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Korkmazer B, Kemerdere R, Bas G, Arslan S, Demir B, Batkitar A, Kizilkilic O, Hanci MM. The efficacy of preoperative diffusion tensor tractography on surgical planning and outcomes in patients with intramedullary spinal tumor. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4321-4327. [PMID: 37530950 DOI: 10.1007/s00586-023-07872-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/14/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE The aim of this study was to investigate the efficacy of diffusion tensor tractography (DTT) of spinal cord on surgical planning and postoperative neurological outcomes in patients with spinal intramedullary tumors. METHODS The study was conducted retrospectively from the radiological and clinical data of our hospital database. Patients with intramedullary spinal cord tumors who underwent diffusion tensor imaging for spinal cord lesions were selected between 2019 and 2022. Demographic characteristics and intraoperative neurophysiological monitoring data were evaluated. The McCormick scale was used to grade the pre- and postoperative neurological status of the patients. The tumoral lesions were categorized into 3 types according to the fiber course on DTT. RESULTS Eleven patients were found to have radiological findings that were compatible with intramedullary tumor; eight (72.7%) of them ultimately underwent surgery following being approved as surgical candidates in the spinal diffusion tensor imaging studies. Six cases had Type 1, one case had Type 2, and 4 cases had Type 3 tumors according to the fiber course. All Type 1 tumors were classified as resectable and all of them were gross totally resected. Type 2 lesion that was rated as resectable by DTI was subtotally resected. Type 3 lesions were followed without surgery except the one with tumoral progression and neurological deficit. The postoperative neurological outcomes were compatible with intraoperative neurophysiological monitoring results. CONCLUSION Diffusion tensor imaging and tractography may be beneficial regarding the selection of patients suitable for surgery and in the subsequent surgical planning.
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Affiliation(s)
- Bora Korkmazer
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey.
| | - Rahsan Kemerdere
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Gulcin Bas
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Serdar Arslan
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Bilal Demir
- Department of Radiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Abdulmelik Batkitar
- Department of Radiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Mehmet Murat Hanci
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
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Fiani B, Noblett C, Nanney J, Doan T, Pennington E, Jarrah R, Sarno E, Nikolaidis D. Diffusion tensor imaging of the spinal cord status post trauma. Surg Neurol Int 2020; 11:276. [PMID: 33033638 PMCID: PMC7538980 DOI: 10.25259/sni_495_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background Since its development in 1994, diffusion tensor imaging (DTI) has been successfully used to assess structural and functional changes to neurological tissue within the central nervous system. Namely, DTI is a noninvasive magnetic resonance imaging (MRI)-based technique that uses anisotropic diffusion to visualize and estimate the organization of white matter in neuronal tissue. It has been used to study various spinal pathologies including neoplastic diseases, degenerative myelopathy, demyelinating diseases, and infections involving the spinal cord. However, due to technical uncertainties and experimental limitations, DTI has rarely been clinically applied to assess trauma-related spinal pathologies. Methods An extensive review of the published literature on DTI was performed utilizing PubMed, OVID Medline, and EMBASE journals. Terms used for the search included DTI and spine trauma. Results The search yielded full text English language-related articles regarding DTIs application, limitations, and functional outcomes secondary to spinal trauma. Conclusion DTI relies on anisotropy in CNS tissues to determine the spatial orientation of surrounding axon tracts and define anatomical boundaries. Diffusion along three principle axes is used to calculate the following four DTI indices; fractional anisotropy, apparent diffusion coefficient (ADC), longitudinal ADC, and transverse ADC. Using DTI as a diagnostic tool status, post spine trauma has proven useful in examining the morphological and physiological extent of spinal lesions beyond conventional MRI. Experimental studies are now utilizing DTI to analyze the severity of spinal cord trauma during the hyperacute phase and may potentially be used to providing additional diagnostic information for improved treatment efficiency (e.g., as shown during the stem cell therapy trials).
