title: Limbic pathway lesions in patients with multiple sclerosis.
abstract: BACKGROUND
  Multiple sclerosis (MS) is a well-known demyelinating disease to cause cognitive dysfunction. The limbic system, relevant to memory, can be easily overlooked in conventional magnetic resonance imaging (MRI).
  
  
  OBJECTIVE
  To investigate the distribution and frequency of demyelinating lesions affecting white matter connections of the limbic system based on localization with diffusion tensor imaging (DTI)-derived fractional anisotropy (FA) color maps compared to three-dimensional T2-weighted (T2W) and FLAIR volumes in MS patients.
  
  
  METHODS
  One hundred and fifty patients with a known diagnosis of MS were identified for this Health Insurance Portability and Accountability (HIPAA)-compliant retrospective cross-sectional study. DTI-derived FA color maps, co-registered to T2W and FLAIR images, were analyzed for lesions affecting the three white matter tracts of the limbic system including cingulum, fornix, and mammilothalamic tracts by two investigators. The approximate location of the lesions on FLAIR was always confirmed on the co-registered DTI-derived FA color maps.
  
  
  RESULTS
  Of the 150 patients analyzed, 14.6% had cingulum lesions, 2.6% had fornix lesions, and 2.6% had mammilothalamic tract lesions; 21.3% of patients had at least one of the three tracts affected.
  
  
  CONCLUSIONS
  A relatively high frequency of lesions involving the limbic tracts may explain memory deficits and emotional dysfunction commonly experienced by patients with MS. The combined information from T2W, FLAIR, and DTI-derived FA color map allowed for more accurate localization of lesions affecting the major white matter tracts of the limbic system.
authors: Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA Department of Radiology, Sifa University School of Medicine, İzmir, Turkey neslinshn@gmail.com.
authors: Neslin
authors: N
authors: Sahin
authors: Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Roger
authors: R
authors: Selouan
authors: Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Clyde E
authors: CE
authors: Markowitz
authors: Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors: Elias R
authors: ER
authors: Melhem
authors: Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Michel
authors: M
authors: Bilello
mesh_terms: D000328:Adult; D000368:Aged; D016880:Anisotropy; D003430:Cross-Sectional Studies; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008032:Limbic System / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Cingulum; diffusion tensor imaging; fornix; mammilothalamic tract; multiple sclerosis