Identification of Stria Medullaris Fibers in the Massa Intermedia Using Diffusion Tensor Imaging.

Background: The massa intermedia (MI) or interthalamic adhesion is an inconsistent band spanning between bilateral medial thalami that is absent in up to 20%-30% of individuals. Little is known of its significance, especially in regard to functional pathways. Probabilistic diffusion tensor imaging (DTI) has recently been used to seed the lateral habenula and define its afferent white matter pathway, the stria medullaris thalami (SM). We sought to determine whether the MI serves as a conduit for crossing of limbic fibers such as the SM.

Methods: Probabilistic DTI was performed on 10 subjects who had presence of a MI as visualized on magnetic resonance imaging. Tractography was also performed on 2 subjects without MI. Manual identification of the lateral habenula on axial T1-weighted magnetic resonance imaging was used for the initial seed region for tractography.

Results: In all subjects, the SM was reliably visualized. In 7 of the 10 subjects with MI, there was evidence of SM fibers that crossed to the ipsilateral hemisphere. Three subjects with small diameter MI did not have tractographic evidence of crossing SM fibers. Of the 7 subjects with crossing SM fibers within the MI, 5 showed predilection toward the right orbitofrontal cortex from both the left and right seed regions.

Conclusions: Probabilistic DTI provides evidence of SM fibers within the MI. Given its anatomic location as a bridging pathway between thalami, further studies are necessary to assess its role within the limbic functional network.