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA
| | - Christian Noblett
- College of Osteopathic Medicine, University of New England, Biddeford, ME
| | - Jacob Nanney
- College of Medicine, University of Kentucky, Lexington, KY
| | - Thao Doan
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | | | - Ryan Jarrah
- College of Literature, Arts, and Sciences, University of Michigan-Flint, Flint, MI, United States
| | - Erika Sarno
- College of Osteopathic Medicine, Michigan State University, East Lansing
| | - Daniel Nikolaidis
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
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Dauleac C, Frindel C, Mertens P, Jacquesson T, Cotton F. Overcoming challenges of the human spinal cord tractography for routine clinical use: a review. Neuroradiology 2020; 62:1079-1094. [DOI: 10.1007/s00234-020-02442-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023]
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Wang H, Li X, Wang Y, Sun J, Wang Y, Xu X, Zhang B, Shi J. Assessing Spinal Cord Injury Area in Patients with Tethered Cord Syndrome by Diffusion Tensor Imaging. World Neurosurg 2019; 127:e542-e547. [DOI: 10.1016/j.wneu.2019.03.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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Diffusion tensor imaging (DTI) and Tractography of the spinal cord in pediatric population with spinal lipomas: preliminary study. Childs Nerv Syst 2019; 35:129-137. [PMID: 30073389 DOI: 10.1007/s00381-018-3935-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/25/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Diffusion tensor imaging (DTI) allows studying the micro and macro architecture. One of the major challenges in dysraphism is to know the morphologic organization of the spinal cord. In a preliminary work, spinal lipoma was chosen for analyzing the micro-architecture parameters and fiber morphology of the spinal cord by DTI with tractography. METHODS Twelve patients (0-8 years) related to spinal lipomas treated between May 2017 and March 2018 were included. Tractography reconstruction of the conus medullaris of 12 patients were obtained using the MedINRIA software. The diffusion parameters have been calculated by Osirix DTImap plugin. RESULTS We found a significant difference in the FA (p = 0.024) between two age groups (< 24 months old and > 24 months old). However, no significant differences in the mean values of FA, RD, and MD between the level of the lipoma and the level above were noted. The tractography obtained in each case was coherent with morphologic sequences and reproducible. The conus medullaris was deformed and shifted. Destruction or disorganization of fibers and any passing inside the lipomas was not observed. CONCLUSIONS Tractography of the conus medullaris in a very young pediatric population (0-8 years old) with a spinal lipoma is possible, reproductive, and allows visualization of the spinal cord within the dysraphism. Analysis of the FA shows that the presence of a lipoma seems to have an effect on the myelination of the conus medullaris. It is during the probable myelination phase that the majority of symptoms appear. Is the myelination per se the cause?
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Wei LF, Wang SS, Zheng ZC, Tian J, Xue L. Analysis of the diffusion tensor imaging parameters of a normal cervical spinal cord in a healthy population. J Spinal Cord Med 2017; 40:338-345. [PMID: 27814138 PMCID: PMC5472022 DOI: 10.1080/10790268.2016.1244905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) shows great advantage in the diagnosis of brain diseases, including cervical spinal cord (CSC) disease. This study aims to obtain the normal values of the DTI parameters for a healthy population and to establish a baseline for CSC disease diagnosis using DTI. METHODS A total of 36 healthy adults were subjected to magnetic resonance imaging (MRI) for the entire CSC using the Siemens 3.0 T MR System. Sagittal DTI acquisition was carried out with a single-shot spin-echo echo-planar imaging (EPI) sequence along 12 non-collinear directions. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were determined at different cervical levels using a region of interest (ROI) method, following which they were correlated with parameters, like age and sex. Further, diffusion tensor tracking (DTT) was carried out to reconstruct the white matter fiber bundles of the CSC. RESULTS The full and complete fiber bundle structure of a normal CSC was confirmed in both the T2-weighted and DTI images. The FA and ADC values were significantly negatively correlated with each other and showed strongly negative and positive correlations with age, respectively, but not with sex. Additionally, there was no significant difference between the FA and the ADC values at different cervical levels. CONCLUSION The DTI technique can act as an important supplement to the conventional MRI technique for CSC observation. Moreover, the FA and ADC values can be used as sensitive parameters in the DTI study on the CSC by taking the effects of age into consideration.
