Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
권호 표지
DOI QR코드

DOI QR Code

The Fornix: Functional Anatomy, Normal Neuroimaging, and Various Pathological Conditions

  • Choi, Young Jae (Department of Radiology, Dongguk University Ilsan Hospital) ;
  • Lee, Eun Ja (Department of Radiology, Dongguk University Ilsan Hospital) ;
  • Lee, Jung Eun (Department of Radiology, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2021.01.13
  • Accepted : 2021.05.05
  • Published : 2021.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

The fornix is the major white-matter outflow tract from the hippocampus; it has a significant role in cognitive function. It is readily imaged via magnetic resonance imaging; its main parts are the crura, commissure, body, and columns. In this pictorial essay, we describe and illustrate the functional and imaging anatomy of the fornix and limbic system, as well as various disease entities involving the fornix.

Keywords

References

  1. Thomas AG, Koumellis P, Dineen RA. The fornix in health and disease: an imaging review. Radiographics 2011;31:1107-1121 https://doi.org/10.1148/rg.314105729
  2. Lovblad KO, Schaller K, Vargas MI. The fornix and limbic system. Semin Ultrasound CT MR 2014;35:459-473 https://doi.org/10.1053/j.sult.2014.06.005
  3. Yu D, Yan H, Zhou J, Yang X, Lu Y, Han Y. A circuit view of deep brain stimulation in Alzheimer's disease and the possible mechanisms. Mol Neurodegener 2019;14:33 https://doi.org/10.1186/s13024-019-0334-4
  4. Christiansen K, Aggleton JP, Parker GD, O'Sullivan MJ, Vann SD, Metzler-Baddeley C. The status of the precommissural and postcommissural fornix in normal ageing and mild cognitive impairment: an MRI tractography study. Neuroimage 2016;130:35-47 https://doi.org/10.1016/j.neuroimage.2015.12.055
  5. Daitz H. Note on the fibre content of the fornix system in man. Brain 1953;76:509-512 https://doi.org/10.1093/brain/76.3.509
  6. Tsivilis D, Vann SD, Denby C, et al. A disproportionate role for the fornix and mammillary bodies in recall versus recognition memory. Nat Neurosci 2008;11:834-842 https://doi.org/10.1038/nn.2149
  7. Hodgetts CJ, Stefani M, Williams AN, et al. The role of the fornix in human navigational learning. Cortex 2020;124:97-110 https://doi.org/10.1016/j.cortex.2019.10.017
  8. Catani M, Dell'acqua F, Thiebaut de Schotten M. A revised limbic system model for memory, emotion and behaviour. Neurosci Biobehav Rev 2013;37:1724-1737 https://doi.org/10.1016/j.neubiorev.2013.07.001
  9. Papez JW. A proposed mechanism of emotion. 1937. J Neuropsychiatry Clin Neurosci 1995;7:103-112 https://doi.org/10.1176/jnp.7.1.103
  10. Shah A, Jhawar SS, Goel A. Analysis of the anatomy of the Papez circuit and adjoining limbic system by fiber dissection techniques. J Clin Neurosci 2012;19:289-298 https://doi.org/10.1016/j.jocn.2011.04.039
  11. Jang SH, Kwon HG. Neural injury of the Papez circuit following hypoxic-ischemic brain injury: a case report. Medicine (Baltimore) 2016;95:e5173 https://doi.org/10.1097/md.0000000000005173
  12. Chang MC, Yeo SS, Do Lee H, Jang SH. Diffusion tensor tractography in a patient with memory impairment following encephalitis. Acta Neurol Belg 2016;116:629-631 https://doi.org/10.1007/s13760-015-0591-0
