Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2003 Feb;74(2):203–207. doi: 10.1136/jnnp.74.2.203

Pyramidal tract mapping by diffusion tensor magnetic resonance imaging in multiple sclerosis: improving correlations with disability

M Wilson 1, C Tench 1, P Morgan 1, L Blumhardt 1
PMCID: PMC1738288  PMID: 12531950

Abstract

Background: Current magnetic resonance imaging (MRI) outcome measures such as T2 lesion load correlate poorly with disability in multiple sclerosis. Diffusion tensor imaging (DTI) of the brain can provide unique information regarding the orientation and integrity of white matter tracts in vivo.

Objective: To use this information to map the pyramidal tracts of patients with multiple sclerosis, investigate the relation between burden of disease in the tracts and disability, and compare this with more global magnetic resonance estimates of disease burden.

Methods: 25 patients with relapsing-remitting multiple sclerosis and 17 healthy volunteers were studied with DTI. An algorithm was used that automatically produced anatomically plausible maps of white matter tracts. The integrity of the pyramidal tracts was assessed using relative anisotropy and a novel measure (Lt) derived from the compounded relative anisotropy along the tracts. The methods were compared with both traditional and more recent techniques for measuring disease burden in multiple sclerosis (T2 lesion load and "whole brain" diffusion histograms).

Results: Relative anisotropy and Lt were significantly lower in patients than controls (p < 0.05). Pyramidal tract Lt in the patients correlated significantly with both expanded disability status scale (r = -0.48, p < 0.05), and to a greater degree, the pyramidal Kurtzke functional system score (KFS-p) (r = -0.75, p < 0.0001). T2 lesion load and diffusion histogram parameters did not correlate with disability.

Conclusions: Tract mapping using DTI is feasible and may increase the specificity of MRI in multiple sclerosis by matching appropriate tracts with specific clinical scoring systems. These techniques may be applicable to a wide range of neurological conditions.