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Affiliation(s)
| | - Shou-sen Wang
- Correspondence to: Shou-sen Wang, Department of Neurosurgery, Fuzhou General Hospital, Fuzhou Clinical Medicine School of Second Military Medical University, No. 156, Xi'erhuanbei Road, Fuzhou, 350025, P. R. China.
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Chen HB, Zhong ZW, Li CS, Bai B. Enough positive rate of paraspinal mapping and diffusion tensor imaging with levels which should be decompressed in lumbar spinal stenosis. J Orthop Sci 2016; 21:431-438. [PMID: 27188929 DOI: 10.1016/j.jos.2016.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In lumbar spinal stenosis, correlating symptoms and physical examination findings with decompression levels based on common imaging is not reliable. Paraspinal mapping (PM) and diffusion tensor imaging (DTI) may be possible to prevent the false positive occurrences with MRI and show clear benefits to reduce the decompression levels of lumbar spinal stenosis than conventional magnetic resonance imaging (MRI) + neurogenic examination (NE). However, they must have enough positive rate with levels which should be decompressed at first. The study aimed to confirm that the positive of DTI and PM is enough in levels which should be decompressed in lumbar spinal stenosis. MATERIALS AND METHODS The study analyzed the positive of DTI and PM as well as compared the preoperation scores to the postoperation scores, which were assessed preoperatively and at 2 weeks, 3 months 6 months, and 12 months postoperatively. RESULTS 96 patients underwent the single level decompression surgery. The positive rate among PM, DTI, and (PM or DTI) was 76%, 98%, 100%, respectively. All post-operative Oswestry Disability Index (ODI), visual analog scale for back pain (VAS-BP) and visual analog scale for leg pain (VAS-LP) scores at 2 weeks postoperatively were measured improvement than the preoperative ODI, VAS-BP and VAS-LP scores with statistically significance (p-value = 0.000, p-value = 0.000, p-value = 0.000, respectively). CONCLUSIONS In degenetive lumbar spinal stenosis, the positive rate of (DTI or PM) is enough in levels which should be decompressed, thence using the PM and DTI to determine decompression levels will not miss the level which should be operated.
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Affiliation(s)
- Hua-Biao Chen
- Departments of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou 510120, People's Republic of China.
| | - Zhi-Wei Zhong
- Departments of Radiology, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou 510120, People's Republic of China.
| | - Chun-Sheng Li
- Departments of Radiology, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou 510120, People's Republic of China.
| | - Bo Bai
- Departments of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou 510120, People's Republic of China; Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou 510120, People's Republic of China.
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Talekar K, Poplawski M, Hegde R, Cox M, Flanders A. Imaging of Spinal Cord Injury: Acute Cervical Spinal Cord Injury, Cervical Spondylotic Myelopathy, and Cord Herniation. Semin Ultrasound CT MR 2016; 37:431-47. [PMID: 27616315 DOI: 10.1053/j.sult.2016.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We review the pathophysiology and imaging findings of acute traumatic spinal cord injury (SCI), cervical spondylotic myelopathy, and briefly review the much less common cord herniation as a unique cause of myelopathy. Acute traumatic SCI is devastating to the patient and the costs to society are staggering. There are currently no "cures" for SCI and the only accepted pharmacologic treatment regimen for traumatic SCI is currently being questioned. Evaluation and prognostication of SCI is a demanding area with significant deficiencies, including lack of biomarkers. Accurate classification of SCI is heavily dependent on a good clinical examination, the results of which can vary substantially based upon the patient׳s condition or comorbidities and the skills of the examiner. Moreover, the full extent of a patients׳ neurologic injury may not become apparent for days after injury; by then, therapeutic response may be limited. Although magnetic resonance imaging (MRI) is the best imaging modality for the evaluation of spinal cord parenchyma, conventional MR techniques do not appear to differentiate edema from axonal injury. Recently, it is proposed that in addition to characterizing the anatomic extent of injury, metrics derived from conventional MRI and diffusion tensor imaging, in conjunction with the neurological examination, can serve as a reliable objective biomarker for determination of the extent of neurologic injury and early identification of patients who would benefit from treatment. Cervical spondylosis is a common disorder affecting predominantly the elderly with a potential to narrow the spinal canal and thereby impinge or compress upon the neural elements leading to cervical spondylotic myelopathy and radiculopathy. It is the commonest nontraumatic cause of spinal cord disorder in adults. Imaging plays an important role in grading the severity of spondylosis and detecting cord abnormalities suggesting myelopathy.
