|The main purpose of this site is to extend the
intraoperative monitoring to include the neurophysiologic
parameters with intraoperative navigation guided with Skyra 3
tesla MRI and other radiologic facilities to merge the
morphologic and histochemical data in concordance with the
Located in Jordan Amman near Al-Shmaisani hospital, where all
ambulatory activity is going on.
Contact: Tel: +96265677695, +96265677694.
A magnetom Skyra 3 tesla MRI with all clinical applications
started to run in our hospital in 28-October-2013.
The hospital where the project is located and running diagnostic
and surgical activity.
Tractography is a procedure to
demonstrate the neural tracts. It uses special techniques of
magnetic resonance imaging (MRI), and computer-based image
analysis. The results are presented in two- and
three-dimensional images. In addition to the long tracts that
connect the brain to the rest of the body, there is a
complicated 3D network formed by short connections among
different cortical and subcortical regions. The existence of
these bundles has been revealed by histochemistry and biological
techniques on post-mortem specimens. Brain tracts are not
identifiable by direct exam, CT, or MRI scans. This difficulty
explains the paucity of their description in neuroanatomy
atlases and the poor understanding of their functions.
The MRI sequences used look at the symmetry of brain water
diffusion. Bundles of fiber tracts make the water diffuse
asymmetrically in a tensor, the major axis parallel to the
direction of the fibers. The asymmetry here is called
anisotropy. There is a direct relationship between the number of
fibers and the degree of anisotropy.
|Diffusion tensor imaging (DTI) data has been used to
seed various tractographic assessments of this patient's
brain. These are seen in superior (A), posterior (B), and
lateral views (C&D). The seeds have been used to develop arcuate
and superior longitudinal fasciculi in (A) and (B), for
brainstem, and corona radiata in (C), and as combined data sets
in (D). Some of the two dimensional projections of the
tractographic result are also shown. The data set may be rotated
continuously into various planes to better appreciate the
structure. Color has been assigned based on the dominant
direction of the fibers. There is asymmetry in the tractographic
fiber volume between the right and left arcuate fasciculus (Raf
& Laf) (smaller on the left) and between the right and left
superior longitudinal fasciculus (Rslf & Lslf) (smaller on the
right). Also seen are Tapetum (Ta), Left corona radiata (Lcr)
and Left middle cerebellar peduncle (Lmcp).
Tractographic reconstruction of neural connections via Diffusion
tensor imaging (DTI).
Tractography and FA map superimposed on morphology with
the syngo 3D Neuro Track Card
White matter fiber tracts seen with
syngo DTI Tractography ( 256 diffusion directions)
White matter fiber tracts seen with
syngo DTI Tractography ( 256 diffusion directions)
Tensor image of the brain at
FA map generated with syngo DTI
Tractography and inline function
FA map showing displacement of fiber
tracks by intraventricular meningioma
Tractography is performed using Diffusion Tensor Imaging, an MR
technique which is sensitive to the diffusion of water in the
body, and can be used to reveal its 3D shape. Free diffusion
occurs equally in all directions. This is termed "isotropic"
diffusion. If the water diffuses in a medium with barriers, the
diffusion will be uneven, which is termed "anisotropic"
diffusion. In such a case, the relative mobility of the
molecules from the origin has a shape different from a sphere.
This shape is often modeled as an ellipsoid, and the technique
is then called Diffusion Tensor Imaging. Barriers can be many
things--cell membranes, axons, myelin, etc; but in white matter
the principal barrier is the myelin sheath of axons. Bundles of
axons provide a barrier to perpendicular diffusion and a path
for parallel diffusion along the orientation of the fibers.
Anisotropic diffusion is expected to be increased in areas of
high mature axonal order. Conditions where the myelin or the
structure of the axon are disrupted, such as trauma, tumors, and
inflammation reduce anisotropy, as the barriers are affected by
destruction or disorganization.
Anisotropy is measured in several ways. One way is by a ratio
called "fractional anisotropy" (FA). An anisotropy of "0"
corresponds to a perfect sphere, whereas 1 is an ideal linear
diffusion. Well-defined tracts have FA larger than 0.20. Few
regions have FA larger than 0.90. The number gives information
of how aspherical the diffusion is but says nothing of the
Each anisotropy is linked to an orientation of the predominant
axis (predominant direction of the diffusion). Post-processing
programs are able to extract this directional information.
This additional information is difficult to represent on 2D
grey-scaled images. To overcome this problem a color code is
introduced . Basic colors can tell the observer how the fibers
are oriented in a 3D-coordinate system: This is termed an
"anisotropic map". The software could encode the colors in this
Red indicates directions in the X axis: right to left or left to
Green indicates directions in the Y axis: posterior to anterior
or from anterior to posterior.
Blue indicates directions in the Z axis: foot-to-head direction
or vice versa
Notice that the technique is unable to discriminate the
"positive" or "negative" direction in the same axis.
syngo DTI (Diffusion Tensor Imaging) Tractography
syngo DTI Tractography uses diffusion tensor data and allows 3D
visualization of specific white matter tracts. For example, one
can determine the location of the corticospinal tract or the
thalamocortical tract with the help of syngo DTI Tractography.