Full Text

The Full Text of this article is available as a PDF (172.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barbosa S., Blumhardt L. D., Roberts N., Lock T., Edwards R. H. Magnetic resonance relaxation time mapping in multiple sclerosis: normal appearing white matter and the "invisible" lesion load. Magn Reson Imaging. 1994;12(1):33–42. doi: 10.1016/0730-725x(94)92350-7. [DOI] [PubMed] [Google Scholar]
  2. Basser P. J., Pajevic S., Pierpaoli C., Duda J., Aldroubi A. In vivo fiber tractography using DT-MRI data. Magn Reson Med. 2000 Oct;44(4):625–632. doi: 10.1002/1522-2594(200010)44:4<625::aid-mrm17>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  3. Basser P. J., Pierpaoli C. A simplified method to measure the diffusion tensor from seven MR images. Magn Reson Med. 1998 Jun;39(6):928–934. doi: 10.1002/mrm.1910390610. [DOI] [PubMed] [Google Scholar]
  4. Cercignani M., Iannucci G., Rocca M. A., Comi G., Horsfield M. A., Filippi M. Pathologic damage in MS assessed by diffusion-weighted and magnetization transfer MRI. Neurology. 2000 Mar 14;54(5):1139–1144. doi: 10.1212/wnl.54.5.1139. [DOI] [PubMed] [Google Scholar]
  5. Christiansen P., Gideon P., Thomsen C., Stubgaard M., Henriksen O., Larsson H. B. Increased water self-diffusion in chronic plaques and in apparently normal white matter in patients with multiple sclerosis. Acta Neurol Scand. 1993 Mar;87(3):195–199. doi: 10.1111/j.1600-0404.1993.tb04100.x. [DOI] [PubMed] [Google Scholar]
  6. Davie C. A., Barker G. J., Webb S., Tofts P. S., Thompson A. J., Harding A. E., McDonald W. I., Miller D. H. Persistent functional deficit in multiple sclerosis and autosomal dominant cerebellar ataxia is associated with axon loss. Brain. 1995 Dec;118(Pt 6):1583–1592. doi: 10.1093/brain/118.6.1583. [DOI] [PubMed] [Google Scholar]
  7. Davie C. A., Hawkins C. P., Barker G. J., Brennan A., Tofts P. S., Miller D. H., McDonald W. I. Serial proton magnetic resonance spectroscopy in acute multiple sclerosis lesions. Brain. 1994 Feb;117(Pt 1):49–58. doi: 10.1093/brain/117.1.49. [DOI] [PubMed] [Google Scholar]
  8. Filippi M., Iannucci G., Cercignani M., Assunta Rocca M., Pratesi A., Comi G. A quantitative study of water diffusion in multiple sclerosis lesions and normal-appearing white matter using echo-planar imaging. Arch Neurol. 2000 Jul;57(7):1017–1021. doi: 10.1001/archneur.57.7.1017. [DOI] [PubMed] [Google Scholar]
  9. Gonen O., Catalaa I., Babb J. S., Ge Y., Mannon L. J., Kolson D. L., Grossman R. I. Total brain N-acetylaspartate: a new measure of disease load in MS. Neurology. 2000 Jan 11;54(1):15–19. doi: 10.1212/wnl.54.1.15. [DOI] [PubMed] [Google Scholar]
  10. Grossman R. I., Gomori J. M., Ramer K. N., Lexa F. J., Schnall M. D. Magnetization transfer: theory and clinical applications in neuroradiology. Radiographics. 1994 Mar;14(2):279–290. doi: 10.1148/radiographics.14.2.8190954. [DOI] [PubMed] [Google Scholar]
  11. Horsfield M. A., Lai M., Webb S. L., Barker G. J., Tofts P. S., Turner R., Rudge P., Miller D. H. Apparent diffusion coefficients in benign and secondary progressive multiple sclerosis by nuclear magnetic resonance. Magn Reson Med. 1996 Sep;36(3):393–400. doi: 10.1002/mrm.1910360310. [DOI] [PubMed] [Google Scholar]
  12. Horsfield M. A., Larsson H. B., Jones D. K., Gass A. Diffusion magnetic resonance imaging in multiple sclerosis. J Neurol Neurosurg Psychiatry. 1998 May;64 (Suppl 1):S80–S84. [PubMed] [Google Scholar]
  13. Hsu E. W., Muzikant A. L., Matulevicius S. A., Penland R. C., Henriquez C. S. Magnetic resonance myocardial fiber-orientation mapping with direct histological correlation. Am J Physiol. 1998 May;274(5 Pt 2):H1627–H1634. doi: 10.1152/ajpheart.1998.274.5.H1627. [DOI] [PubMed] [Google Scholar]
  14. Jones D. K., Simmons A., Williams S. C., Horsfield M. A. Non-invasive assessment of axonal fiber connectivity in the human brain via diffusion tensor MRI. Magn Reson Med. 1999 Jul;42(1):37–41. doi: 10.1002/(sici)1522-2594(199907)42:1<37::aid-mrm7>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  15. Kurtzke J. F. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983 Nov;33(11):1444–1452. doi: 10.1212/wnl.33.11.1444. [DOI] [PubMed] [Google Scholar]
  16. Miller D. H., Grossman R. I., Reingold S. C., McFarland H. F. The role of magnetic resonance techniques in understanding and managing multiple sclerosis. Brain. 1998 Jan;121(Pt 1):3–24. doi: 10.1093/brain/121.1.3. [DOI] [PubMed] [Google Scholar]