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Affiliation(s)
- Kiran Talekar
- Section of Neuroradiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Michael Poplawski
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Rahul Hegde
- Section of Neuroradiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Mougnyan Cox
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Adam Flanders
- Section of Neuroradiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Chen HB, Wan Q, Xu QF, Chen Y, Bai B. Reducing surgical levels by paraspinal mapping and diffusion tensor imaging techniques in lumbar spinal stenosis. J Orthop Surg Res 2016; 11:47. [PMID: 27113931 PMCID: PMC4845428 DOI: 10.1186/s13018-016-0382-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Correlating symptoms and physical examination findings with surgical levels based on common imaging results is not reliable. In patients who have no concordance between radiological and clinical symptoms, the surgical levels determined by conventional magnetic resonance imaging (MRI) and neurogenic examination (NE) may lead to a more extensive surgery and significant complications. We aimed to confirm that whether the use of diffusion tensor imaging (DTI) and paraspinal mapping (PM) techniques can further prevent the occurrence of false positives with conventional MRI, distinguish which are clinically relevant from levels of cauda equina and/or nerve root lesions based on MRI, and determine and reduce the decompression levels of lumbar spinal stenosis than MRI + NE, while ensuring or improving surgical outcomes. METHODS We compared the data between patients who underwent MRI + (PM or DTI) and patients who underwent conventional MRI + NE to determine levels of decompression for the treatment of lumbar spinal stenosis. Outcome measures were assessed at 2 weeks, 3 months, 6 months, and 12 months postoperatively. RESULTS One hundred fourteen patients (59 in the control group, 54 in the experimental group) underwent decompression. The levels of decompression determined by MRI + (PM or DTI) in the experimental group were significantly less than that determined by MRI + NE in the control group (p = 0.000). The surgical time, blood loss, and surgical transfusion were significantly less in the experimental group (p = 0.001, p = 0.011, p = 0.001, respectively). There were no differences in improvement of the visual analog scale back and leg pain (VAS-BP, VAS-LP) scores and Oswestry Disability Index (ODI) scores at 2 weeks, 3 months, 6 months, and 12 months after operation between the experimental and control groups. CONCLUSIONS MRI + (PM or DTI) showed clear benefits in determining decompression levels of lumbar spinal stenosis than MRI + NE. In patients with lumbar spinal stenosis, the use of PM and DTI techniques reduces decompression levels and increases safety and benefits of surgery.
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Affiliation(s)
- Hua-Biao Chen
- Department of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China
| | - Qi Wan
- Department of Radiology, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China
| | - Qi-Feng Xu
- Department of Electromyography, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China
| | - Yi Chen
- Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China
| | - Bo Bai
- Department of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China. .,Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, People's Republic of China.
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Alkherayf F, Arab AF, Tsai E. Conus Medullaris Teratoma with Utilization of Fiber Tractography: Case Report. J Neurol Surg Rep 2015; 76:e183-7. [PMID: 26251802 PMCID: PMC4521003 DOI: 10.1055/s-0035-1555134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/28/2015] [Indexed: 11/17/2022] Open
Abstract
Objective Conus medullaris teratomas are very rare tumors. Traditional preoperative diagnosis depended on the findings from magnetic resonance imaging (MRI). Tractography is a novel technique that has recently been utilized to diagnose spinal cord lesions. This case report shows that fiber tractography has great potential in preoperative diagnosis and postoperative follow-up of teratomas of the conus medullaris. Methods A 50-year-old man with a conus medullaris teratoma underwent tractography with the aim of visualizing the tumor in relation to the white matter tracts. The patient underwent a T12–L2 laminectomy, and the lesion was resected. The histopathology diagnosis was of a mature teratoma. Study Design Case report. Results Diffusion tensor imaging (DTI) and tractography provide more details about the white matter tracts in relation to space-occupying lesions that may be more sensitive than conventional MRI and have recently been utilized in spinal cord lesions. Fiber tracking has the ability to visualize the integrity of the white matter tracts at the level of the conus medullaris in relation to the lesion. The tracts appeared to be displaced by the lesion at the conus medullaris. Tractography also showed no white matter tracts within the lesion. Such findings are consistent with the characteristics of a benign lesion. Exploiting tractography in this case was helpful in predicting the nature of the lesion preoperatively and in planning the surgical intervention. Conclusions Conus medullaris teratomas mostly affect adults. Patients generally present with a long history of clinical symptoms prior to diagnosis. Surgery is required for diagnosis, and the goal should be complete tumor excision without sacrificing any neurologic functions. The use of DTI and tractography, in addition to conventional MRI, has the potential to be very valuable for the diagnosis, surgical planning, and follow-up of patients with conus medullaris teratomas.
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Affiliation(s)
- Fahad Alkherayf
- Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada ; Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Abdullah Faisal Arab
- Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada ; Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada ; Division of Spine Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Eve Tsai
- Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada ; Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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El Maati AAA, Chalabi N. Diffusion tensor tractography as a supplementary tool to conventional MRI for evaluating patients with myelopathy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Hendrix P, Griessenauer CJ, Cohen-Adad J, Rajasekaran S, Cauley KA, Shoja MM, Pezeshk P, Tubbs RS. Spinal diffusion tensor imaging: A comprehensive review with emphasis on spinal cord anatomy and clinical applications. Clin Anat 2014; 28:88-95. [DOI: 10.1002/ca.22349] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 10/28/2013] [Indexed: 12/14/2022]
Affiliation(s)
- Philipp Hendrix
- Department of Neurosurgery; University of Alabama at Birmingham; Birmingham Alabama
| | | | - Julien Cohen-Adad
- Department of Biomedical Engineering; Ecole Polytechnique de Montreal; Quebec Canada
| | | | - Keith A. Cauley
- Department of Radiology; Columbia-Presbyterian Medical Center; New York New York
| | | | - Parham Pezeshk
- Department of Radiology; Veterans Affairs Long Beach Healthcare System; University of California Irvine, California
| | - R. Shane Tubbs
- Department of Pediatric Neurosurgery; Children's Hospital; Birmingham Alabama
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Wang W, Qin W, Hao N, Wang Y, Zong G. Diffusion tensor imaging in spinal cord compression. Acta Radiol 2012; 53:921-8. [PMID: 22893728 DOI: 10.1258/ar.2012.120271] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although diffusion tensor imaging has been successfully applied in brain research for decades, several main difficulties have hindered its extended utilization in spinal cord imaging. PURPOSE To assess the feasibility and clinical value of diffusion tensor imaging and tractography for evaluating chronic spinal cord compression. MATERIAL AND METHODS Single-shot spin-echo echo-planar DT sequences were scanned in 42 spinal cord compression patients and 49 healthy volunteers. The mean values of the apparent diffusion coefficient and fractional anisotropy were measured in region of interest at the cervical and lower thoracic spinal cord. The patients were divided into two groups according to the high signal on T2WI (the SCC-HI group and the SCC-nHI group for with or without high signal). A one-way ANOVA was used. Diffusion tensor tractography was used to visualize the morphological features of normal and impaired white matter. RESULTS There were no statistically significant differences in the apparent diffusion coefficient and fractional anisotropy values between the different spinal cord segments of the normal subjects. All of the patients in the SCC-HI group had increased apparent diffusion coefficient values and decreased fractional anisotropy values at the lesion level compared to the normal controls. However, there were no statistically significant diffusion index differences between the SCC-nHI group and the normal controls. In the diffusion tensor imaging maps, the normal spinal cord sections were depicted as fiber tracts that were color-encoded to a cephalocaudal orientation. The diffusion tensor images were compressed to different degrees in all of the patients. CONCLUSION Diffusion tensor imaging and tractography are promising methods for visualizing spinal cord tracts and can provide additional information in clinical studies in spinal cord compresion.
