Jeong Pyo Seo

Functional Role of the Corticoreticular Pathway in Chronic Stroke Patients

Background and Purpose— The corticoreticular pathway (CRP) is known to be an important extrapyramidal tract for walking ability. However, little is known about the functional role of the CRP in recovery of walking ability. We investigated relation between the CRP and walking ability in chronic hemiparetic stroke patients. Methods— Among 209 consecutive patients, 54 patients, who showed complete injury of the corticospinal tract (CST) in the affected hemisphere on diffusion tensor tractography, and 20 normal subjects were recruited. Functional ambulation category was used in measurement of walking ability. The fractional anisotropy value, apparent diffusion coefficient value, and fiber volume of the CRP and CST were used for the diffusion tensor imaging parameters. Results— In the affected hemisphere, no significant difference in diffusion tensor imaging parameters of the CRP was observed between patient subgroups. In the unaffected hemisphere, patients who were able to walk showed significantly increased fiber volume of the CRP, compared with patients who could not walk and normal control subjects (P<0.05), without significant difference in fractional anisotropy and apparent diffusion coefficient values. In addition, the fiber volume of the CRP in the unaffected hemisphere showed positive correlation with functional ambulation category (P<0.05). In contrast, diffusion tensor imaging parameters of the CST in the unaffected hemisphere showed no correlation with functional ambulation category (P>0.05). Conclusions— The increased fiber volume of the CRP in the unaffected hemisphere seems to be related to walking ability in patients with chronic stroke. Therefore, the compensation of the CRP in the unaffected hemisphere seems to be one of the mechanisms for recovery of walking ability after stroke.

Neural tracts injuries in patients with hypoxic ischemic brain injury: Diffusion tensor imaging study

Many studies have reported on vulnerable areas of the brain in hypoxic ischemic brain injury (HI-BI). However, little is known about the involvement of neural tracts following HI-BI. We investigated neural tract injuries in adult patients with HI-BI, using diffusion tensor tractography (DTT). Twelve consecutive patients with HI-BI and 12 control subjects were recruited for this study. We classified the patients into two subgroups according to the preservation of alertness: subgroup A-5 patients who had intact alertness and subgroup B-7 patients who had impaired alertness. DTI-Studio software was used for evaluation of seven neural tracts: corticospinal, cingulum, fornix, superior longitudinal fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and optic radiation. We measured the DTT parameters (fractional anisotropy, apparent diffusion coefficient and voxel number) of each neural tract. In the individual analysis, all 12 patients showed injuries in all 24 neural tracts in terms of both DTT parameters and integrity, except for the corticospinal tract (75.0% injury). In the group analysis, the patient group showed neural injuries in all 24 neural tracts. In comparison of subgroups A and B, subgroup B showed more severe injuries: subgroup B showed a higher rate of disruption (39.8%) than subgroup A (12.9%) on individual DTTs and subgroup B had more severe injuries in both the cingulum and superior longitudinal fasciculus. In conclusion, we found that extensive injuries in the neural tracts were accompanied by HI-BI. Patients with impaired alertness appeared to show more severe injuries of neural tracts.

The cortical activation pattern by a rehabilitation robotic hand: a functional NIRS study

Introduction: Clarification of the relationship between external stimuli and brain response has been an important topic in neuroscience and brain rehabilitation. In the current study, using functional near infrared spectroscopy (fNIRS), we attempted to investigate cortical activation patterns generated during execution of a rehabilitation robotic hand. Methods: Ten normal subjects were recruited for this study. Passive movements of the right fingers were performed using a rehabilitation robotic hand at a frequency of 0.5 Hz. We measured values of oxy-hemoglobin (HbO), deoxy-hemoglobin (HbR) and total-hemoglobin (HbT) in five regions of interest: the primary sensory-motor cortex (SM1), hand somatotopy of the contralateral SM1, supplementary motor area (SMA), premotor cortex (PMC), and prefrontal cortex (PFC). Results: HbO and HbT values indicated significant activation in the left SM1, left SMA, left PMC, and left PFC during execution of the rehabilitation robotic hand (uncorrected, p < 0.01). By contrast, HbR value indicated significant activation only in the hand somatotopic area of the left SM1 (uncorrected, p < 0.01). Conclusions: Our results appear to indicate that execution of the rehabilitation robotic hand could induce cortical activation.

