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Diffusion Tensor Tractography in the Head-and-Neck Reg ion Using a Clinical 3-T MR Scanner

Posted Jun 30, 2009 Updated Apr 7, 2023
By Masuma Akter MD , Toshinori Hirai MD PhD , Ryosei Minoda MD , Ryuji Murakami MD , Shutaro Saiki , Tomoyuki Okuaki , Mika Kitajima MD , Hirofumi Fukuoka MD , Akira Sasao MD , Shinichiro Nishimura MD , Eiji Yumoto MD PhD , Kazuo Awai MD , Yasuyuki Yamashita MD PhD
12 min read

Rationale and Objectives

Diffusion tensor tractography (DTT) for neural fibers of the head-and-neck region at 3T has not been reported. The purpose of this study was to evaluate the feasibility of using DTT for visualizing neural fibers in the head-and-neck region at 3T and to explore the use of this method in patients with head-and-neck mass lesions.

Materials and Methods

Using a 3T scanner, we obtained magnetic resonance images of the head and neck region in 5 healthy volunteers and 5 patients with head and neck mass lesions. All subjects underwent anatomic T1-weighted and diffusion-tensor imaging using a sequence with six motion-probing gradient orientations, a b value of 800 second/mm 2 , and a 128 × 128 pixel matrix. Fiber tracking was with the continuous tracking method. Different postprocessing parameters were investigated to optimize fiber density detection and minimize noise. In five patients with head-and-neck mass lesions, comparison of tractography results and operative findings with regards to mass and nerve relationship was also performed by two observers.

Results

Using the two regions-of-interest method, the greatest fiber density of presumed inferior alveolar nerves was depicted at a maximum angle of 40° and a minimum fiber length of 10 mm. DTT was successfully depicted in all 5 patients. In 4 patients, the relationship between DTT and operative findings was coincided or similar. The interobserver agreement was good.

Conclusions

DTT of the neural fibers in the head and neck region is feasible using a clinical 3T magnetic resonance scanner. Data from a small number of patients with head-and-neck lesions show good agreement between tractography and operative results.

Diffusion tensor magnetic resonance imaging (DT-MRI) and fiber tractography or diffusion tensor tractography (DTT) can be used to visualize the three-dimensional macroscopic fiber tract architecture . These techniques, widely used to demonstrate specific white matter tracts, are useful for evaluating various pathologic conditions in the brain . They have also been applied to visualize neural fibers of the cranial nerves .

Surgery of the head and neck raises the possibility of cranial or cervical nerve damage . Understanding the relationship between the course of nerve fibers and lesions of the head and neck may help to prevent postoperative neurologic complications. To our knowledge, DTT for neural fibers of the head-and-neck region at 3 T has not been reported, probably because of susceptibility or chemical shift artifacts. DTT with a 3-T MRI scanner using a parallel imaging technique and a fat saturation method may allow visualization of the neural fibers in the head and neck. The purpose of this study was to evaluate the feasibility of DTT to depict neural fibers in the head and neck using a 3-T MRI scanner, a parallel imaging technique, and a fat saturation method.

Materials and methods

Study Subjects

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Table 1

Summary of Patient Characteristics and DTT and Operative Findings in 5 Patients Treated by Surgery

Degree of Coincidence Case/Age/Sex Tumor Type DTT Findings Surgical Findings Observer 1 Observer 2 1/40/F Vagus nerve Schwannoma A tract bundle lateral to a mass A nerve superficial to a mass Grade 2 Grade 2 2/87/F Thyroid carcinoma with LN metastasis Tract bundles lateral to a mass Nerves superficial to a mass Grade 1 Grade 1 3/72/M Warthin tumor Tract bundles lateral and anterior to a mass Nerves superficial to a mass Grade 1 Grade 1 4/66/M Pleomorphic adenoma Tract bundles lateral and medial to a mass Nerves superficial and deep to a mass Grade 1 Grade 1 5/54/M Ductal-type carcinoma Tract bundles lateral to a mass Nerves superficial to a mass Grade 1 Grade 0

DTT: diffusion tensor tractography; LN: lymph node; Grade 2: the relationship of the tracts to the mass depicted on DTT images well coincided with that of the nerves to the mass observed during the operation; Grade 1: the relationship of the tracts to the mass depicted on DTT images partially coincided with that of the nerves to the mass observed during the operation; Grade 0: the relationship of the tracts to the mass depicted on DTT images was not simillar to that of the nerves to the mass observed during the operation.

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MRI Data Acquisition

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Image Analysis

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Fiber Tracking

Fiber Tracking optimization

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Figure 1, Diffusion tensor tractography (DTT) in a 25-year-old female volunteer. (a) In the single region-of-interest (ROI) method, the ROI ( pink area ) was manually placed to cover the orifice of the right inferior alveolar canal in the mandible on transverse ( left ) and coronal ( right ) b = 0 image of diffusion-weighted magnetic resonance imaging (MRI). In the two-ROI method, the first ROI was identically placed and the second ROI ( brown area ) was placed 1 cm apart and above the first ROI. On the DTT images obtained with the two-ROI method with a maximum angle of 40° and a minimum fiber length of 10 mm, the presumed inferior alveolar nerve bundles ( green tract ) to the inferior alveolar canal are depicted. (b) With the single-ROI method with a maximum angle of 60° and a minimum fiber length of 10 mm, DTT images superimposed on transverse ( left ) and coronal ( right ) b = 0 image of diffusion-weighted MRIs showed many “noise” fibers that appear to be muscle fibers. On the coronal DTT image ( right ), the presumed inferior alveolar nerve bundles ( arrow ) to the inferior alveolar canal are visualized.