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Affiliation(s)
- Wei Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai
| | - Wen Qin
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin
| | - Nanxin Hao
- Department of Radiology, East Hospital, Tongji University, Shanghai, China
| | - Yibin Wang
- Department of Radiology, East Hospital, Tongji University, Shanghai, China
| | - Genlin Zong
- Department of Radiology, East Hospital, Tongji University, Shanghai, China
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Lundell H, Barthelemy D, Biering-Sørensen F, Cohen-Adad J, Nielsen JB, Dyrby TB. Fast diffusion tensor imaging and tractography of the whole cervical spinal cord using point spread function corrected echo planar imaging. Magn Reson Med 2012; 69:144-9. [PMID: 22396180 DOI: 10.1002/mrm.24235] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 01/09/2012] [Accepted: 02/03/2012] [Indexed: 11/10/2022]
Abstract
Diffusion tensor imaging has been used in a number of spinal cord studies, but severe distortions caused by susceptibility induced field inhomogeneities limit its applicability to investigate small volumes within acceptable acquisition times. A way to evaluate image distortions is to map the point spread function of the voxel intensity in a reference scan. In this study, the point spread function was mapped for an echo-planar imaging sequence in the human cervical spinal cord with isotropic resolution and large field of view. Correction with the point spread function map improved anatomical consistency, and full cervical tractography was thereby possible from a C1 seed region in healthy controls and one individual with spinal cord injury. It is suggested that point spread function mapping of the spinal cord can be used in combination with sequence-based methods for reduction of susceptibility artifacts or in high-field imaging settings where off-resonance effects are pronounced.
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Affiliation(s)
- Henrik Lundell
- Department of Exercise and Sport Sciences, University of Copenhagen, Copenhagen, Denmark.
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Kamble RB, Venkataramana NK, Naik AL, Rao SV. Diffusion tensor imaging in spinal cord injury. Indian J Radiol Imaging 2011; 21:221-4. [PMID: 22013299 PMCID: PMC3190496 DOI: 10.4103/0971-3026.85372] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE To assess the feasibility of spinal tractography in patients of spinal cord injury vs a control group and to compare fractional anisotropy (FA) values between the groups. MATERIALS AND METHODS Diffusion tensor imaging (DTI) was performed in the spinal cord of 29 patients (18 patients and 11 controls). DTI was done in the cervical region if the cord injury was at the dorsal or lumbar region and in the conus region if cord injury was in the cervical or dorsal region. FA was calculated for the patients and the controls and the values were compared. RESULTS The mean FA value was 0.550±0.09 in the control group and 0.367±0.14 in the patients; this difference was statistically significant (P=0.001). CONCLUSION Spinal tractography is a feasible technique to assess the extent of spinal cord injury by FA, which is reduced in patients of spinal cord injury, suggesting possible Wallerian degeneration. In future, this technique may become a useful tool for assessing cord injury patients after stem cell therapy, with improvement in FA values indicating axonal regeneration.
