Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

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Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : TC05 - TC08 Full Version

Diffusion Tensor MRI of Brain in Healthy Adult Population: Normative Fractional Anisotropy Values at 3 Tesla MRI


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/59334.17360
Deepakkumar V Mehta, Dolly A Sharma

1. Professor, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Bhaikaka University, Gokal Nagar, Karamsad, District Anand, Gujarat, India. Orchid ID. No.: 0000-0002-9090-5545. 2. Assistant Professor, Department of Medical Imaging Technology, BDIPS, Charotar University of Science and Technology, Changa, Anand, Gujarat, India; Research Scholar, Department of Medical Imaging Technology, Pramukhswami Medical College, Bhaikaka University, Gokal Nagar, Karamsad, District Anand, Gujarat, India.

Correspondence Address :
Dr. Deepakkumar V Mehta,
Professor, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Bhaikaka University, Gokal Nagar, Karamsad-388325, District Anand, Gujarat, India.
E-mail: drdeepakvmehta1@gmail.com; deepakvm@charutarhealth.org

Abstract

Introduction: Diffusion Tensor Imaging (DTI) technique and its clinical application are increasing in clinical routine practice, still very less normative data is available. Awareness regarding regional differences in Fractional Anisotropy (FA) measurements is very important when routinely DTI is used in clinical Magnetic Resonance Imaging (MRI).

Aim: To determine the normative FA values data at 3 Tesla (3T) MRI and to determine the degradation of FA values in various regions of brain values with age.

Materials and Methods: This cross-sectional study involved a total of 52 participants without any abnormal findings ( presence of tumour, stroke, infarct, degeneration, etc) and whose brain scanning was performed at 3T MRI, in the Department of Radiodiagnosis, Shree Krishna Hospital, and Pramukhswami Medical College, Karamsad, Anand, Gujarat, India. A DTI protocol was set for the healthy patient’s brain scanning. The colour-coded DTI brain images were postprocessed carefully to draw a circular Region of Interest (ROI) in the required areas of white matter and FA values were noted. Descriptive statistics were used to find out the normative data in 11 regions of the brain on right and left side. Pearson correlation was used to check the correlation of FA values with age.

Results: There were 52 patients in the present study, with a male to female ratio of 1.7:1 and a mean age of 52 years. The highest FA values were observed in the splenium (0.809), genu (0.767), the body of the corpus callosum (0.627), and the posterior limb of the internal capsule (0.721), rest areas showed moderate to low FA values. Pearson correlation was used to find the variation in the FA values with age in three age groups 18-40, 41-60 and >60 years, where moderate changes in FA values with age were seen in a few regions of the brain such as genu (right side) with p-value=0.003 and foramen magnum at CVJ level (right side) with a p-value of 0.001.

Conclusion: Generally, FA values intend to change with the presence of multiple tract areas, field strength, coil sensitivity, and partial volume averaging. FA values were also found to be affected with respect to increasing age.

Keywords

Diffusion Tensor Imaging (DTI), Frontal deep white matter, Centrum Semiovale, Internal Capsule, brain stem white matter, FA values

The constant evolution in MRI techniques and its contrast mechanism has made MRI a powerful tool for the diagnosis of any abnormality related to brain. One of the recent applications of MRI is Diffusion Tensor Imaging (DTI). DTI may be used to plot and distinguish the three-dimensional diffusion of water as a function of spatial location (1),(2). Many developmental, aging, and pathologic conditions of the Central Nervous System (CNS) affect the microstructural architecture of the affected tissues. Diffusion-weighted (DW) MRI techniques, such as DTI and FA, are potent probes for evaluating the impact of disease and aging on microstructure because changes in tissue microstructure and organisation will affect the diffusion of water inside tissues. The most commonly applied quantitative parameters derived from DTI scans are Fractional Anisotropy (FA), which is a measure of the directionality of diffusion, and Apparent Diffusion Coefficient (ADC), which measures the magnitude of the diffusion (3).