Cingulum injury in patients with diffuse axonal injury: A diffusion tensor imaging study

Accurate assessment of the cingulum is difficult, because it is a long neural tract that extends from the orbitofrontal cortex to the medial temporal lobe. We divided the cingulum into five parts and investigated changes caused by injury in these regions in patients with diffuse axonal injury (DAI) using diffusion tensor tractography (DTT). Twenty-one patients with DAI and 21 control subjects were recruited. The cingulum was divided into; the anterior, superior (the anterior and posterior portions), posterior, and inferior regions. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), and tract number were measured in each region. FA values and tract numbers in the patient group were lower in the anterior superior cingulum than in controls (p<0.05); whereas the ADC values in the patient group were higher in the anterior and posterior superior cingulum than in controls (p<0.05). In the superior cingulum, increases in the ADC values of the anterior portion (Δ8.1%) were higher than those of the posterior portion (Δ5.5%). We found that the superior cingulum was injured in patients with DAI, and that the anterior portion of the superior cingulum was more injured than the posterior portion. Consequently, the superior cingulum appears to be a vulnerable area and the anterior superior cingulum appears more vulnerable than the posterior superior cingulum in DAI.

Anatomical location of the corticospinal tract according to somatotopies in the centrum semiovale.

Little is known about the somatotopic location of the corticospinal tract (CST) in the centrum semiovale (CS). We investigated the somatotopic location of the CST in the CS in the human brain using diffusion tensor tractography (DTT). Fifty-two healthy volunteers were recruited for this study. Diffusion tensor images (DTIs) were obtained at 1.5T, and CSTs for the hand and leg were obtained using FMRIB software. Normalized DTT images were reconstructed using the Montreal Neurological Institute echo-planar imaging template supplied with the SPM. Individual DTI data were calculated as number of pixels in the CS. In the mediolateral direction, average distances of the highest probabilistic locations for hand and leg somatotopies were 25.57 mm and 21.72 mm from the midline between the right and left hemispheres, respectively. For the anteroposterior direction, the average distance of the highest probabilistic locations for hand and leg somatotopies were 0.4 mm and 5.2 mm behind the horizontal line between the medial end of the central sulcus and midline, respectively. In conclusion, hand somatotopy of the CST was found to be located at about 26 mm lateral to the midline almost along the horizon line between the medial end of central sulcus and midline, and leg somatotopy of the CST was found to be located medioposteriorly to the hand somatotopy of the CST.

Neural injury of uncinate fasciculus in patients with diffuse axonal injury

The recent development of diffusion tensor imaging (DTI) allows visualization and estimation of the uncinate fasciculus (UF). We investigated injuries of the UF in patients with diffuse axonal injury (DAI) who showed no specific lesions except for DAI lesions on conventional brain MRI. Twenty-one chronic patients with DAI, and 21 age- and sex-matched normal control subjects were recruited for this study. Diffusion tensor images were acquired using a sensitivity-encoding head coil at 1.5 T and the UF was reconstructed using DTI-Studio software. Fractional anisotropy (FA), apparent diffusion coefficient (ADC) value, and fiber number of the UF were measured. In the DAI group, the FA values and fiber numbers were significantly decreased compared to those of the control group (P< 0.05). The FA value and fiber number decreased 8.4% and 26.5% in the DAI group compared to those of the control group. By contrast, the ADC value did not show any difference between the DAI and control groups (P> 0.05). Changes in the DTI parameters of the DAI group appeared to indicate neural injury of the UF. We believe that DTI can be a useful evaluation tool for detecting hidden neural injuries of UF in patients with DAI.

Damage to the Optic Radiation in Patients With Mild Traumatic Brain Injury.

Background: There are known limitations of conventional computed tomography and magnetic resonance imaging in detecting neural injury in patients with mild traumatic brain injury (TBI). Diffusion tensor imaging (DTI) provides a method to further assess cerebral injury in this patient population. We report 2 patients with mild TBI who showed injury of the optic radiation (OR) as demonstrated by DTI. Method: Two patients who complained of visual field loss after mild TBI and 9 age-matched normal control subjects were recruited for this study. Peripheral field defects were detected with automated perimetry in both patients. Results: Regarding the configuration of OR, the total volume of OR was decreased in the right OR of both patients compared with controls; in contrast, the left ORs were divided into 2 parts in both patients. The voxel numbers of both ORs in both patients were more than 2 standard deviations lower than that of normal control subjects. The apparent diffusion coefficient value of the right OR in patient 2 was more than 2 standard deviations higher than that of normal controls. Conclusions: We demonstrated injury of the OR using DTI in 2 patients who showed visual field defects after mild TBI.

