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Duraffourg M, Rougereau G, Fawaz R, Ltaief A, Jacquesson T, Freydier M, Baude C, Robert R, Mertens P. Lumbosacral plexus and pudendal nerve magnetic resonance tractography: A systematic review of the clinical applications for pudendal neuralgia. Magn Reson Imaging 2024; 112:18-26. [PMID: 38797289 DOI: 10.1016/j.mri.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
Diffusion tensor imaging (DTI) is commonly used to establish three-dimensional mapping of white-matter bundles in the supraspinal central nervous system. DTI has also been the subject of many studies on cranial and peripheral nerves. This non-invasive imaging technique enables virtual dissection of nerves in vivo and provides specific measurements of microstructural integrity. Adverse effects on the lumbosacral plexus may be traumatic, compressive, tumoral, or malformative and thus require dedicated treatment. DTI could lead to new perspectives in pudendal neuralgia diagnosis and management. We performed a systematic review of all articles or posters reporting results and protocols for lumbosacral plexus mapping using the DTI technique between January 2011 and December 2023. Twenty-nine articles published were included. Ten studies with a total of 351 participants were able to track the lumbosacral plexus in a physiological context and 19 studies with a total of 402 subjects tracked lumbosacral plexus in a pathological context. Tractography was performed on a 1.5T or 3T MRI system. DTI applied to the lumbosacral plexus and pudendal nerve is feasible but no microstructural normative value has been proposed for the pudendal nerve. The most frequently tracking parameters used in our review are: 3T MRI, b-value of 800 s/mm2, 33 directions, 3 × 3 × 3 mm3, AF threshold of 0.1, minimum fiber length of 10 mm, bending angle of 30°, and 3DT2 TSE anatomical resolution. Increased use of DTI could lead to new perspectives in the management of pudendal neuralgia due to entrapment syndrome, whether at the diagnostic, prognostic, or preoperative planning level. Prospective studies of healthy subjects and patients with the optimal acquisition parameters described above are needed to establish the accuracy of MR tractography for diagnosing pudendal neuralgia and other intrapelvic nerve entrapments.
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Affiliation(s)
- M Duraffourg
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France
| | - G Rougereau
- Service de chirurgie orthopédique et traumatologique Hôpital Pitié Salpetrière, Paris, France
| | - R Fawaz
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Service de Neurochirurgie - Hôpital d'Instruction des Armées Percy, Clamart, France.
| | - A Ltaief
- Service d'imagerie médicale et interventionnelle - Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - T Jacquesson
- Service de Neurochirurgie crânienne générale, tumorale et vasculaire - Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
| | - M Freydier
- Centre d'Évaluation et de Traitement de la Douleur - Centre Hospitalier de Macon, Macon, France; Centre d'Évaluation et de Traitement de la Douleur - Médipôle Hôpital Mutualiste, Villeurbanne, France
| | - C Baude
- Centre d'Évaluation et de Traitement de la Douleur - Médipôle Hôpital Mutualiste, Villeurbanne, France
| | - R Robert
- Service de chirurgie - Hôpital Privé du Confluent, Nantes, France; Faculté de Médecine de Nantes, Nantes, France
| | - P Mertens
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
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Stacey P, Mensinkai A, Bansal P, Hosseini SH, Lavigne A, Gwardjan B, Leylachian S, Deng Z(J, Chari V, Giles S, Nesathurai S. Using Nutraceuticals to Help Manage Traumatic Spinal Cord Injury. Pharmaceuticals (Basel) 2024; 17:71. [PMID: 38256904 PMCID: PMC10820888 DOI: 10.3390/ph17010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/26/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Traumatic spinal cord injury (TSCI) is a significant public health challenge that has an adverse impact on functional independence, quality of life, and life expectancy. Management of people's chronic conditions is a key aspect of contemporary medical practice. Our study was an open label, single arm, prospective pilot study to evaluate the feasibility of treating people with TSCI. The study intervention was treatment with oral selenium and vitamin E. Participants were 18 years or older and experienced a TSCI at least one year prior to enrollment. Daily doses of 50 mcg of selenium and 400 IU of vitamin E were administered. Participants had radiologic (MRI tractography) and clinical (ASIA) assessments prior to initiating treatment, and these assessments were repeated after one year of treatment. Four subjects completed the full twelve-month study. Adherence, based on pill counts, was approximately 75% in all subjects. There were no adverse events related to study medications. During the treatment period, subjects reported improvement in certain symptoms. There was no significant difference in ASIA scores before and after the intervention. Combination treatment with vitamin E and selenium has been demonstrated as safe for TSCI patients. It is possible to use DTI values to locate the epicenter of a lesion as well as gauge the extent of injury. MRI tractography may serve as a meaningful surrogate endpoint. The results of this study suggest that it is feasible to conduct a larger long-term clinical trial to evaluate the efficacy of combination treatment of TSCI.
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Affiliation(s)
- Paul Stacey
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Arun Mensinkai
- Department of Diagnostic Imaging, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
- Department of Medical Imaging, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Pankaj Bansal
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Seyed-Hossein Hosseini
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Andrew Lavigne
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Basia Gwardjan
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Sayna Leylachian
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Zhihui (Joy) Deng
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Vinjamuri Chari
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Sandra Giles
- Department of Medical Imaging, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Shanker Nesathurai
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada (V.C.)
- Division of Physical Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
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Khan AF, Mohammadi E, Haynes G, Hameed S, Rohan M, Anderson DB, Weber KA, Muhammad F, Smith ZA. Evaluating tissue injury in cervical spondylotic myelopathy with spinal cord MRI: a systematic review. 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 2024; 33:133-154. [PMID: 37926719 DOI: 10.1007/s00586-023-07990-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/02/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Cervical Spondylotic Myelopathy (CSM) is a degenerative condition that leads to loss of cervical spinal cord (CSC) integrity. Various spinal cord Magnetic Resonance Imaging (MRI) methods can identify and characterize the extent of this damage. This systematic review aimed to evaluate the diagnostic, biomarker, and predictive utilities of different spinal cord MRI methods in clinical research studies of CSM. The aim was to provide a comprehensive understanding of the progress in this direction for future studies and effective diagnosis and management of CSM. METHODS A comprehensive literature search was conducted on PubMed and EMBASE from 2010 to 2022 according to PRISMA guidelines. Studies with non-human subjects, less than 3T magnetic field strength, non-clinical design, or not quantitatively focusing on the structural integrity of CSC were excluded. The extracted data from each study included demographics, disease severity, MRI machine characteristics, quantitative metrics, and key findings in terms of diagnostic, biomarker, and predictive utilities of each MRI method. The risk of bias was performed using the guide from AHRQ. The quality of evidence was assessed separately for each type of utility for different MRI methods using GRADE. RESULTS Forty-seven studies met the inclusion criteria, utilizing diffusion-weighted imaging (DTI) (n = 39), magnetization transfer (MT) (n = 6), MR spectroscopy (n = 3), and myelin water imaging (n = 1), as well as a combination of MRI methods (n = 12). The metric fractional anisotropy (FA) showed the highest potential in all facets of utilities, followed by mean diffusivity. Other promising metrics included MT ratio and intracellular volume fraction, especially in multimodal studies. However, the level of evidence for these promising metrics was low due to a small number of studies. Some studies, mainly DTI, also reported the usefulness of spinal cord MRI in mild CSM. CONCLUSIONS Spinal cord MRI methods can potentially facilitate the diagnosis and management of CSM by quantitatively interrogating the structural integrity of CSC. DTI is the most promising MRI method, and other techniques have also shown promise, especially in multimodal configurations. However, this field is in its early stages, and more studies are needed to establish the usefulness of spinal cord MRI in CSM.
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Affiliation(s)
- Ali Fahim Khan
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Grace Haynes
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, USA
| | - Sanaa Hameed
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Michael Rohan
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - David B Anderson
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Kenneth A Weber
- Systems Neuroscience and Pain Laboratory, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Zachary A Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA.
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Abstract
Spinal cord tumors are best identified by conventional MR imaging with contrast. Most intramedullary spinal cord tumors have characteristic MR imaging features that allow an accurate preoperative diagnosis. The spinal cord tumors reviewed in this article include the most common tumors, ependymomas and astrocytomas, as well as the less common tumors such as hemangioblastomas and metastases. Rare tumors such as primary CNS lymphoma and melanocytic tumors are also described. Advanced imaging techqniques of more common intramedullary tumors are also reviewed.
