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DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions

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Published on: August 26, 2014

Visual pathway impairment by pituitary adenomas: quantitative diagnostics by diffusion tensor imaging.

Ylva Lilja^1,2, Oscar Gustafsson^3,4, Maria Ljungberg^3,4

¹Department of Clinical Neuroscience and Rehabilitation and.

Journal of Neurosurgery

|November 26, 2016

Summary

Diffusion tensor imaging (DTI) can objectively assess visual pathway injury from pituitary adenomas. This technique detects early signs of demyelination and atrophy, aiding surgical decisions.

Keywords:

AD = axial diffusivity DTI = diffusion tensor imaging FA = fractional anisotropy HRP = high-pass resolution perimetry MD = mean diffusivity OT = optic tract RD = radial diffusivity ROI = region of interest SIPAP = suprasellar, infrasellar, parasellar, anterior, and posterior VFD = visual field defect anterior visual pathways diffusion tensor imaging pituitary adenoma pituitary surgery quantitative diagnostics, diagnostic technique visual impairment

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Area of Science:

Neuroimaging
Ophthalmology
Neurosurgery

Background:

Pituitary adenomas can cause visual impairment by compressing anterior visual pathways.
Objective markers for assessing this visual pathway injury are lacking.
Diffusion tensor imaging (DTI) offers a potential method for objective assessment.

Purpose of the Study:

To explore DTI's utility in objectively assessing injury to the anterior visual pathways in patients with pituitary adenomas.
To correlate DTI parameters with visual field defects and chiasmal lift.
To develop a predictive model for visual impairment.

Main Methods:

Included 23 patients with pituitary adenomas and 20 healthy controls.
Performed neuroophthalmological examinations, conventional MRI, and DTI before and 6 months after surgery.
Assessed chiasmal lift, visual field defects (VFD), and DTI parameters (radial diffusivity, fractional anisotropy, axial diffusivity) of optic tracts.

Main Results:

VFD and chiasmal lift correlated significantly with radial diffusivity and fractional anisotropy.
Axial diffusivity differed between controls and patients with VFD, both pre- and post-surgery.
A DTI-based prediction model accurately classified patients with and without VFD and controls.

Conclusions:

DTI can detect pathology and quantify injury in visual pathways compressed by pituitary adenomas.
Radial diffusivity changes may indicate demyelination, while low axial diffusivity may suggest early atrophy.
DTI provides objective data, detects early injury, and can assist in surgical decision-making for pituitary adenomas.