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Affiliation(s)
- Ravindra B Kamble
- Department of Radiology and Neurosciences, BGS Global Hospital, Bangalore, Karnataka, India
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Pease A, Miller R. The use of diffusion tensor imaging to evaluate the spinal cord in normal and abnormal dogs. Vet Radiol Ultrasound 2011; 52:492-7. [PMID: 21689202 DOI: 10.1111/j.1740-8261.2011.01837.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Diffusion tensor imaging (DTI) is a specialized magnetic resonance sequence to determine the direction of water molecule motion. Our hypothesis was that information derived from DTI will be significantly different in dogs with a spinal cord lesion compared with a normal dog. Eleven normal dogs and six dogs with a spinal cord lesions were imaged. DTI was performed along with standard T1- and T2-weighted sequences in transverse and sagittal planes. Fractional anisotrophy and apparent diffusion coefficient (ADC) were obtained using regions of interests centered on the cranial aspect, middle cranial, middle caudal, and caudal aspects of the spinal cord. In normal dogs, the DTI sequence was characterized by normal fiber tracking with no statistical difference between the four sections of spinal cord (P>0.05). In the dogs with a spinal cord lesion, there was a significant difference in fractional anisotropy between the two groups (P=0.0003) and the ADC analysis statistical significance (P=0.048) at the caudal most site. Based on these findings, DTI is a potentially useful method to evaluate the spinal cord in dogs.
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Affiliation(s)
- Anthony Pease
- College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA.
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Setzer M, Murtagh RD, Murtagh FR, Eleraky M, Jain S, Marquardt G, Seifert V, Vrionis FD. Diffusion tensor imaging tractography in patients with intramedullary tumors: comparison with intraoperative findings and value for prediction of tumor resectability. J Neurosurg Spine 2010; 13:371-80. [PMID: 20809733 DOI: 10.3171/2010.3.spine09399] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The aim of this retrospective study was to evaluate the predictive value of diffusion tensor (DT) imaging with respect to resectability of intramedullary spinal cord tumors and to determine the concordance of this method with intraoperative surgical findings.
Methods
Diffusion tensor imaging was performed in 14 patients with intramedullary lesions of the spinal cord at different levels using a 3-T magnet. Routine MR imaging scans were also obtained, including unenhanced and enhanced T1-weighted images and T2-weighted images. Patients were classified according to the fiber course with respect to the lesion and their lesions were rated as resectable or nonresectable. These results were compared with the surgical findings (existence vs absence of cleavage plane). The interrater reliability was calculated using the κ coefficient of Cohen.
Results
Of the 14 patients (7 male, 7 female; mean age 49.2 ± 15.5 years), 13 had tumors (8 ependymomas, 2 lymphomas, and 3 astrocytoma). One lesion was proven to be a multiple sclerosis plaque during further diagnostic workup. The lesions could be classified into 3 types according to the fiber course. In Type 1 (5 cases) fibers did not pass through the solid lesion. In Type 2 (3 cases) some fibers crossed the lesion, but most of the lesion volume did not contain fibers. In Type 3 (6 cases) the fibers were completely encased by tumor. Based on these results, 6 tumors were considered resectable, 7 were not. During surgery, 7 tumors showed a good cleavage plane, 6 did not. The interrater reliability (Cohen κ) was calculated as 0.83 (p < 0.003), which is considered to represent substantial agreement. The mean duration of follow-up was 12.0 ± 2.9. The median McCormick grade at the end of follow-up was II.
Conclusions
These preliminary data suggest that DT imaging in patients with spinal cord tumors is capable of predicting the resectability of the lesion. A further prospective study is needed to confirm these results and any effect on patient outcome.