Aging of corticospinal tract fibers according to the cerebral origin in the human brain: a diffusion tensor imaging study.

The corticospinal tract (CST) is known to originate from multiple cerebral areas, including the primary motor cortex (M1). In this study, using diffusion tensor imaging (DTI), we attempted to investigate the differences of aging of CST fibers according to the cerebral origin in the human brain. Sixty healthy subjects aged from the 20s to the 70s were recruited, and 10 subjects were assigned to each age group. CST fibers were reconstructed from the M1 (Broadmanns area [BA] 4), the secondary motor area (M2, BA 6), and the primary somatosensory cortex (S1, BA 1-3), respectively. Values of fractional anisotropy (FA), mean diffusivity (MD), and tract volume (TV) of CST fibers from each cerebral area were measured. Significant differences in the TV values of CST fibers from the M2 were observed between the 70s age group and the other age groups, except the 60s age group (p<0.05). However, no significant difference in the values of FA and MD of CST fibers from the M2 were observed between age group (p>0.05). No significant differences in the values of FA, MD, and TV of CST fibers from the S1 and M1 were observed between age groups (p>0.05). We found that the fiber number of CST fibers from the M2 was decreased in the 70s age group compared with the 20s-50s age groups. Because the main function of the M2 is motor planning and coordination, our results would be helpful in development of strategies for coping with aging of the CST.

The anatomical location of the corticobulbar tract at the corona radiata in the human brain: Diffusion tensor tractography study

Many studies have reported on the anatomical location of the corticobulbar tract (CBT). However, no study has reported on the anatomical location of the corona radiata (CR). Using diffusion tensor tractography, we investigated the anatomical location of the CBT at the CR in normal subjects. Forty healthy normal subjects were enrolled in this study. Diffusion tensor images were acquired at 1.5-T, and the CBT was reconstructed using FMRIB software. The highest probabilistic location of the CBT was defined as the location on an axial slice in the upper and lower CRs. The CBT was located at an average of 49.13% and 49.91% in the antero-posterior direction between the most anterior point and the most posterior point of the lateral ventricle at the upper and lower CR, respectively. Regarding medio-lateral direction, between the midline and the most lateral point of the brain, the CBT was located at an average of 36.58% and 32.73% at the upper and lower CR, respectively. According to our findings, the CBT was located almost halfway between the most anterior point and the most posterior point of the lateral ventricle at the CR, and almost one third between the midline and the most lateral point of the brain at the CR.

Aging of the cingulum in the human brain: Preliminary study of a diffusion tensor imaging study

The cingulum, a major structure of the limbic system, is closely associated with memory function. In the current study, we investigated aging of the cingulum according to the location of the cingulum in each part of the cingulum after dividing the cingulum into five parts in normal subjects, using DTT parameters (fractional anisotropy (FA) and fiber number (FN)). Ninety healthy subjects (males: 44, females: 46, mean age: 49.0 years; range: 20-78 years) were enrolled in this study. Subjects were categorized according to six groups by age intervals of 10 years; each age group consisted of 15 subjects. The cingulum was divided into five parts (anterior, anterior superior, posterior superior cingulum, posterior, and inferior cingulum). The FA and FN of each part were measured. The FA value indicates the degree of directionality and integrity of white matter microstructures such as axons, myelin, and microtubules, and the FN reflects the total number of fibers in a neural tract. Age-related decline in the FA value may indicate demyelination, and a decline in the number of myelinated fibers of a neural tract can also lead to a decline of the FN. Significant differences in the FA value of the anterior cingulum and anterior superior cingulum, and the FN of the inferior cingulum were observed between age groups (AVOVA, p<0.05). A significant decrease was observed in the FA values of the anterior and anterior superior cingulum of the 60s and 70s age groups compared with those of the 20s and 30s age groups, and in the FN of the inferior cingulum of the 60s and 70s age groups compared with that of the 20s age group (LSD post hoc test, p<0.05). Aging of the cingulum began at both ends of the cingulum in the 20s or 30s, and progressed steadily at a near continuous rate over the lifespan and a significant degenerative aging effect at both ends of the cingulum occurred into the 60s, compared with the 20s or 30s.