  17. Mori S., Crain B. J., Chacko V. P., van Zijl P. C. Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol. 1999 Feb;45(2):265–269. doi: 10.1002/1531-8249(199902)45:2<265::aid-ana21>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  18. Moseley M. E., Cohen Y., Kucharczyk J., Mintorovitch J., Asgari H. S., Wendland M. F., Tsuruda J., Norman D. Diffusion-weighted MR imaging of anisotropic water diffusion in cat central nervous system. Radiology. 1990 Aug;176(2):439–445. doi: 10.1148/radiology.176.2.2367658. [DOI] [PubMed] [Google Scholar]
  19. Nusbaum A. O., Tang C. Y., Wei T., Buchsbaum M. S., Atlas S. W. Whole-brain diffusion MR histograms differ between MS subtypes. Neurology. 2000 Apr 11;54(7):1421–1427. doi: 10.1212/wnl.54.7.1421. [DOI] [PubMed] [Google Scholar]
  20. Riahi F., Zijdenbos A., Narayanan S., Arnold D., Francis G., Antel J., Evans A. C. Improved correlation between scores on the expanded disability status scale and cerebral lesion load in relapsing-remitting multiple sclerosis. Results of the application of new imaging methods. Brain. 1998 Jul;121(Pt 7):1305–1312. doi: 10.1093/brain/121.7.1305. [DOI] [PubMed] [Google Scholar]
  21. Rowley H. A., Grant P. E., Roberts T. P. Diffusion MR imaging. Theory and applications. Neuroimaging Clin N Am. 1999 May;9(2):343–361. [PubMed] [Google Scholar]
  22. Roychowdhury S., Maldjian J. A., Grossman R. I. Multiple sclerosis: comparison of trace apparent diffusion coefficients with MR enhancement pattern of lesions. AJNR Am J Neuroradiol. 2000 May;21(5):869–874. [PMC free article] [PubMed] [Google Scholar]
  23. Scollan D. F., Holmes A., Winslow R., Forder J. Histological validation of myocardial microstructure obtained from diffusion tensor magnetic resonance imaging. Am J Physiol. 1998 Dec;275(6 Pt 2):H2308–H2318. doi: 10.1152/ajpheart.1998.275.6.H2308. [DOI] [PubMed] [Google Scholar]
  24. Stevenson V. L., Miller D. H. Magnetic resonance imaging in the monitoring of disease progression in multiple sclerosis. Mult Scler. 1999 Aug;5(4):268–272. doi: 10.1177/135245859900500413. [DOI] [PubMed] [Google Scholar]
  25. Tievsky A. L., Ptak T., Farkas J. Investigation of apparent diffusion coefficient and diffusion tensor anisotrophy in acute and chronic multiple sclerosis lesions. AJNR Am J Neuroradiol. 1999 Sep;20(8):1491–1499. [PMC free article] [PubMed] [Google Scholar]
  26. Werring D. J., Clark C. A., Barker G. J., Thompson A. J., Miller D. H. Diffusion tensor imaging of lesions and normal-appearing white matter in multiple sclerosis. Neurology. 1999 May 12;52(8):1626–1632. doi: 10.1212/wnl.52.8.1626. [DOI] [PubMed] [Google Scholar]
  27. Werring D. J., Toosy A. T., Clark C. A., Parker G. J., Barker G. J., Miller D. H., Thompson A. J. Diffusion tensor imaging can detect and quantify corticospinal tract degeneration after stroke. J Neurol Neurosurg Psychiatry. 2000 Aug;69(2):269–272. doi: 10.1136/jnnp.69.2.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Wieshmann U. C., Symms M. R., Parker G. J., Clark C. A., Lemieux L., Barker G. J., Shorvon S. D. Diffusion tensor imaging demonstrates deviation of fibres in normal appearing white matter adjacent to a brain tumour. J Neurol Neurosurg Psychiatry. 2000 Apr;68(4):501–503. doi: 10.1136/jnnp.68.4.501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Wilson M., Morgan P. S., Lin X., Turner B. P., Blumhardt L. D. Quantitative diffusion weighted magnetic resonance imaging, cerebral atrophy, and disability in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2001 Mar;70(3):318–322. doi: 10.1136/jnnp.70.3.318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Xue R., van Zijl P. C., Crain B. J., Solaiyappan M., Mori S. In vivo three-dimensional reconstruction of rat brain axonal projections by diffusion tensor imaging. Magn Reson Med. 1999 Dec;42(6):1123–1127. doi: 10.1002/(sici)1522-2594(199912)42:6<1123::aid-mrm17>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  31. van Waesberghe J. H., Kamphorst W., De Groot C. J., van Walderveen M. A., Castelijns J. A., Ravid R., Lycklama à Nijeholt G. J., van der Valk P., Polman C. H., Thompson A. J. Axonal loss in multiple sclerosis lesions: magnetic resonance imaging insights into substrates of disability. Ann Neurol. 1999 Nov;46(5):747–754. doi: 10.1002/1531-8249(199911)46:5<747::aid-ana10>3.3.co;2-w. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES