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Research ArticleBRAIN

Diffusion Tensor Imaging in Chronic Subdural Hematoma: Correlation between Clinical Signs and Fractional Anisotropy in the Pyramidal Tract

K. Yokoyama, M. Matsuki, H. Shimano, S. Sumioka, T. Ikenaga, K. Hanabusa, S. Yasuda, H. Inoue, T. Watanabe, M. Miyashita, R. Hiramatsu, K. Murao, A. Kondo, H. Tanabe and T. Kuroiwa
American Journal of Neuroradiology June 2008, 29 (6) 1159-1163; DOI: https://doi.org/10.3174/ajnr.A1001
K. Yokoyama
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M. Matsuki
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H. Shimano
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S. Sumioka
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T. Ikenaga
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K. Hanabusa
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S. Yasuda
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H. Inoue
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T. Watanabe
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M. Miyashita
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R. Hiramatsu
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K. Murao
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A. Kondo
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H. Tanabe
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T. Kuroiwa
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    Fig 1.

    A and B, Head CT and T2-weighted MR images of CSDH, respectively. C and D, Regions of interest in the bilateral pyramidal tract of the cerebral peduncle. C, FA map. D, Apparent diffusion coefficient map.

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    Fig 2.

    Region-of-interest analysis of FA values in the cerebral peduncle for lesion sides and contralateral sides. The Wilcoxon signed rank test was used for analysis of the differences. A, In patients with CSDH, FA values of the affected sides are significantly lower than those of intact sides (P < .0001). B, In healthy volunteers, there is no significant difference between bilateral sides (P > .5). Lt. indicates left; Rt, right.

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    Fig 3.

    Region-of-interest analysis of MD values in the cerebral peduncle for lesion sides and contralateral sides. The Wilcoxon signed rank test was used for analysis of the differences. A, In patients with CSDH, there is no significant difference in MD values between the affected sides and the contralateral sides (P > .5). B, In healthy volunteers, there is no significant difference between bilateral sides (P > .5). Lt. indicates left; Rt, right.

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    Fig 4.

    The correlation between the initial FA ratio and motor weakness. Initial FA ratios are significantly correlated with motor weakness (R2 = 0.32, P = .002) by linear regression analysis. Preope. indicates preoperative.

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    Fig 5.

    The comparison FA ratios before and after burr-hole craniotomy in 23 patients with CSDH. FA ratios are significantly increased after surgery (Wilcoxon signed rank test, P = .0004). Pre-ope indicates preoperative; Post-ope, postoperative.

Tables

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    Table 1:

    Patient details and clinical information

    Case No./Age (yr)/SexSideMotor Fun. (MMT)Preop. FA (affect.)Preop. FA RatioPreop. MD RatioPostop. FA Ratio*
    1/83/FRt40.6850.920.930.99
    2/88/MRt40.6450.950.97–
    3/82/MLt50.680.91.07–
    4/89/MLt40.6270.841.09–
    5/73/MRt20.6250.841.160.94
    6/78/MRt40.5950.780.911.02
    7/67/MRt30.6990.880.861
    8/59/MRt50.710.961.150.97
    9/80/MLt50.79610.981.05
    10/90/MRt30.5360.790.950.96
    11/73/MRt50.6870.920.970.97
    12/74/FLt40.4890.790.950.96
    13/64/MRt40.6740.861.141.12
    14/78/MLt50.7090.930.970.89
    15/82/FLt50.6940.911.051.04
    16/67/FRt40.6730.940.840.92
    17/77/MRt40.7630.960.960.88
    18/81/FLt30.4980.71.250.72
    19/44/MLt40.730.920.761
    20/77/MLt50.7190.911.060.97
    21/88/MLt40.6150.771.080.91
    22/76/MRt40.6360.881.030.94
    23/76/FRt50.6550.970.790.99
    24/76/FRt40.6580.910.970.97
    25/69/MRt50.62811.081.02
    26/65/FLt40.6610.841.040.93
    • Note:—Fun. indicates function; affect., affected side; Preop, preoperative; Postop, postoperative; Rt, right; Lt, left; FA, fractional anisotropy; MD, mean diffusivity; MMT, Manual Muscle Test.

    • * Patients 2, 3, and 4 could not undergo postoperative DTI. They hoped to leave hospital within 5 days after surgery.

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    Table 2:

    Relationship between clinical data and FA ratio

    FactorPatient No.FA Ratio (mean ± SD)P Value*
    Age (yrs)
        <75100.895 ± 0.064.792
        >75160.883 ± 0.084
    Sex
        Male180.894 ± 0.070.718
        Female80.873 ± 0.090
    Hematoma thickness (mm)†
        <22130.895 ± 0.078.573
        >22130.879 ± 0.075
    Midline shift (mm)‡
        <9.0140.914 ± 0.068.037
        >9.0120.856 ± 0.074
    Interval from trauma (days)
        <4090.839 ± 0.071.0008
        >40100.944 ± 0.041
    CT
        Mixed density150.906 ± 0.071.078
        Non-mixed density110.862 ± 0.077
    • * The Mann-Whitney U test was used for analysis of the differences.

    • † Calculated on CT as the maximal width of the hematoma.

    • ‡ Calculated on CT as the distance from the center of the Monro foramen to a perpendicular line connecting the anterior and posterior insertions of the falx cerebri.

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American Journal of Neuroradiology: 29 (6)
American Journal of Neuroradiology
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June 2008
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K. Yokoyama, M. Matsuki, H. Shimano, S. Sumioka, T. Ikenaga, K. Hanabusa, S. Yasuda, H. Inoue, T. Watanabe, M. Miyashita, R. Hiramatsu, K. Murao, A. Kondo, H. Tanabe, T. Kuroiwa
Diffusion Tensor Imaging in Chronic Subdural Hematoma: Correlation between Clinical Signs and Fractional Anisotropy in the Pyramidal Tract
American Journal of Neuroradiology Jun 2008, 29 (6) 1159-1163; DOI: 10.3174/ajnr.A1001

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Diffusion Tensor Imaging in Chronic Subdural Hematoma: Correlation between Clinical Signs and Fractional Anisotropy in the Pyramidal Tract
K. Yokoyama, M. Matsuki, H. Shimano, S. Sumioka, T. Ikenaga, K. Hanabusa, S. Yasuda, H. Inoue, T. Watanabe, M. Miyashita, R. Hiramatsu, K. Murao, A. Kondo, H. Tanabe, T. Kuroiwa
American Journal of Neuroradiology Jun 2008, 29 (6) 1159-1163; DOI: 10.3174/ajnr.A1001
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