Article Figures & Data
Figures
- Fig 1.
MR imaging and DTI of a 15-year-old patient with diffuse pontine tumor.
A, Sagittal T1-weighted image. The pontine tumor is diffusely infiltrative. B, Axial T2-weighted image. The pons appears expanded and hyperintense with an area of focal necrosis. C, Axial ADC map. The tumor demonstrates elevated diffusion, and the necrosis is extremely hyperintense. D, Axial FA map. The tumor demonstrates diminished fractional anisotropy, and necrosis is hypointense.
- Fig 2.
Axial diffusion tensor color maps of the brain stem at the level of the middle cerebellar peduncles.
A, Image of patient with a pontine tumor showing destruction of the normal anisotropy of the corticospinal tracts and posterior displacement of the medial lemnisci.
B, Control image showing normal corticospinal tracts, transverse pontine fibers, and medial lemnisci.
C, Image of patient with a pontine tumor showing a diffusely infiltrating pattern.
- Fig 3.
Axial diffusion tensor color maps demonstrating tract invasion.
A, Image of a 6-year-old patient with a diffusely infiltrating pontine tumor. The left corticospinal tract is enlarged, compared with the right, and tumor infiltration separates the corticospinal (anterior arrow) and corticobulbar (posterior arrow) components.
B, Image of an 8-year-old patient with a focally exophytic pontine tumor. Mild lateral expansion of the left corticospinal tract (medial arrow), with focally exophytic tumor (lateral arrow).
- Fig 4.
Graphs show diffusion tensor imaging parameters for major white matter tracts in the brain stem.
A, Fractional anisotropy (FA). B, Apparent diffusion coefficient (ADC). Data are shown for the corticospinal (CS, blue bars), transverse pontine (TP, red bars), and medial lemnisci (ML, yellow bars). Subject groups included patients with pontine tumors, patient control (PAT), and healthy volunteer (VOL) groups.
Tables
- Table 1:
Comparison of conventional MR imaging and diffusion tensor imaging measures in 7 pediatric patients with pontine tumors
Patient No. Tumor Characteristics Conventional MR Imaging Diffusion Tensor Imaging Location Size (cm) T1W T2W Enhancement Focality Necrosis Mass Effect Hydrocephalus Corticospinal Tracts Transverse Pontine Tracts Sensory Tracts 1 Midbrain/pons 4.6 × 3.6 Hypo Hyper No No No Moderate Shunt in place Bilateral sev exp, distinct CB Sev exp of left tract Posterior displ, noninfiltrated 2 Pons 3.0 × 3.4 Hypo Hyper No No No Minimal No Mild exp, lateral displ of right tract Sev bilateral exp Posterior displ, noninfiltrated Mild reduction, medial deviation, and slightly isotropic left tract 3 Pons 2.8 × 3.1 Hypo Hyper No No No Minimal No Bilateral sev exp, minimal posterior displ of right tract Mild bilateral exp Normal 4 Pons 3.2 × 4.3 Sev hypo Sev hyper No No No Minimal No Bilateral sev exp Sev bilateral exp Bilateral grossly posterior displ (left > right) 5 Pons 3.8 × 4.5 Sev hypo Sev hyper Surrounding necrosis No Yes* Moderate Mild Bilateral sev exp, distinct CB Sev bilateral exp, necrosis Bilateral grossly posterior displ (left > right) 6 Pons 3.9 × 4.7 Sev hypo Sev hyper No No No Mild No Bilateral sev exp, posterior displ, distinct right CB Sev prominently anterior exp Bilateral grossly posterior displ (left > right) 7† Pons 1.6 × 1.0 Hypo Hyper Minimal focal Yes No Minimal No Mild exp of left tract Normal Normal 1.0 × 0.8 Note:—hypo indicates hypointense; hyper, hyperintense; sev, severe; exp, expansion; CB, corticobulbar tracts; displ, displacement.
* The necrotic region measured 2.2 × 2.5 cm.
† This patient’s tumor had an exophytic component that measured 1.0 × 0.8 cm.
- Table 2:
Color map assessment of diffusion tensor images of brain stem white matter tracts in 7 pediatric patients with pontine tumors*
Patient No. Corticospinal Tracts Transvers Pontine Tracts Medial Lemnisci Left Right Left Right Left Right 1 D/I I I I D D 2 I X/I I I D D 3 I I I I D/I D/I 4 I I X/I X/I D D 5 X/I X/I X/I X/I I I 6 I X/I I I N I 7 I N N N N N * The condition of the tracts was classified as follows: D, displaced; E, edematous; I, infiltrated; N, normal; X, destroyed.
Patient No. Neurologic Deficit (Grade* and Location) Corticospinal Cranial Nerves Sensory Ataxia 1 Mild (left) Mild (left) VI N/A Absent 2 Mild (right) M/S (left) VI, VII, IX N/A Absent 3 Absent Absent N/A Absent 4 Absent M/S (bilateral) VI (left), VII, IX Absent M/S (bilateral), worse on left 5 Absent M/S left gaze, VI, VII, and partial IX Absent Severe gait, moderate bilateral limb dysmetria 6 Mild (bilateral), worse on left M/S (bilateral) VI, IX, worse on right N/A Mild gait, left limb dysmetria 7 Absent Absent Absent Mild limb dysmetria Note:—N/A indicates not available.
* Deficits were classified into 2 grades: absent/mild, and M/S, moderate/severe.
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