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Diffusion Tensor Imaging and Fiber Tractography in Children with Craniosynostosis Syndromes
B F M Rijken1, A Leemans2, Y Lucas3
1From the Departments of Plastic and Reconstructive Surgery and Hand Surgery (B.F.M.R., Y.L., I.M.J.M.) b.rijken@erasmusmc.nl.
Insights
Diffusion tensor imaging (DTI) fiber tractography in craniosynostosis patients is challenging but reveals normal fiber organization despite altered white matter microarchitecture. Increased diffusivity suggests underlying tissue property changes in these patients.
Area of Science:
- Neuroimaging
- Medical Physics
- Genetics
Background:
- Craniosynostosis syndromes result from genetic mutations (FGFR-2, FGFR-3, TWIST1) causing premature suture fusion and brain anomalies.
- Altered white matter microarchitecture is a known complication in craniosynostosis patients.
Purpose of the Study:
- To investigate the reliability and reproducibility of Diffusion Tensor Imaging (DTI) fiber tractography in patients with craniosynostosis syndromes.
- To compare DTI outcomes between patients with craniosynostosis and healthy controls.
Main Methods:
- DTI datasets acquired using a 1.5T MR imaging system.
- Reconstruction of white matter tracts (corpus callosum, cingulate gyrus, fornix, corticospinal tracts, medial cerebellar peduncle) using ExploreDTI software.
- Study included 58 surgically treated craniosynostosis patients and 7 controls (age 6-18 years).
Main Results:
- DTI fiber tractography was challenging due to brain deformity and abnormal ventricular shapes in craniosynostosis patients.
- Adapted tracking protocols yielded reliable tracts.
- No significant difference in fractional anisotropy was observed between patients and controls (0.44 vs 0.45).
- Increased mean, axial, and radial diffusivity parameters were found in the white matter of craniosynostosis patients (P < .001).
Conclusions:
- DTI fiber tractography in craniosynostosis is feasible but technically demanding due to anatomical distortions.
- Despite normal fiber organization, increased diffusivity parameters indicate abnormal white matter microstructural tissue properties.
- Findings suggest subtle microstructural changes in white matter tracts of craniosynostosis patients.
Background And Purpose:
Patients with craniosynostosis syndromes caused by mutations in FGFR-2, FGFR-3, and TWIST1 genes are characterized by having prematurely fused skull sutures and skull base synchondroses, which result in a skull deformity and are accompanied by brain anomalies, including altered white matter microarchitecture. In this study, the reliability and reproducibility of DTI fiber tractography was investigated in these patients. The outcomes were compared with those of controls.
Materials And Methods:
DTI datasets were acquired with a 1.5T MR imaging system with 25 diffusion gradient orientations (voxel size = 1.8 × 1.8 × 3.0 mm(3), b-value = 1000 s/mm(2)). White matter tracts studied included the following: corpus callosum, cingulate gyrus, fornix, corticospinal tracts, and medial cerebellar peduncle. Tract pathways were reconstructed with ExploreDTI in 58 surgically treated patients with craniosynostosis syndromes and 7 controls (age range, 6-18 years).
Results:
Because of the brain deformity and abnormal ventricular shape and size, DTI fiber tractography was challenging to perform in patients with craniosynostosis syndromes. To provide reliable tracts, we adapted standard tracking protocols. Fractional anisotropy was equal to that in controls (0.44 versus 0.45 ± 0.02, P = .536), whereas mean, axial, and radial diffusivity parameters of the mean white matter were increased in patients with craniosynostosis syndromes (P < .001). No craniosynostosis syndrome-specific difference in DTI properties was seen for any of the fiber tracts studied in this work.
Conclusions:
Performing DTI fiber tractography in patients with craniosynostosis syndromes was difficult due to partial volume effects caused by an anisotropic voxel size and deformed brain structures. Although these patients have a normal fiber organization, increased diffusivity parameters suggest abnormal microstructural tissue properties of the investigated white matter tracts.