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Affiliation(s)
- Lubdha M Shah
- Department of Radiology, University of Utah, 30 North 1900 East, Room#1A71, Salt Lake City, UT, USA.
| | - Karen L Salzman
- Department of Radiology, University of Utah, 30 North 1900 East, Room#1A71, Salt Lake City, UT, USA
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Khan AF, Haynes G, Mohammadi E, Muhammad F, Hameed S, Smith ZA. Utility of MRI in Quantifying Tissue Injury in Cervical Spondylotic Myelopathy. J Clin Med 2023; 12:jcm12093337. [PMID: 37176777 PMCID: PMC10179707 DOI: 10.3390/jcm12093337] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
Cervical spondylotic myelopathy (CSM) is a progressive disease that worsens over time if untreated. However, the rate of progression can vary among individuals and may be influenced by various factors, such as the age of the patients, underlying conditions, and the severity and location of the spinal cord compression. Early diagnosis and prompt treatment can help slow the progression of CSM and improve symptoms. There has been an increased use of magnetic resonance imaging (MRI) methods in diagnosing and managing CSM. MRI methods provide detailed images and quantitative structural and functional data of the cervical spinal cord and brain, allowing for an accurate evaluation of the extent and location of tissue injury. This review aims to provide an understanding of the use of MRI methods in interrogating functional and structural changes in the central nervous system in CSM. Further, we identified several challenges hindering the clinical utility of these neuroimaging methods.
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Affiliation(s)
- Ali Fahim Khan
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Grace Haynes
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Sanaa Hameed
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Zachary A Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Ouyang Z, Zhang N, Li M, Hong T, Ouyang T, Meng W. A meta-analysis of the role of diffusion tensor imaging in cervical spinal cord compression. J Neuroimaging 2023. [PMID: 36914383 DOI: 10.1111/jon.13093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND AND PURPOSE At present, the role of diffusion tensor imaging (DTI) remains controversial. This study aimed to confirm the role of DTI by comparing the differences in fractional anisotropy (FA) values between patients with cervical spinal cord compression (CSCC) and healthy individuals. METHODS A systematic and comprehensive literature search was conducted using the Web of Science, Embase, PubMed, and Cochrane Library databases to compare the mean FA values of patients with CSCC and healthy controls across all compression levels in the cervical spinal cord. Essential data from the literature, such as demographic information, imaging parameters, and DTI analysis method, were extracted. Fixed- or random-effect models based on I2 heterogeneity were applied to the pooled and subgroup analyses. RESULTS Ten studies containing 445 patients and 197 healthy volunteers were eligible. The pooled results demonstrated a decrease in mean FA values across all compression levels in the experiment group compared to those in healthy controls (standardized mean difference = -1.54; 95% confidence interval = [-1.95, -1.14]; p < .001). Meta-regression revealed that the scanner field strength and DTI analysis method had a significant effect on heterogeneity. CONCLUSIONS Our results show that FA values in the spinal cord decline in patients with CSCC, thus confirming the crucial role of DTI in CSCC.
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Affiliation(s)
- Ziqiang Ouyang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Department of the First Clinical Medical College, Nanchang University, Jiangxi Province, China
| | - Na Zhang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meihua Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Hong
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Taohui Ouyang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Meng
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Li G, Ma X, Li S, Ye X, Börnert P, Zhou XJ, Guo H. Comparison of uniform-density, variable-density, and dual-density spiral samplings for multi-shot DWI. Magn Reson Med 2023; 90:133-149. [PMID: 36883748 DOI: 10.1002/mrm.29633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE To compare the performances of uniform-density spiral (UDS), variable-density spiral (VDS), and dual-density spiral (DDS) samplings in multi-shot diffusion imaging, and determine a sampling strategy that balances reliability of shot navigator and overall DWI image quality. THEORY AND METHODS UDS, VDS, and DDS trajectories were implemented to achieve four-shot diffusion-weighted spiral imaging. First, the static B0 off-resonance effects in UDS, VDS, and DDS acquisitions were analyzed based on a signal model. Then, in vivo experiments were performed to verify the theoretical analyses, and fractional anisotropy (FA) fitting residuals were used to quantitatively assess the quality of spiral diffusion data for tensor estimation. Finally, the SNR performances and g-factor behavior of the three spiral samplings were evaluated using a Monte Carlo-based pseudo multiple replica method. RESULTS Among the three spiral trajectories with the same readout duration, UDS sampling exhibited the least off-resonance artifacts. This was most evident when the static B0 off-resonance effect was severe. The UDS diffusion images had higher anatomical fidelity and lower FA fitting residuals than the other two counterparts. Furthermore, the four-shot UDS acquisition achieved the best SNR performance in diffusion imaging with 12.11% and 40.85% improvements over the VDS and DDS acquisitions with the same readout duration, respectively. CONCLUSION UDS sampling is an efficient spiral acquisition scheme for high-resolution diffusion imaging with reliable navigator information. It provides superior off-resonance performance and SNR efficiency over the VDS and DDS samplings for the tested scenarios.
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Affiliation(s)
- Guangqi Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Xiaodong Ma
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Sisi Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Xinyu Ye
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Peter Börnert
- Radiology, C.J. Gorter Center for High-Field MRI, Leiden University Medical Center, Leiden, The Netherlands.,Philips Research, Hamburg, Germany
| | - Xiaohong Joe Zhou
- Center for MR Research and Departments of Radiology, Neurosurgery, and Biomedical Engineering, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
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Kauthankar AA, Jaseemudheen M. Diffusion Tensor Imaging in Spinal Cord Injury: A Review. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1751068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractMagnetic resonance diffusion tensor imaging (DTI) is a recent technique that can measure the direction and magnitude of diffusion of water. It is widely being utilized to evaluate several brain and spinal cord pathologies. The objective of this review is to evaluate the importance of the DTI in patients with spinal cord injury (SCI). It aims to review various articles on DTI SCI and includes both animal and human studies. This will help to describe the current status of the clinical applications of DTI and show its potential as a helpful instrument in clinical practice. The PubMed database was searched for articles relating to the application of DTI in SCI. Relevant articles were also used for the review. A variety of DTI parameters have been studied in various articles. The standard parameters are fractional anisotropy (FA) values, apparent diffusion coefficient (ADC) values, radial diffusivity values, and axial diffusivity values, followed by tractography. FA and ADC values are the most commonly used parameters. The findings observed in most of the studies are increased FA and reduced ADC values following injury to the spinal cord. DTI data metrics possess the potential to become a potent clinical tool in patients with SCI. It is helpful for diagnosis, prognosis, treatment planning, as well as to evaluate the recovery. Nonetheless, to overcome the limitations and determine its reliability clinically, more research has to be performed.
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Affiliation(s)
- Akshada Atchut Kauthankar
- Department of Radio-diagnosis and Imaging, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - M.M Jaseemudheen
- Department of Radio-diagnosis and Imaging, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
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Zhu F, Wang Y, Kong X, Liu Y, Zeng L, Jing X, Yao S, Chen K, Yang L, Guo X. Assessment of acute traumatic cervical spinal cord injury using conventional magnetic resonance imaging in combination with diffusion tensor imaging-tractography: a retrospective comparative study. 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 2022; 31:1700-1709. [PMID: 35639157 DOI: 10.1007/s00586-022-07207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/10/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The application of conventional magnetic resonance imaging (MRI) in combination with diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) to diagnose acute traumatic cervical SCI has not been studied. This study explores the role of MRI with DTI-DTT in the diagnosis of acute traumatic cervical spinal cord injury (SCI). METHODS Thirty patients with acute traumatic cervical SCI underwent conventional MRI and DTI-DTT. Conventional MRI was used to detect the intramedullary lesion length (IMLL) and intramedullary hemorrhage length (IMHL). DTI was used to detect the spinal cord's fractional anisotropy (FA) and apparent diffusion coefficient value, and DTT detected the imaginary white matter fiber volume and the connection rates of fiber tractography (CRFT). Patients' neurological outcome was determined using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades. RESULTS Patients were divided into group A (without AIS grade conversion) and group B (with AIS grade conversion). The IMLL and IMHL of group A were significantly higher than those of group B. The FA and CRFT of group A were significantly lower than those of group B. The final AIS grade was negatively correlated with the IMLL and IMHL, and positively correlated with the FA and CRFT. According to imaging features based on conventional MRI and DTI-DTT, we propose a novel classification and diagnostic procedure. CONCLUSIONS The combination of conventional MRI with DTI-DTT is a valid diagnostic approach for SCI. Lower IMLL and IMHL, and higher FA value and CRFT are linked to better neurological outcomes.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China.,Department of Orthopaedics, Xinqiao Hospital, Army Military University, Chongqing, China
| | - Yulong Wang
- Department of Orthopedics, Wuhan No. 1 Hospital, Wuhan Integrated TCM & Western Medicine Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuan Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lian Zeng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China
| | - Xirui Jing
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China
| | - Sheng Yao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China
| | - Kaifang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaodong Guo
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China.
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Liu Y, Liu C, Qin C, Zhang X, Feng H, Wang Z, Li J. Evaluation of the effect of myelotomy on nerve function in rats with spinal cord injury by diffusion tensor imaging. Acta Radiol 2021; 62:1666-1673. [PMID: 33287549 DOI: 10.1177/0284185120975182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) is a severe central nervous system injury that can generally induce different degrees of sensory and motor dysfunction. PURPOSE To clarify the changes of diffusion tensor imaging (DTI) parameters after spinal cord myelotomy in rats with SCI. MATERIAL AND METHODS Eighteen Sprague Dawley (SD) rats were randomly divided into the Sham group (n=6), SCI group (n=6), and Mye group (n=6), respectively. The DTI values at 1, 3, 7, and 21 days after modeling were collected by magnetic resonance imaging (MRI). The spinal specimen at the injury site was collected on the 21st day for Nissl's staining to assess the changes in neurons. RESULTS The fractional anisotropy (FA) values in both the SCI group and Mye group significantly decreased. In addition, the FA values between the two groups were statistically significant (P < 0.001). The apparent diffusion coefficient (ADC), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) values all decreased and then increased (P < 0.001). Pearson correlation test showed that the ADC, MD, and AD values were positively correlated with the Basso Beattie Bresnahan (BBB) score. Nissl's staining showed a higher number of Nissl's bodies, and deep staining of Nissl's bodies in the Mye group, while the morphology of neurons was relatively good. The number of neurons in the Mye group was significantly higher after myelotomy compared to the SCI group (P < 0.001). CONCLUSION The DTI parameters, especially ADC values, could non-invasively and quantifiably evaluate the efficacy of myelotomy for rats with SCI.
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Affiliation(s)
- Yi Liu
- School of Rehabilitation Medicine, Capital Medical University, Beijing, PR China
- China Rehabilitation Science Institute, Beijing, PR China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, PR China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, PR China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, PR China
| | - Changbin Liu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Beijing, PR China
| | - Chuan Qin
- School of Rehabilitation Medicine, Capital Medical University, Beijing, PR China
- China Rehabilitation Science Institute, Beijing, PR China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, PR China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, PR China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, PR China
| | - Xin Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, PR China
- China Rehabilitation Science Institute, Beijing, PR China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, PR China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, PR China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, PR China
| | - Hao Feng
- School of Rehabilitation Medicine, Capital Medical University, Beijing, PR China
- China Rehabilitation Science Institute, Beijing, PR China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, PR China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, PR China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, PR China
| | - Zhanjing Wang
- Medical Experiment and Test Center, Capital Medical University, Beijing, PR China
| | - Jianjun Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, PR China
- China Rehabilitation Science Institute, Beijing, PR China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, PR China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, PR China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, PR China
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11
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High-fidelity diffusion tensor imaging of the cervical spinal cord using point-spread-function encoded EPI. Neuroimage 2021; 236:118043. [PMID: 33857617 DOI: 10.1016/j.neuroimage.2021.118043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/16/2021] [Accepted: 03/31/2021] [Indexed: 01/21/2023] Open
Abstract
Diffusion tensor imaging (DTI) of the spinal cord is technically challenging due to the size of its structure and susceptibility-induced field inhomogeneity, which impedes clinical applications. This study aimed to achieve high-fidelity spinal cord DTI with reasonable SNR and practical acquisition efficiency. Particularly, a distortion-free multi-shot EPI technique, namely point-spread-function encoded EPI (PSF-EPI), was adopted for diffusion imaging of the cervical spinal cord (CSC). The shot number can be reduced to six for sagittal scans through titled-CAIPI acceleration and partial Fourier undersampling, consequently rendering this technique beneficial in clinics. Fifteen healthy volunteers and seven patients with metallic implants underwent sagittal scans using tilted-CAIPI PSF-EPI at 3T. Unsuppressed fat signals were further removed by retrospective water/fat separation using the intrinsic chemical-shift encoded signals. Compared with multi-shot interleaved EPI method, highly accelerated PSF-EPI method provided evidently improved distortion reduction and higher consistency with anatomical references even with metallic implants. Additionally, axial DTI scans using PSF-EPI were also evaluated quantitatively, and the measured DTI metrics are similar to those obtained from the zonal oblique multi-slice EPI (ZOOM-EPI) method and reported values. The high anatomical consistency, practical scan time and quantitative reliability indicate PSF-EPI's clinical potential for CSC diffusion imaging.
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Condette-Auliac S, Gratieux J, Boulin A, Di Maria F, Consoli A, Coskun O, Smajda S, Rodesch G. Imaging of vascular diseases of the spinal cord. Rev Neurol (Paris) 2021; 177:477-489. [PMID: 33902944 DOI: 10.1016/j.neurol.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Affiliation(s)
- S Condette-Auliac
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France.
| | - J Gratieux
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Boulin
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - F Di Maria
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Consoli
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - O Coskun
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - S Smajda
- Department of interventional Neuroradiology, Fondation Rotschild, Paris, France
| | - G Rodesch
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
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13
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Zhu F, Zeng L, Gui S, Liu Y, Wang Y, Cao X, Lin H, Yang L, Kong X, Guo X. The Role of Diffusion Tensor Imaging and Diffusion Tensor Tractography in the Assessment of Acute Traumatic Thoracolumbar Spinal Cord Injury. World Neurosurg 2021; 150:e23-e30. [PMID: 33561552 DOI: 10.1016/j.wneu.2021.01.146] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study explored diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) to assess the prognosis of thoracolumbar spinal cord injury (SCI). METHODS Twenty patients with acute traumatic thoracolumbar complete SCI (T1-L1, American Spinal Injury Association Impairment Scale [AIS] grade A) underwent conventional magnetic resonance imaging and DTI examinations. DTI measured the fractional anisotropy (FA) and apparent diffusion coefficient adjacent to the lesion epicenter. DTT was used to detect the white matter fiber morphology and measure the imaginary white matter fiber volume and connection rates of fiber tractography (CRFT). The patients' neurological functions were evaluated by the AIS grades. RESULTS At the final-follow-up, among the 20 patients with AIS grade A, 15 maintained the AIS grade (group A), and 5 patients showed improvement of AIS grade (group B). Group A's mean FA value was significantly lower than that of group B, whereas the mean apparent diffusion coefficient value among the 2 groups showed no significant difference. The white matter fibers of most patients in group A were completely ruptured (11/15), but the white matter fibers of all patients in group B were retained in different number (5/5). The mean CRFT of group B was significantly higher than that of group A (P < 0.05). The improvement of AIS grade was slightly positively correlated with FA values and highly positively correlated with CRFT. CONCLUSIONS The prognosis of complete thoracolumbar SCI may be related to the FA value and the CRFT. The application of DTI and DTT may optimize the diagnosis of thoracolumbar SCI.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lian Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shan Gui
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuan Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yulong Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaojian Cao
- Department of Spine Surgery, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Haodong Lin
- Department of Orthopaedics, Shanghai First People's Hospital, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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14
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Irimia A, Van Horn JD. Mapping the rest of the human connectome: Atlasing the spinal cord and peripheral nervous system. Neuroimage 2021; 225:117478. [PMID: 33160086 PMCID: PMC8485987 DOI: 10.1016/j.neuroimage.2020.117478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
The emergence of diffusion, structural, and functional neuroimaging methods has enabled major multi-site efforts to map the human connectome, which has heretofore been defined as containing all neural connections in the central nervous system (CNS). However, these efforts are not structured to examine the richness and complexity of the peripheral nervous system (PNS), which arguably forms the (neglected) rest of the connectome. Despite increasing interest in an atlas of the spinal cord (SC) and PNS which is simultaneously stereotactic, interactive, electronically dissectible, scalable, population-based and deformable, little attention has thus far been devoted to this task of critical importance. Nevertheless, the atlasing of these complete neural structures is essential for neurosurgical planning, neurological localization, and for mapping those components of the human connectome located outside of the CNS. Here we recommend a modification to the definition of the human connectome to include the SC and PNS, and argue for the creation of an inclusive atlas to complement current efforts to map the brain's human connectome, to enhance clinical education, and to assist progress in neuroscience research. In addition to providing a critical overview of existing neuroimaging techniques, image processing methodologies and algorithmic advances which can be combined for the creation of a full connectome atlas, we outline a blueprint for ultimately mapping the entire human nervous system and, thereby, for filling a critical gap in our scientific knowledge of neural connectivity.
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Affiliation(s)
- Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue, Los Angeles CA 90089, United States; Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, United States.
| | - John Darrell Van Horn
- Department of Psychology, University of Virginia, 485 McCormick Road, Gilmer Hall, Room 102, Charlottesville, Virginia 22903, United States; School of Data Science, University of Virginia, Dell 1, Charlottesville, Virginia 22903, United States.
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15
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Magnetic-Resonance Diffusion-Tensor Tractography in the Diagnosis of Tumefactive Spinal-Cord Lesions in Neuromyelitis Optica. Diagnostics (Basel) 2020; 10:diagnostics10060401. [PMID: 32545605 PMCID: PMC7344653 DOI: 10.3390/diagnostics10060401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022] Open
Abstract
Magnetic-resonance (MR) imaging is the modality of choice for the evaluation of spinal-cord lesions. However, challenges persist in discriminating demyelinating processes from neoplastic lesions using conventional MR sequences. Consequently, an invasive spinal-cord biopsy is likely for most patients. MR diffusion-tensor imaging is an emerging noninvasive and powerful method for characterizing changes in tissue microstructure associated with spinal disorders. We currently present the case of a middle-aged woman suffering from neuromyelitis optica, and highlight that MR diffusion-tensor tractography can be helpful in the identification of tumefactive spinal-cord lesions.
