Potential of diffusion tensor MRI in the assessment of periventricular leukomalacia.

AIM: To investigate magnetic resonance (MR) diffusion tensor imaging (DTI) and fibre tractography in the assessment of altered major white matter (WM) fibre tracts in periventricular leukomalacia (PVL).

MATERIALS AND METHODS: Twelve children (male:female = 7:5, age range 3-10 years; mean age = 6.5 years) who had suffered PVL were included in this study. Meanwhile, Twelve age-matched normal controls (male:female = 6:6, age range 4-12 years; mean age = 7.3 years) with normal MRI findings and no neurological abnormalities were recruited for comparison. DTI was performed with 15 different diffusion gradient directions and DTI colour maps were created from fractional anisotropy (FA) values and the three vector elements. To identify alteration of WM fibre tracts in patient of PVL quantitatively, FA values on diffusion tensor colour maps were compared between the patients and controls. Quantitative analysis was performed using the regions of interest (ROI) method settled on the central part of all identifiable WM fibres, including the corticospinal tract (CST) in the brainstem, middle cerebellar peduncle (MCP), medial lemniscus (ML), anterior/posterior limb of internal capsule (ICAL/ICPL), arcuate fasciculus (AF), posterior thalamic radiation (PTR), genu of corpus callosum (GCC), splenium of corpus callosum (SCC), corona radiata (CR), cingulum (CG), and superior longitudinal fasciculus (SLF). The averaged FA value of each WM fibre was measured and summarized as the mean +/- standard deviation (SD). All data were analysed by paired Student's t-test. A p-value of less than 0.05 was considered to indicate statistical significance.

RESULTS: Visual investigation of WM fibre tracts showed that the ICAL, brainstem CST, ML, MCP, and external capsule (EC) was similar in controls and subjects. However, the ICPL, AF, PTR, CR, CG, SLF and corpus callosum, were all attenuated in size. All 12 cases of PVL showed a significant mean FA reduction in the ICPL, AF, PTR, CR, CG, SLF, SCC, and GCC in comparison with the ipsilateral regions of healthy controls (p<0.05). However, there were no statistically significant differences of the ICAL, ML, MCP, and brainstem CST when analysed using a two-tailed Student's t-test for paired data (p>0.01).

CONCLUSION: DTI can provide more information for understanding the pathophysiology of motor disability and associated sensory handicap in PVL.