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Affiliation(s)
- Matthias Setzer
- 1H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, and
- 3Clinic of Neurosurgery, J. W. Goethe University, Frankfurt am Main, Germany
| | | | - F. Reed Murtagh
- 1H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, and
- 2Departments of Neuroradiology and
| | - Mohammed Eleraky
- 1H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, and
| | - Surbhi Jain
- 1H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, and
| | - Gerhard Marquardt
- 3Clinic of Neurosurgery, J. W. Goethe University, Frankfurt am Main, Germany
| | - Volker Seifert
- 3Clinic of Neurosurgery, J. W. Goethe University, Frankfurt am Main, Germany
| | - Frank D. Vrionis
- 1H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, and
- 4Neurosurgery, University of South Florida College of Medicine, Tampa, Florida; and
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Magnetic resonance diffusion tensor imaging and tractography of the lower spinal cord: application to diastematomyelia and tethered cord. Eur Radiol 2010; 20:2194-9. [DOI: 10.1007/s00330-010-1797-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/24/2010] [Accepted: 02/27/2010] [Indexed: 11/25/2022]
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Yamada K, Sakai K, Akazawa K, Yuen S, Nishimura T. MR tractography: a review of its clinical applications. Magn Reson Med Sci 2010; 8:165-74. [PMID: 20035125 DOI: 10.2463/mrms.8.165] [Citation(s) in RCA: 213] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Magnetic resonance tractography based on diffusion-tensor imaging was first introduced to the medical imaging community a decade ago. It has been successfully applied to a number of neurological conditions and most commonly used for preoperative planning for brain tumors and vascular malformations. Areas of active research include stroke, and dementia, where it provides valuable information not available through other imaging techniques. This technique was first introduced using the deterministic streamline algorithm and has evolved to use more sophisticated probabilistic approaches. We will review the past, present, and future of tractography, focusing primarily on its clinical applications.
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Affiliation(s)
- Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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van Hecke W, Nagels G, Emonds G, Leemans A, Sijbers J, van Goethem J, Parizel PM. A diffusion tensor imaging group study of the spinal cord in multiple sclerosis patients with and without T2 spinal cord lesions. J Magn Reson Imaging 2009; 30:25-34. [PMID: 19557843 DOI: 10.1002/jmri.21817] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To examine the T(2)-normal appearing spinal cord of patients with multiple sclerosis (MS) using diffusion tensor imaging. MATERIALS AND METHODS Diffusion tensor images of the spinal cord were acquired from 21 healthy subjects, 11 MS patients with spinal cord lesions, and 10 MS patients without spinal cord lesions on the T(2)-weighted MR images. Different diffusion measures were evaluated using both a region of interest (ROI) -based and a diffusion tensor tractography-based segmentation approach. RESULTS It was observed that the FA, the transverse diffusivity lambda(perpendicular), and the ratio of the longitudinal and transverse diffusivities (lambda(parallel)/lambda (perpendicular)) were significantly lower in the spinal cord of MS patients with spinal cord lesions compared with the control subjects using both the ROI method (P = 0.014, P = 0.028, and P = 0.039, respectively) and the tractography-based approach (P = 0.006, P = 0.037, and P = 0.012, respectively). For both image analysis methods, the FA and the lambda (parallel)/lambda (perpendicular) values were significantly different between the control group and the MS patient group without T(2) spinal cord lesions (P = 0.013). CONCLUSION Our results suggest that the spinal cord may still be affected by MS, even when lesions are not detected on a conventional MR scan. In addition, we demonstrated that diffusion tensor tractography is a robust tool to analyze the spinal cord of MS patients.
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Affiliation(s)
- Wim van Hecke
- Visionlab (Department of Physics), University of Antwerp, Antwerp, Belgium.
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Thurnher MM, Law M. Diffusion-weighted imaging, diffusion-tensor imaging, and fiber tractography of the spinal cord. Magn Reson Imaging Clin N Am 2009; 17:225-44. [PMID: 19406356 DOI: 10.1016/j.mric.2009.02.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the brain, diffusion-weighted imaging (DWI) is an established and reliable method for the characterization of neurologic lesions. Although the diagnostic value of DWI in the early detection of ischemia has not diminished with time, many new clinical applications of DWI have also emerged. Diffusion-tensor imaging and fiber tractography have more recently been developed and optimized, allowing quantification of the magnitude and direction of diffusion along three principal eigenvectors. Diffusion-tensor imaging and fiber tractography are proving to be useful in clinical neuroradiology practice, with application to several categories of disease, and to be a powerful research tool. This article describes some of the applications of DWI and diffusion-tensor imaging in the evaluation of the diseases of the spinal cord.
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Affiliation(s)
- Majda M Thurnher
- Department of Radiology, Medical University of Vienna, Vienna, Austria
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