As a matter of fact, the applications of DTI are rapidly growing because the technique is highly responsive to changes at the cellular and microstructural levels (4). These parameters can be calculated by voxel-based morphometric and ROI based measurement. although voxel-wise analysis is not much operator dependent and more easily automated than ROI analysis, it requires inter-subject registration and image smoothing (5),(6), which may cause errors in the acquired FA values. In the clinical setting, the ROI-based analysis is more readily applicable.

Despite the increase in the usage of DTI application, comparatively very low normal reference data is available which is measured on 3T MRI scanner. In our knowledge there are only three existed studies (7),(8),(9) in which FA and ADC values are measured at 3T MRI scanners. We have expanded the previous work by increasing the number of anatomical regions and a number of subjects with different age groups, hence the primary aim was to determine the normal FA values in 11 regions of the brain at 3T MRI. The secondary aim was to find out the correlation of FA values with age in healthy adult population.

Material and Methods

This cross-sectional study was conducted in the department of Radiodiagnosis, Shree Krishna Hospital and Pramukhswami Medical College, Karamsad, Gujarat, India from April 2020 to August 2022. Institutional Ethical Committee (IEC approval no: IEC/HMPCMCE/117/Faculty/14/77/2020) approval was obtained. Participants were selected following a convenient sampling technique and informed consent was taken from all the participants. Total 52 adult patients were selected and were divided in three age groups: 18-40 years, 41-60 years, and >60 years.

Inclusion and Exclusion criteria: Patients who were referred with clinical indication for MRI scan of brain (without and/or with contrast study} were included in the study as standard care of patient. Patients, who had given informed consent were included in an additional MRI DTI sequence for this research study; which took about 12 minutes of additional time. Patients below the age of 18 years and adults who had needed sedation or anaesthesia for MRI scans were excluded from the study.

Data Acquisition

Brain MRI was performed on participants using 3T MRI Siemens spectra scanner, a head/neck 16 channel 3T Tim coil. First a 3D T1W Sagittal T1_mprage_sag_p2_iso, T2 weighted sequence, and coronal flair sequences were obtained for anatomical guidance and to ensure that there were no unexpected abnormal findings. Diffusion tensor MRI was performed using a single shot, spin echo, echo planar DT sequence named as Ep2d_diff_mddw_20p2_dti with TR=7500 ms, TE=103 ms, FOV=220 mm, number of averages=5, acquisition time=9 mins, bipolar gradients applied in 12 directions (max b factor=8000 s/mm2). None of the subjects had significant abnormalities observed on conventional MRI sequences reported by certified radiologists.

DTI Image Analysis

Carefully and manually, a freehand ROI on colour coded directional maps was drawn, based on principal anisotropy, in 11 different regions on right and left side of brain. Regions were anterior and posterior side of frontal lobe (Table/Fig 1), centrum semiovale (Table/Fig 2), body of the corpus callosum (Table/Fig 3), genu (Table/Fig 4), splenium (Table/Fig 5), posterior limb of internal capsule (Table/Fig 6), midbrain (Table/Fig 7), pons (Table/Fig 8), medulla oblongata (Table/Fig 9) and foramen magnum (Table/Fig 10). To minimise the influence of taking samples at random sites along the tract, we chose certain natural “crossroads or intermediate stations” that are simple to designate, only to ensure that the slices utilised for analysis were as near to the same level as feasible for all of the participants.

Statistical Analysis

The mean FA and standard deviation for each region of the brain (right and left) were calculated and averaged using descriptive statistics. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 20. Pearson correlation was used to find out the correlation of FA values with different age groups.

Results

Total 52 adult patients were selected with 33 males and 19 females. The mean age of the study participants was 52 years. The majority of the data was normally distributed, so a parametric test was used to check the normality of FA values at 3T MRI. (Table/Fig 11) shows the mean FA values ranged from 0.280 on the right side of the medulla oblongata to 0.820 on the left side of the splenium.

