Diffusion tensor imaging in chronic subdural hematoma: correlation between clinical signs and fractional anisotropy in the pyramidal tract.
OBJECTIVE
Diffusion tensor imaging (DTI) was introduced as a good technique to evaluate structural abnormalities in the white matter. In this study, we used DTI to examine anisotropic changes of the pyramidal tracts displaced by chronic subdural hematoma (CSDH).


METHODS
Twenty-six patients with unilateral CSDH underwent DTI before and after surgery. We measured fractional anisotropy (FA) values in pyramidal tracts of bilateral cerebral peduncles and calculated the ratio of the FA value on the lesion side to that on the contralateral side (FA ratio) and compared the ratios with motor weakness. Moreover, the relationships between FA ratios and clinical factors such as age, sex, midline shift, interval from trauma, and hematoma attenuation on CT were evaluated.


RESULTS
FA values of pyramidal tracts on the lesion side were significantly lower than those on the contralateral side (0.66 +/- 0.07 versus 0.74 +/- 0.05, P < .0001). The FA ratio was correlated to the severity of motor weakness (r(2) = 0.32, P = .002). FA ratios after surgery improved significantly compared with those before surgery (0.96 +/- 0.08 versus 0.89 +/- 0.07, P = .0004). Intervals from trauma and the midline shift were significantly associated with decreased FA ratios (P = .0008 and P = .037).


CONCLUSIONS
In patients with CSDH, a reversible decrease of FA in the affected pyramidal tract on DTI was correlated to motor weakness. These anisotropic changes were considered to be caused by a reversible distortion of neuron fibers and vasogenic edema due to the hematoma.
Yokoyama
K
K
Department of Neurosurgery, Brain and Spine Surgery Center and Research Institution of Microvascular Decompression, Shiroyama Hospital, Osaka, Japan. neu100@poh.osaka-med.ac.jp
Matsuki
M
M
Shimano
H
H
Sumioka
S
S
Ikenaga
T
T
Hanabusa
K
K
Yasuda
S
S
Inoue
H
H
Watanabe
T
T
Miyashita
M
M
Hiramatsu
R
R
Murao
K
K
Kondo
A
A
Tanabe
H
H
Kuroiwa
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016880:Anisotropy; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000473:pathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011712:Pyramidal Tracts / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic