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Diffusion Tensor MRI and Fiber Tractography of Cerebellar Atrophy in Phenytoin Users
Author(s) -
Lee SeungKoo,
Mori Susumu,
Kim Dong Joon,
Kim Sei Young,
Kim Si Yeon,
Chu Minkyung,
Heo Kyoung,
Lee Byung In,
Kim Dong Ik
Publication year - 2003
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.0013-9580.2003.43502.x
Subject(s) - cerebellum , fractional anisotropy , diffusion mri , atrophy , olivopontocerebellar atrophy , magnetic resonance imaging , medicine , nuclear medicine , psychology , gastroenterology , pathology , central nervous system disease , radiology , degenerative disease
Summary: Purpose: The usefulness of diffusion tensor magnetic resonance imaging (DT‐MRI) is still in debate, and the development of clinically feasible scan protocol is encouraged. The purpose of this study was to investigate the afferent fiber system to the cerebellum in patients with phenytoin (PHT)‐induced cerebellar atrophy in comparison with cerebellar atrophy of other etiologies by using DT‐MRI. Methods: Thirteen patients (M/F ratio, 7:6; mean age, 42.5 years) and age‐matched normal controls (n = 8) participated in this study. The patient group consisted of epilepsy patients who had received PHT therapy (n = 9) and clinically diagnosed as having olivopontocerebellar atrophy (OPCA; n = 4). DT‐MRI was performed by using diffusion weighting of b = 600 s/mm 2 , and fractional anisotropy (FA) and color‐coded vector maps were generated. FA of the middle cerebellar peduncle (MCP), the cerebellum, and transverse pontine fibers (TPF) was measured and compared between PHT and OPCA patients. Results: Normal subjects showed FA values of 0.81 ± 0.07 in MCP, 0.69 ± 0.04 in TPF, and PHT users showed FA values of 0.84 ± 0.09 in MCP, 0.72 ± 0.08 in TPF, and 0.21 ± 0.04 in cerebellum. OPCA patients showed FA values of 0.39 ± 0.11 in MCP, 0.46 ± 0.12 in TPF, and 0.22 ± 0.07 in cerebellum. PHT users showed a statistically significant reduction of FA only in cerebellum, whereas OPCA demonstrated significant decrease of FA in MCP, TPF, and cerebellum (one‐way analysis of variance, p < 0.01). Three‐dimensional reconstruction of fiber tracts demonstrated decreased volume and altered fiber integrity within the peduncles and transverse pontine fibers in the OPCA group, whereas fiber course patterns in PHT users were similar to those in controls. Conclusions: PHT users showed normal orientation and anisotropy of MCP and TPF, whereas OPCA demonstrated impaired values, suggesting that PHT directly affects the cerebellum. DT‐MRI can demonstrate detailed fiber configurations in degenerative diseases of brainstem and cerebellum and provides insight into the pathomechanisms of cerebellar atrophy.