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16
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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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17
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Noguerol TM, Barousse R, Amrhein TJ, Royuela-del-Val J, Montesinos P, Luna A. Optimizing Diffusion-Tensor Imaging Acquisition for Spinal Cord Assessment: Physical Basis and Technical Adjustments. Radiographics 2020; 40:403-427. [DOI: 10.1148/rg.2020190058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Teodoro Martín Noguerol
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Rafael Barousse
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Timothy J. Amrhein
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Javier Royuela-del-Val
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Paula Montesinos
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Antonio Luna
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
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18
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Kaushal M, Shabani S, Budde M, Kurpad S. Diffusion Tensor Imaging in Acute Spinal Cord Injury: A Review of Animal and Human Studies. J Neurotrauma 2019; 36:2279-2286. [PMID: 30950317 DOI: 10.1089/neu.2019.6379] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Diffusion tensor imaging (DTI), based on the property of preferential diffusion of water molecules in biological tissue, is seeing increasing clinical application in the pathologies of the central nervous system. Spinal cord injury (SCI) is one such area where the use of DTI allows for the evaluation of changes to microstructure of the spinal cord not detected on routine conventional magnetic resonance imaging. The insights obtained from pre-clinical models of SCI indicate correlation of quantitative DTI indices with histology and function, which points to the potential of DTI as a non-invasive, viable biomarker for integrity of white matter tracts in the spinal cord. In this review, we describe DTI alterations in the acute phase of SCI in both animal models and human subjects and explore the underlying pathophysiology behind these changes.
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Affiliation(s)
- Mayank Kaushal
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shekar Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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19
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Jin R, Hu Y. Effect of segmentation from different diffusive metric maps on diffusion tensor imaging analysis of the cervical spinal cord. Quant Imaging Med Surg 2019; 9:292-303. [PMID: 30976553 DOI: 10.21037/qims.2019.02.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Segmentation is a crucial and necessary step in diffusion tensor imaging (DTI) analysis of the cervical spinal cord. In existing studies, different diffusive metric maps [B0, fractional anisotropy (FA) and axial diffusivity (AD) maps] have been involved in the segmentation of tissues of the cervical spinal cord. The selection of a diffusive metric map for segmentation may affect the accuracy of segmentation and then affect the validity and effectiveness of the extracted diffusive features. However, there are few discussions on this problem. Therefore, this study would like to examine the effect of segmentation based on different diffusive metric maps for DTI analysis of the cervical spinal cord. Methods Twenty-nine healthy subjects and thirty patients with cervical spondylotic myelopathy (CSM) were finally included in this study. All subjects accepted DTI scanning at cervical levels from C2 to C7/T1. For healthy subjects, all cervical levels were included for analysis; while, for each patient, only one compressed cervical level was included. After DTI scanning, DTI metrics including B0, FA, AD, radial diffusivity (RD) and mean diffusivity (MD) were calculated. The evaluation was performed to B0, FA and AD maps from two aspects. First, the accuracy of segmentation was evaluated via a comparison between segmentation based on each diffusive metric map and segmentation based on an average image, which was acquired by averaging B0, FA, AD, RD and MD maps. The segmentation was achieved by a semi-automatic segmentation process, and the similarity between two segmentation results was denoted by the intersection of the union (IOU). Second, the diversity of extracted diffusive features was equalized as their performance in the classification of image pixels of different regions of interest (ROIs) and then was evaluated by mutual information (MI) and area under the curve (AUC). One-way ANOVA and Bonferroni's post hoc tests were applied to compare the evaluation results. Results One-way ANOVA suggested that there were differences (P<0.001) in IOU, MI and AUC values among the three diffusive metric maps for both healthy subjects and patients. The post-hoc tests further indicated that FA performed the best (P<0.001), i.e., the most substantial accuracy of segmentation and the highest diversity in extracted diffusive features. Conclusions Different evaluation results had been observed for segmentation based on different diffusive metric maps, suggesting the necessity of selection of diffusive metric maps for segmentation in DTI analysis of the cervical spinal cord. Moreover, FA map is suggested for segmentation due to its best performance in the evaluation.
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Affiliation(s)
- Richu Jin
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Yong Hu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, China.,Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518060, China
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20
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Benjamin CG, Frempong-Boadu A, Hoch M, Bruno M, Shepherd T, Pacione D. Combined Use of Diffusion Tractography and Advanced Intraoperative Imaging for Resection of Cervical Intramedullary Spinal Cord Neoplasms: A Case Series and Technical Note. Oper Neurosurg (Hagerstown) 2019; 17:525-530. [DOI: 10.1093/ons/opz039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 02/19/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Intramedullary spinal cord neoplasms (ISCN) pose significant management challenges. Advances in magnetic resonance imaging (MRI) (such as diffusion tensor imaging, DTI) have been utilized to determine the infiltrative nature and resectability of ISCN. However, this has not been applied to intraoperative decision making.
OBJECTIVE
To present a case series of 2 patients with ISCN, the first to combine use of DTI, pre- and intraoperative 3-dimensional (3D) virtual reality imaging, and microscope integrated navigation with heads-up display.
METHODS
Two patients who underwent surgery for ISCN were included. DTI images were obtained and 3D images were created using Surgical Theater (Surgical Theater SRP, Version 7.4.0, Cleveland, Ohio). Fiducials were used to achieve accurate surface registration to C4. Navigation confirmed the levels of laminectomy necessary. The microscope was integrated with Brainlab (Brainlab AG Version 3.0.5, Feldkirchen, Germany) and the tumor projected in the heads-up display. Surgical Theater was integrated with Brainlab to allow for real time evaluation of the 3D tractography.
RESULTS
Case 1: All tracts were pushed away from the tumor, suggesting it was not infiltrative. Surgical Theater and Brainlab assisted in confirming midline despite the abnormal swelling of the cord so the myelotomy could be performed. The heads-up display outline demonstrated excellent correlation to the tumor. Gross total resection was achieved. Diagnosis of ependymoma was confirmed. Case 2: Some tracts were going through the tumor itself, suggesting an infiltrative process. Surgical Theater and Brainlab again allowed for confirmation of the midline raphe. Near total resection of the enhancing portion was achieved. Diagnosis of glioblastoma was confirmed.
CONCLUSION
This is a proof of concept application where multi-modal imaging technology was utilized for safest maximal ISCN resection.
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Affiliation(s)
| | | | - Michael Hoch
- Department of Radiology, NYU Langone Medical Center, New York, New York
| | - Mary Bruno
- Department of Radiology, NYU Langone Medical Center, New York, New York
| | - Timothy Shepherd
- Department of Radiology, NYU Langone Medical Center, New York, New York
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York
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21
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Jiang W, Han X, Guo H, Ma XD, Wang J, Cheng X, Yu A, Song Q, Shi K, Dai J. Usefulness of conventional magnetic resonance imaging, diffusion tensor imaging and neurite orientation dispersion and density imaging in evaluating postoperative function in patients with cervical spondylotic myelopathy. J Orthop Translat 2018; 15:59-69. [PMID: 30310766 PMCID: PMC6176747 DOI: 10.1016/j.jot.2018.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022] Open
Abstract
Objective The objective of this study was to evaluate the usefulness of T2 high signal intensity (T2-HSI) and decreased anteroposterior diameter (APD), diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) in evaluating postoperative cervical cord function. Methods The study included 57 postoperative cervical spondylotic myelopathy patients. Clinical evaluation and functional recovery assessments were performed using the modified Japanese Orthopaedic Association (mJOA) score and recovery rate. The presence of T2-HSI and decreased APD was recorded for exploring the relevance. Spearman correlation was applied to investigate the relationships between DTI and NODDI metrics and mJOA score. Multiple comparisons of T2 signal intensity, APD and diffusion metrics were evaluated by using multiple linear regression. Results Only the recovery rate was significantly different between T2-HSI and non-T2-HSI (nT2-HSI) patients (χ2 = 4.466, p = 0.045). Significant differences were not observed between cervical cords with and without decreased APD. Diffusion metrics, including fractional anisotropy (p = 0.0005), mean diffusivity (p = 0.0008), radial diffusivity (p = 0.0003) and intracellular volume fraction (p = 0.001), were significantly correlated with mJOA score. The ability of T2 signal intensity (p = 0.421) and APD (p = 0.420) to evaluate the postoperative function was inferior to that of fractional anisotropy (p = 0.002), mean diffusivity (p = 0.001), radial diffusivity (p = 0.001) and intracellular volume fraction (p = 0.004). Conclusion Conventional magnetic resonance imaging signs could be considered as a reference to make an approximate assessment, whereas DTI and NODDI could be better quantitative tools for evaluating the postoperative function and may help in interpreting residual symptoms. The translational potential of this article DTI and NODDI could provide reliable postoperative evaluation and analysis for cervical spondylotic myelopathy patients.