  13. Senova S, Fomenko A, Gondard E, Lozano AM. Anatomy and function of the fornix in the context of its potential as a therapeutic target. J Neurol Neurosurg Psychiatry 2020;91:547-559 https://doi.org/10.1136/jnnp-2019-322375
  14. Fletcher E, Raman M, Huebner P, et al. Loss of fornix white matter volume as a predictor of cognitive impairment in cognitively normal elderly individuals. JAMA Neurol 2013;70:1389-1395 https://doi.org/10.1001/jamaneurol.2013.3263
  15. Oishi K, Lyketsos CG. Alzheimer's disease and the fornix. Front Aging Neurosci 2014;6:241
  16. Raslau FD, Augustinack JC, Klein AP, Ulmer JL, Mathews VP, Mark LP. Memory Part 3: the role of the fornix and clinical cases. AJNR Am J Neuroradiol 2015;36:1604-1608 https://doi.org/10.3174/ajnr.A4371
  17. Koo H, Lee KY, Chi JG. Congenital hydrocephalus associated with anomalies of midline telencephalic structures. a case report. Pathol Res Pract 1991;187:939-942 https://doi.org/10.1016/s0344-0338(11)81064-2
  18. Rosenbaum RS, Gao F, Honjo K, et al. Congenital absence of the mammillary bodies: a novel finding in a wellstudied case of developmental amnesia. Neuropsychologia 2014;65:82-87 https://doi.org/10.1016/j.neuropsychologia.2014.09.047
  19. Chun YK, Kim HS, Hong SR, Chi JG. Absence of the septum pellucidum associated with a midline fornical nodule and ventriculomegaly: a report of two cases. J Korean Med Sci 2010;25:970-973 https://doi.org/10.3346/jkms.2010.25.6.970
  20. Kumar R, Lee K, Macey PM, Woo MA, Harper RM. Mammillary body and fornix injury in congenital central hypoventilation syndrome. Pediatr Res 2009;66:429-434 https://doi.org/10.1203/PDR.0b013e3181b3b363
  21. Kapur N, Barker S, Burrows EH, et al. Herpes simplex encephalitis: long term magnetic resonance imaging and neuropsychological profile. J Neurol Neurosurg Psychiatry 1994;57:1334-1342 https://doi.org/10.1136/jnnp.57.11.1334
  22. Zagardo MT, Shanholtz CB, Zoarski GH, Rothman MI. Rhombencephalitis caused by adenovirus: MR imaging appearance. AJNR Am J Neuroradiol 1998;19:1901-1903
  23. Son SM, Jang SH, Lee ES, Ahn SH, Lee DG, Cho HK. Fornix injury in a patient with rotavirus encephalopathy: diffusion tensor tractography study. Ann Rehabil Med 2012;36:551-555 https://doi.org/10.5535/arm.2012.36.4.551
  24. Kwon YW, Moon WJ, Park M, et al. Dynamic susceptibility contrast (DSC) perfusion MR in the prediction of long-term survival of glioblastomas (GBM): correlation with MGMT promoter methylation and 1p/19q deletions. Investig Magn Reson Imaging 2018;22:158-167 https://doi.org/10.13104/imri.2018.22.3.158
  25. Hsu BH, Lee WH, Yang ST, Han CT, Tseng YY. Spinal metastasis of glioblastoma multiforme before gliosarcomatous transformation: a case report. BMC Neurol 2020;20:178 https://doi.org/10.1186/s12883-020-01768-3
  26. Oberndorfer S, Urbanits S, Lahrmann H, Kirschner H, Kumpan W, Grisold W. Akinetic mutism caused by bilateral infiltration of the fornix in a patient with astrocytoma. Eur J Neurol 2002;9:311-313 https://doi.org/10.1046/j.1468-1331.2002.00386.x
  27. Ogawa K, Toita T, Kakinohana Y, et al. A patient with improvement in short-term memory disturbance brought about by radiation therapy for germinoma involving Papez circuit. Radiat Med 1999;17:317-322