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Technique Exploration in Patients with Head and Neck Mass Lesions

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Results

Fiber Tracking Optimization

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Table 2

The Mean Fiber Density of Visualized Tracts in Inferior Alveolar Canal Region on DTT with Single-ROI Method

Maximum Angle 10° 20° 30° 40° 50° 60° 70° Minimum fiber length 10 mm 0.13 ± 0.40 (0/1) 1.05 ± 1.56 (0/7) 2.77 ± 2.43 (10/10) 6.62 ± 4.79 (10/10) 10.4 ± 5.87 (10/10) 16.1 ± 8.70 (10/10) 19.5 ± 9.15 (10/10) 20 mm 0 0.13 ± 0.40 (0/1) 1.08 ± 1.12 (8/8) 3.69 ± 3.15 (10/10) 6.34 ±3.76 (10/10) 8.60 ± 4.08 (10/10) 9.75 ± 5.07 (10/10) 30 mm 0 0 0 0 0.10 ± 0.30 (1/1) 0.61 ± 0.96 (5/5) 1.12 ± 1.82 (5/5)

DTT, diffusion tensor tractography; Minimum fiber length, a minimum length of fiber continuity that is required during fiber tracking; Maximum angle, a maximum angle that prohibited the turning of angles during fiber tracking; ROI, region-of-interest.

The number indicates mean fiber density ± standard deviations. Numbers in parentheses are the number of location having ‘noise’ fibers relative to a total number of location with visualized fibers.

Table 3

The Mean Fiber Density of Visualized Tracts in Inferior Aveolar Canal Region on DTT with Two-ROI Method

Maximum Angle 10° 20° 30° 40° 50° 60° 70° Minimum fiber length 10 mm 0 0.13 ± 0.22 (0/3) 2.01 ± 1.46 (0/9) 6.05 ± 4.03 (0/10) 8.22 ± 3.82 (9/10) 9.43 ± 3.82 (10/10) 10.1 ± 3.87 (10/10) 20 mm 0 0.32 ± 0.10 (0/1) 1.18 ± 1.13 (0/7) 4.24 ± 3.72 (0/10) 5.80 ± 3.83 (8/10) 6.91 ± 3.71 (10/10) 7.55 ± 3.87 (10/10) 30 mm 0 0 0 0 0.03 ± 0.10(1/1) 0.16 ± 0.31(3/3) 0.64 ± 1.29 (4/4)

DTT, diffusion tensor tractography; ROI, region-of-interest.

The number indicates mean fiber density ± standard deviations. Numbers in parantheses are the number of location having “noise” fibers relative to a total number of location with visualized fibers.

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Technique Exploration in Patients with Head-and-Neck Mass Lesions

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Figure 2, A 40-year-old woman with vagus nerve schwannoma. (a) T2-weighted coronal image shows a hyperintense mass (T) in the right deep neck. (b) On diffusion tensor tractography (DTT) image superimposed on a coronal color map, a tract bundle adjacent to a mass (T) is shown ( arrow ). A tract of the other nerves is also visualized ( arrowhead ). (c) On DTT image superimposed on an axial color map, a tract bundle adjacent to a mass (T) is also shown ( arrow ). Arrow head indicates a tract of the other nerves. (d) The operative view shows the hypoglossal nerve ( arrow ) superficial to a mass (T). The relationship of a tract bundle lateral to the mass depicted on the DTT image well coincided with that of the nerve to the mass observed during the operation. Both observers classified this case as Grade 2. The vagus nerve shrunken was seen in deep position of the mass. E: The external carotid artery; A: anterior; P: posterior; Cr: cranial; Ca: caudal.

Figure 3, A 72-year-old man with Warthin tumor. (a) T2-weighted axial image shows a mass (T) in the left parotid gland. (b) On diffusion tensor tractography (DTT) image superimposed on a three-dimensional color map, a tract bundle considered to represent a facial nerve branch superficial to a mass (T) is shown ( arrow ). A tract bundle of the presumed other nerve is also visualized ( arrowhead ). (c) The operative view shows three branches of the facial nerve ( arrows ) superficial to a mass (T). One branch of the facial nerve was visualized on DTT. The relationship of the tracts to the mass depicted on DTT images partially coincided with that of the nerves to the mass observed during the operation. Both observers classified this case as Grade 1. A: anterior; P: posterior; Cr: cranial; Ca: caudal.

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Discussion

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Conclusion

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Academic Radiology, Volume 16, Issue 7
Journals General Radiology
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