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Affiliation(s)
- Wen Jiang
- Department of Radiology, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, China
| | - Xiao Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiao Dong Ma
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jinchao Wang
- Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, No. 31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - Aihong Yu
- Department of Radiology, Beijing Jishuitan Hospital, No. 31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - Qingpeng Song
- Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - Kaining Shi
- Integrated Solution Center, Philips Healthcare China, 16-2-7, Tianzelu, Chaoyang District, Beijing, China
| | - Jianping Dai
- Department of Radiology, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, China
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22
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Dong Z, Dai E, Wang F, Zhang Z, Ma X, Yuan C, Guo H. Model‐based reconstruction for simultaneous multislice and parallel imaging accelerated multishot diffusion tensor imaging. Med Phys 2018; 45:3196-3204. [DOI: 10.1002/mp.12974] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/02/2018] [Accepted: 05/04/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Zijing Dong
- Center for Biomedical Imaging Research Department of Biomedical Engineering School of Medicine Tsinghua University BeijingChina
| | - Erpeng Dai
- Center for Biomedical Imaging Research Department of Biomedical Engineering School of Medicine Tsinghua University BeijingChina
| | - Fuyixue Wang
- Center for Biomedical Imaging Research Department of Biomedical Engineering School of Medicine Tsinghua University BeijingChina
- Harvard‐MIT Health Sciences and Technology MIT Cambridge MAUSA
| | - Zhe Zhang
- Center for Biomedical Imaging Research Department of Biomedical Engineering School of Medicine Tsinghua University BeijingChina
| | - Xiaodong Ma
- Center for Biomedical Imaging Research Department of Biomedical Engineering School of Medicine Tsinghua University BeijingChina
| | - Chun Yuan
- Center for Biomedical Imaging Research Department of Biomedical Engineering School of Medicine Tsinghua University BeijingChina
- Department of Radiology University of Washington Seattle WA USA
| | - Hua Guo
- Center for Biomedical Imaging Research Department of Biomedical Engineering School of Medicine Tsinghua University BeijingChina
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Dai E, Zhang Z, Ma X, Dong Z, Li X, Xiong Y, Yuan C, Guo H. The effects of navigator distortion and noise level on interleaved EPI DWI reconstruction: a comparison between image‐ and k‐space‐based method. Magn Reson Med 2018; 80:2024-2032. [DOI: 10.1002/mrm.27190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/08/2018] [Accepted: 03/03/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Erpeng Dai
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of MedicineTsinghua UniversityBeijing China
| | - Zhe Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of MedicineTsinghua UniversityBeijing China
| | - Xiaodong Ma
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of MedicineTsinghua UniversityBeijing China
| | - Zijing Dong
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of MedicineTsinghua UniversityBeijing China
| | - Xuesong Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of MedicineTsinghua UniversityBeijing China
- School of Computer Science and TechnologyBeijing Institute of TechnologyBeijing China
| | - Yuhui Xiong
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of MedicineTsinghua UniversityBeijing China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of MedicineTsinghua UniversityBeijing China
- Department of RadiologyUniversity of WashingtonSeattle Washington
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of MedicineTsinghua UniversityBeijing China
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Wang S, Hu Y, Shen Y, Li H. Classification of Diffusion Tensor Metrics for the Diagnosis of a Myelopathic Cord Using Machine Learning. Int J Neural Syst 2018; 28:1750036. [DOI: 10.1142/s0129065717500368] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
In this study, we propose an automated framework that combines diffusion tensor imaging (DTI) metrics with machine learning algorithms to accurately classify control groups and groups with cervical spondylotic myelopathy (CSM) in the spinal cord. The comparison between selected voxel-based classification and mean value-based classification were performed. A support vector machine (SVM) classifier using a selected voxel-based dataset produced an accuracy of 95.73%, sensitivity of 93.41% and specificity of 98.64%. The efficacy of each index of diffusion for classification was also evaluated. Using the proposed approach, myelopathic areas in CSM are detected to provide an accurate reference to assist spine surgeons in surgical planning in complicated cases.
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Affiliation(s)
- Shuqiang Wang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China
| | - Yong Hu
- Department of Orthopaedic Surgery, The University of Hong Kong, 12 Sandy Bay Road, Hong Kong, Duchess of Kent Children’s Hospital, Pokfulam, Hong Kong
| | - Yanyan Shen
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P. R. China
| | - Hanxiong Li
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong
- School of Mechanical and Electrical Engineering, Central South University, Changsha, P. R. China
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Abstract
MRI techniques and systems have evolved dramatically over recent years. These advances include higher field strengths, new techniques, faster gradients, improved coil technology, and more robust sequence protocols. This article reviews the most commonly used advanced MRI techniques, including diffusion-weighted imaging, magnetic resonance spectrography, diffusion tensor imaging, and cerebrospinal fluid flow tracking.
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Ren J, Zeng G, Ma YJ, Chen N, Chen Z, Ling F, Zhang HQ. Pediatric thoracic SCIWORA after back bend during dance practice: a retrospective case series and analysis of trauma mechanisms. Childs Nerv Syst 2017; 33:1191-1198. [PMID: 28378287 DOI: 10.1007/s00381-017-3407-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 03/29/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the study was to describe a unique type of low-energy traumatic pediatric thoracic spinal cord injury without radiographic abnormality (SCIWORA) after a back bend during dance practice and analyze the trauma mechanisms and treatment protocols. METHODS This was a retrospective case series from September 2007 to August 2016. The study was conducted at a tertiary medical center in Beijing, China (Xuanwu Hospital, China International Neuroscience Institute [China-INI], Capital Medical University). A total of 12 pediatric patients who had a clear traumatic history after back bend movements and had been diagnosed with thoracic SCIWORA were included. Clinical and imaging data were obtained for each patient. The follow-up data was analyzed. The traumatic mechanisms were investigated by analyzing the patients' medical history, spinal diffusion tensor imaging (DTI) and fiber tractography data. RESULTS Of the 12 patients, 11 (91.7%) were younger than 8 years old. The mean age of the patients was 6.6 years. All patients had a clear traumatic history of severe thoracic spinal cord injury after performing back bend movements. The mean follow-up time was 36.5 months. During the follow-up period, 1 patient (8.3%) recovered completely, and 11 patients (91.7%) had unfavorable prognoses, including 4 (33.3%) with incomplete recovery and 7 (58.3%) with no change. Two patients underwent spinal DTI, which showed rupture of the nerve fiber bundle in the section of the injury. CONCLUSIONS Back bend movements performed during dance practice may cause pediatric thoracic SCIWORA, particularly in children younger than 8 years old. We suggest that the mechanism of primary injury is the longitudinal distraction of the thoracic spine during back bend movements, which leads to violent distraction of the spinal cord and blunt injury of nerve axons, nerve cells, and small vessels. Spinal DTI may facilitate the diagnosis and prognostic evaluation of SCIWORA.
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Affiliation(s)
- Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Gao Zeng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Yong-Jie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Nan Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Hong-Qi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China.
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Magnetic Resonance Imaging and Clinical Features in Acute and Subacute Myelopathies. Clin Neuroradiol 2017; 27:417-433. [PMID: 28667382 DOI: 10.1007/s00062-017-0604-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
Differential diagnosis of acute and subacute transverse myelopathy includes inflammatory, infectious, vascular, metabolic and paraneoplastic etiologies. Information on the diagnostic approach to transverse myelopathy with regard to daily clinical practice is provided. The differentiation between five lesion patterns on magnetic resonance imaging (MRI) in myelitis may be helpful: (1) longitudinal extensive transverse myelitis, (2) short segment ovoid or peripherally located, (3) "polio-like", (4) granulomatous and (5) segmental with rash. A correlation with these imaging features is supported if the clinical course and neurological symptoms are known. Although the mean interval from onset to nadir of symptoms in spinal cord infarction is 1 h, an overlap with a fulminant course of myelitis is possible, and impaired diffusion may also occur in acute inflammatory processes. As a result, laboratory testing, including aquaporin-4 antibodies and cerebrospinal fluid analysis, is crucial for the correct interpretation of imaging findings. Moreover, the discrimination of acute complete and acute partial transverse myelitis is advantageous in order to identify diverse entities, the latter often being a precursor to multiple sclerosis. Additional brain imaging is mandatory in suspected demyelinating, infectious, neoplastic and systemic autoimmune disease. A symmetrical lesion pattern restricted to individual tracts or dorsal columns indicates subacute combined degeneration of the spinal cord and, in addition to deficiency syndromes, a paraneoplastic etiology should be considered.
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Abdelgawad MS, Reda MIS, El-Maaboud NAEMA. Diffusion tensor MR fiber tractography in assessment of inflammatory processes and neoplasms of the cervical cord. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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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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Granata F, Racchiusa S, Mormina E, Barresi V, Garufi G, Grasso G, Salpietro FM, Longo M, Alafaci C. Presurgical role of MRI tractography in a case of extensive cervicothoracic spinal ependymoma. Surg Neurol Int 2017; 8:56. [PMID: 28540122 PMCID: PMC5421221 DOI: 10.4103/sni.sni_33_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/05/2017] [Indexed: 12/04/2022] Open
Abstract
Background: Intramedullary spinal ependymoma is a tumor, hardly characterizable with conventional magnetic resonance (MR) imaging only. MR diffusion tensor imaging (DTI) with three-dimensional fiber-tracking reconstructions allows the evaluation of the relationship between neoplasm and white matter fiber tracts, being a powerful tool in presurgical planning. We present DTI findings in a case of a young female with an extensive cervicothoracic spinal ependymoma. Case Description: The patient complained of a 2-month history of acute urinary retention, weakness and numbness on the lower limbs and the upper left limb. She underwent MR imaging that showed an extensive cervicothoracic spinal mass, difficult to characterize with conventional MR sequences. DTI showed peripherally displacement of fibers, without involvement of the spinal cord, findings consistent with an ependymoma. The patient underwent surgery with a complete resection “en bloc” of the lesion, which showed clear cleavage planes, as detected by DTI. Histopathological findings confirmed the diagnosis of ependymoma. Conclusions: DTI is a useful tool in presurgical planning, helping in differentiating not infiltrating neoplasms, such as spinal ependymomas, from other infiltrative and more aggressive neoplasms, which are considered not resectable.
