Diffusion tensor imaging (DTI) examines water motion in vivo. DTI changes in the corticospinal tract changes have been

correlated with sensorimotor deficits and postoperative improvement in patients with brain tumors,[1-3] and motor function in patients with ischemic strokes.[4, 5] We describe a patient with unilateral enlarged Virchow–Robin spaces in the thalamus and ventral midbrain. The patient did not have any motor symptoms despite compression of the adjacent corticospinal tract, abnormal diffusion tensor metrics, and abnormal tractography. A 54-year-old female with peritoneal and breast carcinomas presented with headaches, memory loss, and confusion. She had no signs or symptoms of motor weakness after complete neurological evaluation. MRI at 1.5 Tesla (Signa HDx, GE Medical Systems, Milwaukee, WI, USA) showed multiple brain metastases and edema distant from the motor cortices and corticospinal tracts. The patient had already received systemic Cabozantinib in vitro chemotherapy and whole brain radiation therapy. Despite additional chemotherapy and stereotactic radiosurgery

to a right frontal lobe metastasis, the patient succumbed to her disease 18 months after diagnosis of the brain metastases. MRI also revealed cystic dilatations in the left thalamus and ventral midbrain adjacent to the corticospinal tract. (Fig 1A). These lesions followed cerebro-spinal fluid (CSF) intensity on all sequences including diffusion-weighted imaging (excluding dermoid or epidermoid), were in the brain (excluding FK506 arachnoid

cyst), and did not enhance (excluding cystic neoplasm or infection). Consistent with enlarged Virchow–Robin spaces along collicular and accessory collicular arteries,[6] comparison with prior studies showed them to be stable for >1 year and present before the brain metastases. DTI was acquired using a single-shot spin-echo echo-planar sequence with: TR/TE 13,500/100 ms, matrix 128 × 128, field of view (FOV) 240 mm, slice thickness 3 mm, b-value 1,000 s/mm2, and number of excitations (NEX) 1 in 25 noncollinear directions. Using DTI Studio v2.5,[7] fractional anisotropy (FA), mean diffusivity (MD), and directionally encoded color FA maps were generated (Fig 1B). Regions-of-interest (ROIs) were drawn around each corticospinal tract on axial slices 上海皓元医药股份有限公司 in the posterior limb of the internal capsule and in the ventral midbrain. Values generated for each voxel within the ROIs were exported in Analyze format into Analysis of Functional Neuroimages,[8] and organized in histograms according to frequency of values per side. Comparisons were made between sides for proportion of FA > .8, distribution of FA, distribution of MD, longitudinal diffusivity (λ0), and radial diffusivity [(λ1+λ2)/2]. Statistical analysis was performed using two-sided Wilcoxon rank-sum nonparametric tests and two-sample tests of proportions (to compare the relative percentage of voxels >.8). Median FA and MD were .82 and 2.2 × 10−3 mm2/second as compared to .74 and 2.