Normally FA values are supposed to be less than 1 in normal patients and the same was observed in the present study, although minor regional differences were observed in FA values of a few regions which were moderate and within SD of 1. The the (Table/Fig 12) shows combined averaged FA values of both sides.

Correlation values <0.5 reflects weak correlation, between 0.50 to 0.70 is moderate and >0.70 reflects strong correlation. In the 18-40 age group, strong positive correlations were observed in the midbrain on both sides (right & left) with statistical significance of 0.006 on right side (Table/Fig 13).

Discussion

The FA does not cast any unique specific tissue quality, it is affected by tissue hydration, myelination, cell-packing density, and fibre diameter, as well as directional coherence, FA is often utilised as a barometer of white matter tissue integrity [10,11]. It is very well known that regional values of FA changes in healthy brain parenchyma (12). In present study the FA values were found to be higher in all three parts of corpus callosum (body 0.627, genu 0.767, splenium 0.809) with least FA value in body of the callosum, similarly according to Brander A et al., (12), the body of the corpus callosum had a lower FA than the genu and splenium, which is likely due to its smaller size, which makes its measurement more susceptible to partial volume influence from neighbouring Cerebrospinal Fluid (CSF) gaps. The FA values observed in present study in the three parts of corpus callosum and posterior limb of internal capsule were slightly different from the findings of Lee CEC et al., (7), Huisman TAGM (8), Husnche S (9) (Table/Fig 14), possible reason could be precision and accuracy of the measurement.

The current study is the rarest one where FA values are measured in so many regions of white matter, and hence it was difficult to locate previous studies in which FA values in additional areas, such as the anterior or posterior part of the frontal lobe, centrum semiovale, midbrain, pons, medulla oblongata and cervico-medullary junction were measured at 3T MRI, however the present results (Table/Fig 14) were aligned with the findings of previous studies which showed that high FA values are typically found in white matter areas with constant fibre orientation and closely packed fibres such as corpus callosum, which is a dense bundle of mediolaterally oriented fibres connecting the cerebral hemispheres (12).

The present study findings were consistent with those of earlier studies which reflect that FA values significantly change as the human ages [7,13]. The existing study showed FA values in the posterior limb of the internal capsule in the 19-35 age group were 0.714±0.04, 0.676±0.081 in the 40-65 age group, in the genu of the corpus callosum were 0.806±0.065 in the 19-35 age group and 0.786±0.076 in the 45-60 age group. In Splenium of Corpus Callosum FA values were 0.775±0.052 in the 19-35 age group and 0.777±0.085 in the 45-65 age group (7), however these investigations were restricted to a small number of brain areas.

Lee CEC et al., (7) and Bisdas S et al., (6) investigated age-related changes in white matter microstructure using diffusion tensor imaging and discovered that FA of inferior frontal white matter decreased with age, their finding points to a regional acceleration of white matter degradation as people get older. In 40-60 age group FA values are highly affected in posterior limb of internal capsule. Reduction in FA values suggested that white matter alterations are not limited to prefrontal white matter and that they occur more frequently in the posterior limb of internal capsule than in specific frontal white matter regions (14), however mild to moderate correlation of few areas of brain was observed in 60 above age group. The present study also came up with the DTI protocol which could be utilised for 3T MRI for brain imaging.

Limitation(s)

Limited number of participants in each age group would be less to confirm the degradation of FA values with age.

Conclusion

In present study FA values are found to be higher in splenium, genu and body of corpus callosum as compared to the other parts of White Matter that could be due to the composition of multiple and histologically heterogeneous tracts. Moderate correlation of FA values in different age groups are also observed in the study which reflects FA values are found to be significantly affected as the human ages.

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DOI and Others

DOI: 10.7860/JCDR/2023/59334.17360

Date of Submission: Jul 27, 2022
Date of Peer Review: Sep 05, 2022
Date of Acceptance: Nov 22, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 28, 2022
• Manual Googling: Nov 15, 2022
• iThenticate Software: Nov 21, 2022 (10%)

ETYMOLOGY: Author Origin

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