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Affiliation(s)
- Francesca Granata
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Sergio Racchiusa
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Enricomaria Mormina
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Valeria Barresi
- Section of Pathological Anatomy, Department of Human Pathology, University of Messina, Messina, Italy
| | - Giada Garufi
- Section of Neurosurgery, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Giovanni Grasso
- Section of Neurosurgery, Department of Experimental Biomedicine and Clinical Neurosciences (BIONEC), University of Palermo, Palermo, Italy
| | | | - Marcello Longo
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Concetta Alafaci
- Section of Neurosurgery, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
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Cohen Y, Anaby D, Morozov D. Diffusion MRI of the spinal cord: from structural studies to pathology. NMR IN BIOMEDICINE 2017; 30:e3592. [PMID: 27598689 DOI: 10.1002/nbm.3592] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 06/01/2016] [Accepted: 07/05/2016] [Indexed: 05/27/2023]
Abstract
Diffusion MRI is extensively used to study brain microarchitecture and pathologies, and water diffusion appears highly anisotropic in the white matter (WM) of the spinal cord (SC). Despite these facts, the use of diffusion MRI to study the SC, which has increased in recent years, is much less common than that in the brain. In the present review, after a brief outline of early studies of diffusion MRI (DWI) and diffusion tensor MRI (DTI) of the SC, we provide a short survey on DTI and on diffusion MRI methods beyond the tensor that have been used to study SC microstructure and pathologies. After introducing the porous view of WM and describing the q-space approach and q-space diffusion MRI (QSI), we describe other methodologies that can be applied to study the SC. Selected applications of the use of DTI, QSI, and other more advanced diffusion MRI methods to study SC microstructure and pathologies are presented, with some emphasis on the use of less conventional diffusion methodologies. Because of length constraints, we concentrate on structural studies and on a few selected pathologies. Examples of the use of diffusion MRI to study dysmyelination, demyelination as in experimental autoimmune encephalomyelitis and multiple sclerosis, amyotrophic lateral sclerosis, and traumatic SC injury are presented. We conclude with a brief summary and a discussion of challenges and future directions for diffusion MRI of the SC. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yoram Cohen
- The Sackler School of Chemistry, The Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
- The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Debbie Anaby
- The Sackler School of Chemistry, The Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Darya Morozov
- The Sackler School of Chemistry, The Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
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Montano N, Papacci F, Trevisi G, Fernandez E. Factors affecting functional outcome in patients with intramedullary spinal cord tumors: results from a literature analysis. Acta Neurol Belg 2017; 117:277-282. [PMID: 27475420 DOI: 10.1007/s13760-016-0684-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/26/2016] [Indexed: 12/31/2022]
Abstract
Recently, great advances have been made in the surgical treatment of intramedullary spinal cord tumors (IMSCTs). Many articles have been published; but looking at the literature of the last 5 years, there are only descriptive reviews and no works in which a literature statistical analysis was performed. Here, we analyzed the literature to identify potential prognosticators of good functional outcome in IMSCT patients. To level out the selected studies, we stratified patients' neurological status as independent (ambulation possible without caregiver assistance) or disabled (cannot ambulate or can only ambulate with caregiver assistance). 18 out of 125 articles were included in the analysis (691 patients). A significant higher percentage of gross total resection (GTR) in ependymomas, hemangioblastomas and cavernomas compared to the astrocytomas (particularly high-grade gliomas) was observed. We found a strong correlation between a good pre-operative neurological function and a good post-operative and at follow-up (FU) neurological status and between GTR and a good post-operative and at FU neurological status. A significant better outcome was found in ependymomas, hemangioblastomas and cavernomas compared to astrocytomas. Our analysis suggests that an early surgery could be reasonable in IMSCTs, because a good pre-operative neurological function is a strong predictor of good neurological outcome. In patients with high-grade gliomas, there is no indication to attempt a GTR due to the infiltrative growth pattern of this tumor that leads to a higher surgical morbidity. Although not innovative, the evidences of our literature statistical analysis strengthen the results from previous surgical series and descriptive reviews.
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Affiliation(s)
- Nicola Montano
- Institute of Neurosurgery, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Fabio Papacci
- Institute of Neurosurgery, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Gianluca Trevisi
- Institute of Neurosurgery, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Eduardo Fernandez
- Institute of Neurosurgery, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
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Improved multi-shot diffusion imaging using GRAPPA with a compact kernel. Neuroimage 2016; 138:88-99. [DOI: 10.1016/j.neuroimage.2016.05.079] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/29/2016] [Accepted: 05/30/2016] [Indexed: 11/20/2022] Open
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Hu Z, Ma X, Truong TK, Song AW, Guo H. Phase-updated regularized SENSE for navigator-free multishot diffusion imaging. Magn Reson Med 2016; 78:172-181. [PMID: 27520840 DOI: 10.1002/mrm.26361] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/07/2022]
Abstract
PURPOSE Either SENSE+CG or POCS-ICE methods can be used to correct for motion-induced phase errors in navigator-free multishot diffusion imaging. SENSE+CG has the advantage of a fast convergence, however, occasionally the convergence can be unstable, thus degrading the image quality. POCS-ICE has a stable convergence and can be used with a high number of shots, but its convergence is slow, which limits its practical usage. The study here proposes an improved method based on both SENSE+CG and POCS-ICE, called Phase-updated Regularized SENSE (PR-SENSE), for navigator-free multishot diffusion imaging. THEORY AND METHODS In PR-SENSE, a total variation regularization method is used to solve the SENSE inverse problem instead of the conjugate gradient method used in SENSE+CG. This method is implemented by using a lagged diffusivity fixed point iteration algorithm. Additionally, the phase is updated during the iteration process to improve the image accuracy. RESULTS Simulations and in vivo experiments demonstrated that PR-SENSE can successfully correct for the motion-induced phase errors in multi-shot DWI. It integrates the advantages of SENSE+CG and POCS-ICE, resulting in a fast and stable convergence with improved image quality. CONCLUSION Given its advantages, PR-SENSE is a significant improvement over other methods for navigator-free high-resolution DWI. Magn Reson Med 78:172-181, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Zhangxuan Hu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Xiaodong Ma
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Trong-Kha Truong
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Allen W Song
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
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Liu X, Tian W, Chen H, LoStracco TA, Zhang J, Li MY, Germin B, Wang HZ. Advanced Neuroimaging in the Evaluation of Spinal Cord Tumors and Tumor Mimics: Diffusion Tensor and Perfusion-Weighted Imaging. Semin Ultrasound CT MR 2016; 38:163-175. [PMID: 28347419 DOI: 10.1053/j.sult.2016.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Spinal cord tumors are an important component of pathologic diseases involving the spinal cord. Conventional magnetic resonance (MR) imaging only provides anatomical information. MR diffusion tensor imaging (DTI) and MR perfusion-weighted imaging (PWI) may detect microstructure diffusion and hemodynamic changes in these tumors. We review recent application studies of MR DTI and PWI in spinal cord tumors. Overall, MR DTI and MR PWI are promising imaging tools that are especially useful in improving differential diagnosis between spinal cord tumors and tumor mimics, preoperative evaluation of resectability, and providing assistance in surgical navigation.
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Affiliation(s)
- Xiang Liu
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY.
| | - Wei Tian
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - Hongyan Chen
- Department of Radiology, Beijing TiantanHospital, Beijing, China
| | - Thomas A LoStracco
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - Jing Zhang
- GE Healthcare MR research center, Beijing, China
| | - Michael Yan Li
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY
| | - Barbara Germin
- (║)Department of Pathology, University of Rochester Medical Center, Rochester, NY
| | - Henry Z Wang
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
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Zhang Q, Alexander M, Ryner L. Multimodality Neurological Data Visualization With Multi-VOI-Based DTI Fiber Dynamic Integration. IEEE J Biomed Health Inform 2016; 20:293-303. [DOI: 10.1109/jbhi.2014.2367026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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38
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Palasis S, Hayes LL. Acquired pathology of the pediatric spine and spinal cord. Pediatr Radiol 2015; 45 Suppl 3:S420-32. [PMID: 26346148 DOI: 10.1007/s00247-015-3328-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/21/2014] [Accepted: 02/24/2015] [Indexed: 12/13/2022]
Abstract
Pediatric spine pathology poses a diagnostic challenge for radiologists. Acquired spine pathology often yields nonspecific signs and symptoms in children, especially in the younger age groups, and diagnostic delay can carry significant morbidity. This review is focused on some of the more common diagnostic dilemmas we face when attempting to evaluate and diagnose acquired pediatric spine anomalies in daily practice. An understanding of some of the key differentiating features of these disease processes in conjunction with pertinent history, physical exam, and advanced imaging techniques can indicate the correct diagnosis.