  28. Saeki N, Sunami K, Kubota M, et al. Heavily T2-weighted MR imaging of white matter tracts in the hypothalamus: normal and pathologic demonstrations. AJNR Am J Neuroradiol 2001;22:1468-1475
  29. Yoon SS, Na DL, Park KC. Retrograde amnesia associated with fornix lymphoma. Eur Neurol 2008;60:155-158 https://doi.org/10.1159/000145334
  30. Blauwblomme T, Varlet P, Goodden JR, et al. Forniceal glioma in children. Clinical article. J Neurosurg Pediatr 2009;4:249-253 https://doi.org/10.3171/2009.4.PEDS08472
  31. Chan S, Erickson JK, Yoon SS. Limbic system abnormalities associated with mesial temporal sclerosis: a model of chronic cerebral changes due to seizures. Radiographics 1997;17:1095-1110 https://doi.org/10.1148/radiographics.17.5.9308104
  32. Shinnar S. Febrile seizures and mesial temporal sclerosis. Epilepsy Curr 2003;3:115-118 https://doi.org/10.1046/j.1535-7597.2003.03401.x
  33. Camacho DL, Castillo M. MR imaging of temporal lobe epilepsy. Semin Ultrasound CT MR 2007;28:424-436 https://doi.org/10.1053/j.sult.2007.09.005
  34. Roosendaal SD, Geurts JJ, Vrenken H, et al. Regional DTI differences in multiple sclerosis patients. Neuroimage 2009;44:1397-1403 https://doi.org/10.1016/j.neuroimage.2008.10.026
  35. Pittock SJ, Weinshenker BG, Lucchinetti CF, Wingerchuk DM, Corboy JR, Lennon VA. Neuromyelitis optica brain lesions localized at sites of high aquaporin 4 expression. Arch Neurol 2006;63:964-968 https://doi.org/10.1001/archneur.63.7.964
  36. Lemos MD, Carvalho GB, Carvalho RS, Bichuetti DB, de Oliveira EM, Abdala N. Neuromyelitis optica spectrum disorders: beyond longitudinally extensive transverse myelitis. Clin Radiol 2015;70:630-637 https://doi.org/10.1016/j.crad.2015.02.016
  37. Kim TE, Lee EJ, Young JB, Shin DJ, Kim JH. Wernicke encephalopathy and ethanol-related syndromes. Semin Ultrasound CT MR 2014;35:85-96 https://doi.org/10.1053/j.sult.2013.09.004
  38. Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature. AJR Am J Roentgenol 2009;192:501-508 https://doi.org/10.2214/AJR.07.3959
  39. Zuccoli G, Santa Cruz D, Bertolini M, et al. MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol 2009;30:171-176 https://doi.org/10.3174/ajnr.A1280
  40. Borges RS, Ventura N, Gasparetto EL, Pinto MV. Forniceal involvement in Wernicke encephalopathy. AJNR Am J Neuroradiol 2011;32:E209; author reply E210 https://doi.org/10.3174/ajnr.A2888
  41. Sugai A, Kikugawa K. Atypical MRI findings of Wernicke encephalopathy in alcoholic patients. AJR Am J Roentgenol 2010;195:W372-373; author reply W374 https://doi.org/10.2214/AJR.10.4539
  42. Mugikura S, Takahashi S. Fornix infarction due to involvement of posterior circulation. J Stroke Cerebrovasc Dis 2015;24:2883-2885 https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.07.009
  43. Moudgil SS, Azzouz M, Al-Azzaz A, Haut M, Gutmann L. Amnesia due to fornix infarction. Stroke 2000;31:1418-1419 https://doi.org/10.1161/01.str.31.6.1418
  44. Karri M, Ramasamy B, Perumal S. Ischemic amnesia caused by bilateral fornix infarction: a rare entity. Ann Indian Acad Neurol 2019;22:333-334 https://doi.org/10.4103/aian.AIAN_303_18
  45. Salvalaggio A, Cagnin A, Nardetto L, Manara R, Briani C. Acute amnestic syndrome in isolated bilateral fornix stroke. Eur J Neurol 2018;25:787-789 https://doi.org/10.1111/ene.13592
