass effects Volume changes Midline shifts Altered synaptic/ metabolic activity, network connectivity

  7. Broad classification scheme Structure Mass effects Volume changes Midline shifts

  8. Broad classification scheme Function Altered synaptic/ metabolic activity, network connectivity Stay tuned …

  9. Diffusion Tensor Imaging (DTI) • MR sequence (available since the 90s) relatively simple to implement and time efficient • Measures microscopic motion of water molecules in brain tissue • Gives an indirect account of integrity & connectivity of white matter fiber tracts

  10. How does it work ?

  11. How does it work ?

  12. Soaker hose analogy

  13. Soaker hose analogy

  14. FA maps – no sense of direction

  15. Tensors code direction of movement

  16. (Directionally) colored FA maps Anterior Superior Left Right Inferior Posterior

  17. Patient 014 • 32-year old OIF veteran • Blow to the head with LOC ~ 2 min, additional LOC in bar fight and motor cycle accident < 1 min • Was in vicinity of numerous mortar blasts – no LOC but confused about circumstances afterwards • Patient complains about severe headache • Was diagnosed with TBI during WRIISC visit

  18. Patient 014

  19. Patient 014

  20. Patient 014

  21. Patient 014

  22. Patient 014

  23. Patient 014

  24. DTI – just pretty pictures ? • DTI imaging (particularly fiber tracking) can be a very powerful tool in identifying otherwise unnoticed white matter compromises • However, customized fiber tracking is very time consuming and difficult to automatize as each patient’s fiber tract architecture is unique • In order to be useful to clinicians more easily interpretable, reliable quantification of white matter damage is needed

  25. DTI – towards a diagnostic tool Please come and visit us at our poster!

  26. Suggested reading If you want to learn more about DTI Recent data showing superior sensitivity of DTI in detecting TBI

  27. THANK YOU!

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