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Affiliation(s)
- Susan Palasis
- Department of Radiology at Scottish Rite, Children's Healthcare of Atlanta, 1001 Johnson Ferry Road, Atlanta, GA, 30342, USA,
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Schmidt M, Kasprian G, Amann G, Duscher D, Aszmann OC. Diffusion tensor tractography for the surgical management of peripheral nerve sheath tumors. Neurosurg Focus 2015; 39:E17. [DOI: 10.3171/2015.6.focus15228] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Peripheral nerve sheath tumors (PNSTs) are uncommon but bear a significant risk of malignancy. High-resolution MRI is the standard technique for characterizing PNSTs. However, planning the appropriate extent of resection and subsequent reconstructive strategies is highly dependent on the intraoperative findings because preoperative MRI evaluation can be insufficient. Diffusion tensor tractography (DTT) represents a recently developed advanced MRI technique that reveals the microstructure of tissues based on monitoring the random movement of water molecules. DTT has the potential to provide diagnostic insights beyond conventional MRI techniques due to its mapping of specific fibrillar nerve structures. Here, DTT was applied to evaluate PNSTs and to examine the usefulness of this method for the correct delineation of tumor and healthy nerve tissue and the value of this information in the preoperative planning of surgical interventions.
METHODS
In this prospective study, patients with the clinical symptoms of a PNST were investigated using DTT 3-Tesla MRI scans. Image data processing and tractography were performed using the FACT (fiber assessment by continuous tracking) algorithm and multiple-regions-of-interest approach. The surgical findings were then compared with the results of the DTT MRI scans. Preoperative fascicle visualization and the correlation with the intraoperative findings were graded.
RESULTS
In a 21-month period, 12 patients with PNSTs were investigated (7 female and 5 male patients with a mean age of 46.2 ± 19.2 years). All patients underwent surgical removal of the tumor. Schwannoma was the most common benign histopathological finding (n = 7), whereas 2 malignant lesions were detected. In 10 of 12 patients, good preoperative nerve fascicle visualization was achieved using DTT scans. In 9 of 10 patients with good preoperative fascicle visualization, good intraoperative correlation between the DTT scans and surgical anatomy was found.
CONCLUSIONS
DTT properly visualizes the peripheral nerve fascicles and their correct anatomical relation to PNST. DTT represents a promising new method for the preinterventional planning of nerve tumor resection.
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Affiliation(s)
- Manfred Schmidt
- 1Section of Plastic and Reconstructive Surgery, General Hospital Linz, Austria; and
| | | | | | - Dominik Duscher
- 1Section of Plastic and Reconstructive Surgery, General Hospital Linz, Austria; and
| | - Oskar C. Aszmann
- 4Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Austria
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Diffusion tensor imaging of the cervical spinal cord in children. Childs Nerv Syst 2015; 31:1239-45. [PMID: 26036198 DOI: 10.1007/s00381-015-2767-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Obtaining fast, reliable, high-resolution diffusion tensor imaging (DTI) of the pediatric cervical spinal cord (CSC) is challenging, given the multitude of technical limitations involved. Overcoming these limitations may further potentiate DTI as a valuable quantitative tool in evaluating the pediatric CSC. METHODS Sixteen patients (9 girls and 7 boys) with hypoxic brain injury, craniocervical junction malformations, and head trauma were included in this retrospective study. Region of interests were placed from C1-C2 through C7-T1 consecutively at the cervical intervertebral disc levels. DTI metrics were compared with a pediatric DTI database of healthy controls. Clinical background and outcomes were tabulated. RESULTS Patients with hypoxic brain injury, Chiari I and II malformations, and head trauma demonstrated lower fractional anisotropy values than that of healthy controls at certain cervical intervertebral disc levels. CONCLUSIONS DTI may be a promising modality for providing additional information beyond that of conventional magnetic resonance imaging in pediatric central nervous system disorders.
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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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Differential Diagnosis of Acute Myelopathies: An Update. Clin Neuroradiol 2015; 25 Suppl 2:183-7. [PMID: 26031429 DOI: 10.1007/s00062-015-0401-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
Abstract
Appropriate description may lead to adequate diagnostic and therapeutic measures, and therefore, a simple scheme to categorize and term the imaging findings of acute myelopathy is suggested based on current literature. Assigning imaging findings to five groups, that is (a) "segmental with rash," (b) "poliolike," (c) "granulomatous-nodular," (d) "longitudinally extensive transverse myelitis," (e) "short-segment ovoid or peripherally located," provides a rationale to lessen differential diagnoses. The key for understanding, proper description and differential diagnosis is the correlation of two time points: When did the first symptoms appear and when did imaging take place? Early infarction within the first 24 h will show neither swelling nor enhancement.
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Szwedowski D, Walecki J. Spinal Cord Injury without Radiographic Abnormality (SCIWORA) - Clinical and Radiological Aspects. Pol J Radiol 2014; 79:461-4. [PMID: 25505497 PMCID: PMC4262055 DOI: 10.12659/pjr.890944] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/24/2014] [Indexed: 11/09/2022] Open
Abstract
The acronym SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) was first developed and introduced by Pang and Wilberger who used it to define "clinical symptoms of traumatic myelopathy with no radiographic or computed tomographic features of spinal fracture or instability". SCIWORA is a clinical-radiological condition that mostly affects children. SCIWORA lesions are found mainly in the cervical spine but can also be seen, although much less frequently, in the thoracic or lumbar spine. Based on reports from different authors, SCIWORA is responsible for 6 to 19% and 9% to 14% of spinal injuries in children and adults, respectively. Underlying degenerative changes, including spondylosis or spinal canal stenosis, are typically present in adult patients. The level of spinal cord injury corresponds to the location of these changes. With recent advances in neuroimaging techniques, especially in magnetic resonance imaging, and with increasing availability of MRI as a diagnostic tool, the overall detection rate of SCIWORA has significantly improved.
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Affiliation(s)
- Dawid Szwedowski
- Department of Orthopedic and Trauma, District Hospital, Toruń, Poland
| | - Jerzy Walecki
- Department of Radiology and Diagnostic Imaging, Medical Center of Postgraduate Education, Warsaw, Poland
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Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology 2014; 57:241-57. [PMID: 25398656 DOI: 10.1007/s00234-014-1464-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The purpose of this study was to analyse MR imaging features and lesion patterns as defined by compromised vascular territories, correlating them to different clinical syndromes and aetiological aspects. METHODS In a 19.8-year period, clinical records and magnetic resonance imaging (MRI) features of 55 consecutive patients suffering from spinal cord ischemia were evaluated. RESULTS Aetiologies of infarcts were arteriosclerosis of the aorta and vertebral arteries (23.6%), aortic surgery or interventional aneurysm repair (11%) and aortic and vertebral artery dissection (11%), and in 23.6%, aetiology remained unclear. Infarcts occurred in 38.2% at the cervical and thoracic level, respectively, and 49% of patients suffered from centromedullar syndrome caused by anterior spinal artery ischemia. MRI disclosed hyperintense pencil-like lesion pattern on T2WI in 98.2%, cord swelling in 40%, enhancement on post-contrast T1WI in 42.9% and always hyperintense signal on diffusion-weighted imaging (DWI) when acquired. CONCLUSION The most common clinical feature in spinal cord ischemia is a centromedullar syndrome, and in contrast to anterior spinal artery ischemia, infarcts in the posterior spinal artery territory are rare. The exclusively cervical location of the spinal sulcal artery syndrome seems to be a likely consequence of anterior spinal artery duplication which is observed preferentially here.
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Affiliation(s)
- Stefan Weidauer
- Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital of the Goethe - University, Frankfurt / Main, Seckbacher Landstraße 65, D 60389, Frankfurt / Main, Germany,
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Vedantam A, Jirjis MB, Schmit BD, Wang MC, Ulmer JL, Kurpad SN. Diffusion tensor imaging of the spinal cord: insights from animal and human studies. Neurosurgery 2014; 74:1-8; discussion 8; quiz 8. [PMID: 24064483 DOI: 10.1227/neu.0000000000000171] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Diffusion tensor imaging (DTI) provides a measure of the directional diffusion of water molecules in tissues. The measurement of DTI indexes within the spinal cord provides a quantitative assessment of neural damage in various spinal cord pathologies. DTI studies in animal models of spinal cord injury indicate that DTI is a reliable imaging technique with important histological and functional correlates. These studies demonstrate that DTI is a noninvasive marker of microstructural change within the spinal cord. In human studies, spinal cord DTI shows definite changes in subjects with acute and chronic spinal cord injury, as well as cervical spondylotic myelopathy. Interestingly, changes in DTI indexes are visualized in regions of the cord, which appear normal on conventional magnetic resonance imaging and are remote from the site of cord compression. Spinal cord DTI provides data that can help us understand underlying microstructural changes within the cord and assist in prognostication and planning of therapies. In this article, we review the use of DTI to investigate spinal cord pathology in animals and humans and describe advances in this technique that establish DTI as a promising biomarker for spinal cord disorders.