Pre-operative planning with combination of tractography and
Brain tumor differentiation.
By combining ADC and anisotropy data, the severity of strokes
can be assessed and acute-ischemic changes can be distinguished
from chronic-ischemic changes.
Diagnosis and follow-up of MS lesions.
May be useful in evaluation of normal brain development and
Measurement of up to 256 directions of diffusion-weighting
with up to 16 different b-values.
Inline processing of the Fractional Anisotropy (FA) maps, ADC
maps and trace-weighted images based on
3D syngo DTI Tractography data in color overlaid onto the
anatomy with the syngo 3D Neuro Task Card allows
easy navigation through the brain.
In the brain, the axons of neurons form fiber tracts which
impose directionality (anisotropy) on measurements of water
diffusion. The aggregate diffusion of water within these tracts
is quantified at each point by the diffusion tensor. Multiple
parameters can be derived from the diffusion tensor, including
the trace, ADC (Apparent Diffusion Coefficient), the relative
anisotropy, and the fractional anisotropy. These secondary
parameters are independent of the frame of reference and are
very sensitive to white matter pathology.
syngo DTI has optimized sequences for a
complete description of the diffusion properties of the brain
within the scope of the tensor diffusion model, both for
anisotropic and isotropic diffusion which support excellent
evaluation of diseases of the white matter. It is a post-processing
tool for data obtained by syngo DTI Tractography and allows for
quantitative evaluation of the rate and direction of water
motion within a voxel, calculation of different diffusion
parameters and visualization of colored diffusion tensor imaging
maps like the Fractional Anisotropy maps. syngo DTI Evaluation
also enables ROI-based evaluation of parameter images.
syngo DTI and syngo DTI Evaluation will help you identify
anatomical substructures and with the help of fiber direction
maps and fiber tracts (tractography) you will be able to assess
the microstructural aspects of the brain lesions.
Step by step:
1. Load the 3D anatomy series and epi DTI Tensor datasets
into the Neuro 3D Task-card. Use the Neuro 3D icon to load these
2. Open the display menu, and right click the clip plane icon.
This will allow you to cut out portions of the head to visualize
areas of interest.
3. Double click the 4th segment to enlarge the 3D anatomy image.
4. Activate the clip plane by left clicking its edge, then left
click and hold to cut image to area of interest.
5. While holding the control key on the keyboard, left click and
draw seed points over area where you wish to create tracts.
Right click on seed points and select start Tractography.
6. The anatomic image can be rotated to better visualize tracts
created by holding the left mouse key and moving in any
Combi Package #T+D
fMRI/DTI Combi Package is a bundle of:
- Inline BOLD Imaging :Performing a Motor Cortex Functional Exam
- 3D PACE syngo : Prospective Acquisition CorrEction
- BOLD 3D Evaluation syngo
- fMRI Trigger Converter
- Diffusion Tensor Imaging
- DTI Evaluation
- DTI Tractography syngo
The bundle comprehends all acquisition and postprocessing tools
for comprehensive BOLD fMRI and DTI exams. BOLD fMRI experiments
can be displayed fused with DTI data and anatomy. The package is
particularly valuable for presurgical planning. The 3D display
of anatomical images, functional brain mapping results and DTI
allows a better understanding of the spatial relationship
between eloquent cortices, cortical landmarks, brain lesions and
tract shifts of white matter.
Inline BOLD Imaging
The BOLD imaging package allows the user to define protocols
which, apart from the measurement, configure automatic
evaluation of the measured data during the scan. With Inline
Technology it is thus possible to generate statistical images
(t-value) based on 3D motion corrected and spatially filtered
data automatically in real time without any further user
interaction. The Inline display of activation cards allows the
user to decide during the scan whether enough statistical power
has built up for his brain mapping task or if the examination is
corrupted by motion. As a result examinations will be shorter
with a higher success rate. Functional brain mapping can be
easily integrated into the clinical routine e.g. prior to
- Inline retrospective 3D motion detection and correction in 3
rotational and 3 translational directions
- Inline t-statistics calculation for variable paradigms and
display of t-value images
- Statistical evaluation by means of “General Linear Model
- Paradigms can be configured
- Transitions between passive and active states can be modeled
by the hemodynamic response function
- Correction of low-frequency trends
- Allows for time delays due to the BOLD-EPI slice order during
- Display of GLM design matrix
- Display of a continuously updated t-value card during
- Display of colored activation cards continuously updated
during measurement, overlaid over the respective BOLD images
using Inline technology
- MOSAIC image mode for accelerating display, processing and
storage of images
3D PACE syngo
By tracking the patients head 3D PACE reduces motion resulting
in increased data quality beyond what can be achieved with a
retrospective motion correction. As a result the sensitivity and
specificity of BOLD experiments are increased.