  46. Ren C, Yuan J, Tong S, et al. Memory impairment due to a small acute infarction of the columns of the fornix. J Stroke Cerebrovasc Dis 2018;27:e138-e143 https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.02.039
  47. Mazarakis NK, Summers F, Murray AD, Waiter GD, Fouyas IP. Partial recovery from amnesia following bilateral surgical fornix transection is correlated with cortical plasticity. Br J Neurosurg 2011;25:658-661 https://doi.org/10.3109/02688697.2011.584982
  48. Kinoshita F, Kinoshita T, Toyoshima H, Shinohara Y. Ipsilateral atrophy of the mammillary body and fornix after thalamic stroke: evaluation by MRI. Acta Radiol 2019;60:1512-1522 https://doi.org/10.1177/0284185119839166
  49. Yallampalli R, Wilde EA, Bigler ED, et al. Acute white matter differences in the fornix following mild traumatic brain injury using diffusion tensor imaging. J Neuroimaging 2013;23:224-227 https://doi.org/10.1111/j.1552-6569.2010.00537.x
  50. Stern RA, Riley DO, Daneshvar DH, Nowinski CJ, Cantu RC, McKee AC. Long-term consequences of repetitive brain trauma: chronic traumatic encephalopathy. PM R 2011;3:S460-467 https://doi.org/10.1016/j.pmrj.2011.08.008
  51. Soleman J, Guzman R. Neurocognitive complications after ventricular neuroendoscopy: a systematic review. Behav Neurol 2020;2020:2536319
  52. Hattori T, Sato R, Aoki S, Yuasa T, Mizusawa H. Different patterns of fornix damage in idiopathic normal pressure hydrocephalus and Alzheimer disease. AJNR Am J Neuroradiol 2012;33:274-279 https://doi.org/10.3174/ajnr.A2780
  53. Milton CK, Palejwala AH, O'Connor KP, McCoy TM, Conner AK, Glenn CA. Diffusion tensor imaging tractography for fornix identification in intraventricular tumor surgery: a case series. Neurosurgery Open 2020;1:okaa005 https://doi.org/10.1093/neuopn/okaa005
  54. Yang JH, Lee HD, Kwak SY, Byun KH, Park SH, Yang D. Mechanism of cognitive impairment in chronic patients with putaminal hemorrhage: a diffusion tensor tractography. Medicine (Baltimore) 2018;97:e11035 https://doi.org/10.1097/md.0000000000011035
  55. Yeo SS, Choi BY, Chang CH, et al. Injury of fornix in patients with intracerebral hemorrhage. Int J Neurosci 2012;122:195-199 https://doi.org/10.3109/00207454.2011.639469
  56. Savastano LE, Hollon TC, Barkan AL, Sullivan SE. Korsakoff syndrome from retrochiasmatic suprasellar lesions: rapid reversal after relief of cerebral compression in 4 cases. J Neurosurg 2018;128:1731-1736 https://doi.org/10.3171/2017.1.jns162719
  57. Yoshida M, Hayashi T, Fujii K, Kawai K, Tsuji S, Iwata A. Recovered recall memory after decompression of the fornix by surgical removal of pineal tumor. Neurology 2016;86:790-791 https://doi.org/10.1212/WNL.0000000000002394
  58. Rudie JD, Rauschecker AM, Nabavizadeh SA, Mohan S. Neuroimaging of dilated perivascular spaces: from benign and pathologic causes to mimics. J Neuroimaging 2018;28:139-149 https://doi.org/10.1111/jon.12493
  59. Sepehrband F, Cabeen RP, Choupan J, et al. Perivascular space fluid contributes to diffusion tensor imaging changes in white matter. Neuroimage 2019;197:243-254 https://doi.org/10.1016/j.neuroimage.2019.04.070
  60. Osborn AG, Salzman KL, Jhaveri MD, Barkovich AJ. Diagnostic imaging: brain. 3rd ed. E-book. Philadelphia: Elsevier Health Sciences, 2015