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Affiliation(s)
- Aditya Vedantam
- *Department of Neurosurgery, and §Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin; ‡Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
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Cui JL, Li X, Chan TY, Mak KC, Luk KDK, Hu Y. Quantitative assessment of column-specific degeneration in cervical spondylotic myelopathy based on diffusion tensor tractography. 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 2014; 24:41-7. [PMID: 25150714 DOI: 10.1007/s00586-014-3522-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE Cervical spondylotic myelopathy (CSM) is a common spinal cord disorder in the elderly. Diffusion tensor imaging (DTI) has been shown to be of great value for evaluating the microstructure of nerve tracts in the spinal cord. Currently, the quantitative assessment of the degeneration on the specific tracts in CSM is still rare. The aim of the present study was to use tractography-based quantification to investigate the column-specific degeneration in CSM. METHODS A total of 43 volunteers were recruited with written informed consent, including 20 healthy subjects and 23 CSM patients. Diffusion MRI was taken by 3T MRI scanner. Fiber tractography was performed using TrackVis to reconstruct the white matter tracts of the anterior, lateral and posterior column on the bilateral sides. The DTI metrics acquired from tractography, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD), were compared between healthy subjects and CSM patients. RESULTS Compared to healthy subjects, FA was found significantly lower in the lateral (Healthy 0.64 ± 0.07 vs. CSM 0.53 ± 0.08) and posterior column (Healthy 0.67 ± 0.08 vs. CSM 0.47 ± 0.08) (p < 0.001), while MD, AD and RD were significantly higher in the anterior, lateral and posterior column in CSM (p < 0.05). CONCLUSION Loss of microstructural integrity was detected in the lateral and posterior column in CSM. Tractography-based quantification was capable of evaluating the subtle pathological insult within white matter on a column-specific basis, which exhibited potential clinical value for in vivo evaluation of the severity of CSM.
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Affiliation(s)
- Jiao-Long Cui
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 12 Sandy Bay Road, Pokfulam, Hong Kong
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Diffusion tensor imaging of somatosensory tract in cervical spondylotic myelopathy and its link with electrophysiological evaluation. Spine J 2014; 14:1493-500. [PMID: 24321168 DOI: 10.1016/j.spinee.2013.08.052] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 07/24/2013] [Accepted: 08/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND CONTEXT Abnormal somatosensory evoked potential (SEP) (ie, prolonged latency) has been associated with poor surgical prognosis of cervical spondylotic myelopathy (CSM). PURPOSE To further characterize the extent of microstructural damage to the somatosensory tract in CSM patients using diffusion tensor imaging (DTI). STUDY DESIGN/SETTING Retrospective study. PATIENT SAMPLE A total of 40 volunteers (25 healthy subjects and 15 CSM patients). OUTCOME MEASURES Clinical, electrophysiological, and radiological evaluations were performed using the modified Japanese Orthopedic Association (mJOA) scoring system, SEP, and cord compression ratio in anatomic magnetic resonance (MR) images, respectively. Axial diffusion MR images were taken using a pulsed gradient, spin-echo-echo-planar imaging sequence with a 3-T MR system. The diffusion indices in different regions of the spinal cord were measured. METHODS Comparison of diffusion indices among healthy and myelopathic spinal cord with intact and impaired SEP responses were performed using one-way analysis of variance. RESULTS In healthy subjects, fractional anisotropy (FA) values were higher in the dorsal (0.73±0.11) and lateral columns (0.72±0.13) than in the ventral column of white matter (0.58±0.10) (eg, at C4/5) (p<.05). FA was dramatically dropped in the dorsal (0.54±0.16) and lateral columns (0.51±0.13) with little change in the ventral column (0.48±0.15) at the compressive lesions in CSM patients. There were no significant differences in the mJOA scores or cord compression ratios between CSM patients with or without abnormal SEP. However, patients with abnormal SEP showed an FA decrease in the dorsal column cephalic to the lesion (0.56±0.06) (ie, at C1/2, compared with healthy subjects [0.66±0.02]), but the same decrease was not observed for those without a SEP abnormality (0.67±0.02). CONCLUSION Spinal tracts were not uniformly affected in the myelopathic cervical cord. Changes in diffusion indices could delineate focal or extensive myelopathic lesions in CSM, which could account for abnormal SEP. DTI analysis of spinal tracts might provide additional information not available from conventional diagnostic tools for prognosis of CSM.
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Wang SQ, Li X, Cui JL, Li HX, Luk KDK, Hu Y. Prediction of myelopathic level in cervical spondylotic myelopathy using diffusion tensor imaging. J Magn Reson Imaging 2014; 41:1682-8. [PMID: 25044870 DOI: 10.1002/jmri.24709] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To investigate the use of a newly designed machine learning-based classifier in the automatic identification of myelopathic levels in cervical spondylotic myelopathy (CSM). MATERIALS AND METHODS In all, 58 normal volunteers and 16 subjects with CSM were recruited for diffusion tensor imaging (DTI) acquisition. The eigenvalues were extracted as the selected features from DTI images. Three classifiers, naive Bayesian, support vector machine, and support tensor machine, and fractional anisotropy (FA) were employed to identify myelopathic levels. The results were compared with clinical level diagnosis results and accuracy, sensitivity, and specificity were calculated to evaluate the performance of the developed classifiers. RESULTS The accuracy by support tensor machine was the highest (93.62%) among the three classifiers. The support tensor machine also showed excellent capacity to identify true positives (sensitivity: 84.62%) and true negatives (specificity: 97.06%). The accuracy by FA value was the lowest (76%) in all the methods. CONCLUSION The classifiers-based method using eigenvalues had a better performance in identifying the levels of CSM than the diagnosis using FA values. The support tensor machine was the best among three classifiers.
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Affiliation(s)
- Shu-Qiang Wang
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China.,Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xiang Li
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Jiao-Long Cui
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Han-Xiong Li
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Hong Kong, China
| | - Keith D K Luk
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Yong Hu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
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Lerner A, Mogensen MA, Kim PE, Shiroishi MS, Hwang DH, Law M. Clinical Applications of Diffusion Tensor Imaging. World Neurosurg 2014; 82:96-109. [DOI: 10.1016/j.wneu.2013.07.083] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 07/04/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
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Brander A, Koskinen E, Luoto TM, Hakulinen U, Helminen M, Savilahti S, Ryymin P, Dastidar P, Öhman J. Diffusion tensor imaging of the cervical spinal cord in healthy adult population: normative values and measurement reproducibility at 3T MRI. Acta Radiol 2014; 55:478-85. [PMID: 23969263 DOI: 10.1177/0284185113499752] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Compared to diffusion tensor imaging (DTI) of the brain, there is a paucity of reports addressing the applicability of DTI in the evaluation of the spinal cord. Most normative data of cervical spinal cord DTI consist of relatively small and arbitrarily collected populations. Comprehensive normative data are necessary for clinical decision-making. PURPOSE To establish normal values for cervical spinal cord DTI metrics with region of interest (ROI)- and fiber tractography (FT)-based measurements and to assess the reproducibility of both measurement methods. MATERIAL AND METHODS Forty healthy adults underwent cervical spinal cord 3T MRI. Sagittal and axial conventional T2 sequences and DTI in the axial plane were performed. Whole cord fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were determined at different cervical levels from C2 to C7 using the ROI method. DTI metrics (FA, axial, and radial diffusivities based on eigenvalues λ1, λ2, and λ3, and ADC) of the lateral and posterior funicles were measured at C3 level. FA and ADC of the whole cord and the lateral and posterior funicles were also measured using quantitative tractography. Intra- and inter-observer variation of the measurement methods were assessed. RESULTS Whole cord FA values decreased and ADC values increased in the rostral to caudal direction from C2 to C7. Between the individual white matter funicles no statistically significant difference for FA or ADC values was found. Both axial diffusivity and radial diffusivity of both lateral funicles differed significantly from those of the posterior funicle. Neither gender nor age correlated with any of the DTI metrics. Intra-observer variation of the measurements for whole cord FA and ADC showed almost perfect agreement with both ROI and tractography-based measurements. There was more variation in measurements of individual columns. Inter-observer agreement varied from moderate to strong for whole cord FA and ADC. CONCLUSION Both ROI- and FT-based measurements are applicable methods yielding reproducible results for cervical spinal cord DTI metrics. Normative values for both measurement methods are presented.
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Affiliation(s)
- Antti Brander
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Eerika Koskinen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Teemu M Luoto
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Ullamari Hakulinen
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Mika Helminen
- School of Health Sciences, University of Tampere, Tampere, Finland and Science Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Sirpa Savilahti
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Pertti Ryymin
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Prasun Dastidar
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Juha Öhman
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
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