- Real time prospective motion correction: Highest accuracy real
time motion detection algorithm feeding a real time feed back
loop to the acquisition system with updated positioning
- 3D motion correction for 6 degrees of freedom (3 translation
and 3 rotation)
- Motion related artifacts are avoided in first place instead of
correcting for them retrospectively
- Significant reduction of motion-related artifacts in
- Increased sensitivity and specificity of BOLD experiments
BOLD 3D Evaluation syngo
All tasks from statistical evaluation of the fMRI datasets to
reading and exporting results are supported by BOLD 3D
Generation of statistical maps:
- In cases an inline calculated statistical map is not available
a statistical map can be generated easily using processing
protocols. An intuitive editor UI allows the paradigm definition
and offers the selection of head motion correction, image
filters and statistical evaluation.
- Predefined processing protocols and paradigms are available,
which can be edited if required.
Statistical evaluation using General Linear Model (GLM)
- Transitions between passive and active states modeled by the
hemodynamic response function.
- Correction of low-frequency trends.
- Corrects for time delays due to the BOLD-EPI slice order
during a measurement.
- Output of a t-value map and the GLM design matrix
Inline monitoring of the fMRI exam
- During an ongoing BOLD imaging exam results are calculated (by
Inline BOLD imaging) and displayed in real time.
- The results are displayed and continuously updated as an
overlay on online adjustable, free angulated cut planes through
the anatomical 3D data set.
- The evolving signal time courses in task-related areas of
activation can be displayed and monitored.
Visualization of fMRI Results
- Visualization with 3D volume rendering.
- Superimposing on cut planes through the volume.
- Interactive Navigation: Zoom, pan and rotate in 3D without
noticeable delay. Free double oblique angulation of up to 6 cut
- Cine display of the BOLD time series and of EPI volumes in 3
orthogonal cuts for evaluation of non-corrected head motion.
Data Quality Monitoring
- Based on the B0 field map, loaded automatically with the fMRI
data, areas with less reliable results are indicated.
fMRI Trigger Converter
An optical trigger signal is available to trigger external
stimulation devices in fMRI experiments.
With the "fMRI Trigger Converter" this signal can be converted
to an electrical signal (TTL/BNC and RS 232 interface for PC;
modes: toggle or impulse).
Diffusion Tensor Imaging
Diffusion Tensor Imaging allows for a complete description of
the diffusion properties of the brain within the scope of the
tensor diffusion model, both for anisotropic and isotropic
diffusion. Efficient diffusion direction schemes are pre-defined
to allow for optimal diffusion directional resolution. Schemes
with up to 256 directions can be selected.
Inline technology enables automatic and immediate calculation of
the diffusion tensor, including grey-scale and colored
“fractional anisotropy" (FA) map derived from it.
- Measurements with up to 256 different directions and with up
to 16 different b-values
- Inline calculation of tensor, grey-scale and colored FA map,
ADC map and trace-weighted image
- Support of parallel imaging (iPAT)
- Clinical protocols with full head coverage, incl. inline
calculation of tensor, FA, ADC and trace-weighted images in 4
DTI Tractography syngo
syngo DTI Tractography is optimized for the clinical use by
providing advanced 3D visualization of white matter tracts in
the context of 2D or 3D anatomical datasets and DTI datasets.
DTI data sets can be explored fast and intuitively using the
interactive QuickTracking. QuickTracking instantaneously
displays the tract originating from the mouse pointer position
while moving over the DTI data set. This also allows identifying
qualified regions to place seeding ROIs. Seed points can be set
to assess connectivity by tracking with single ROI and with
multiple ROIs. Furthermore they can be placed in fused views
displaying the anatomical reference and e.g. the colored FA map
Texture Diffusion, a highly versatile in-plane visualization of
white matter tracts, allows to display and read DTI Tractography
results on PACS reading stations and in the OR.
At the same time the package provides the scientific user with
the flexibility to configure the tracking algorithm and to
change display settings for the tracts. Tract and seeding ROI
statistics are included to support publications (e.g. mean/max
FA value, min/mean/max ADC value).
All views can be exported as DICOM images or bitmaps. Tract and
seeding ROI statistics can be exported as html files.
Clinical applications are supported by a dedicated DTI
evaluation mode to support diagnostics of white matter diseases
(e.g. multiple sclerosis and brain maturation disorders). Based
on the tensor, in addition to the already inline-calculated
parameter maps, further maps characterizing the anisotropy of
diffusion properties can be calculated and stored. Multiple
diffusion parameter maps (e.g. Fractional Anisotropy, ADC, b=0)
and an anatomical image are displayed next to each other in the
same slice position for comparison. The images can be evaluated
together based on ROIs and the results can be documented in a
table. The display options include 2D and 3D tensor graphics,
colour-coded images and overlay images on the anatomical images.
In addition, the package offers the scientific user full
flexibility of 2- and 3-dimensional visualization of the
diffusion tensor with measures of isotropic and anisotropic
(fractional and relative) diffusion, Eigen vectors (E1, E2, E3)
of the diffusion tensor and shape-descriptive measures of the
diffusion tensor (linear, planar, spherical).