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Altorfer FCS, Tan ET, Sneag DB. Editorial for "Clinical Value and Reliability of Quantitative Assessments of Lumbosacral Nerve Root Using Diffusion Tensor and Diffusion Weighted MR Imaging: A Systematic Review". J Magn Reson Imaging 2024. [PMID: 38190425 DOI: 10.1002/jmri.29215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
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Al-shaari H, J F, R M, CJ H. A systematic review of repeatability and reproducibility studies of diffusion tensor imaging of cervical spinal cord. Br J Radiol 2023; 96:20221019. [PMID: 37751162 PMCID: PMC10607424 DOI: 10.1259/bjr.20221019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/12/2023] [Accepted: 08/10/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES Diffusion tensor imaging (DTI) techniques are being studied as a possible diagnostic and predictive tool for the evaluation of cervical spinal cord disease. This systematic review aims to evaluate the previous DTI studies that specifically investigated the repeatability and reproducibility of DTI in the cervical spinal cord. METHODS AND MATERIALS A search in the PubMed, Scopus, Web of Science and Ovid electronic databases was conducted for articles published between January 1990 and February 2022 that related to the repeatability and reproducibility of DTI in evaluating the cervical spinal cord using one of the following measurements: the intraclass correlation coefficient (ICC) and/or the coefficient of variation (CV), and/or Bland-Altman (BA) differences analysis methods. DTI studies that presented full statistical analysis of repeatability and/or reproducibility tests of the cervical spinal cord in peer-reviewed full-text publications published in journals were included. Articles that included at least one of the keywords within the titles or abstracts were identified. Additional full-text papers were found by searching the citations and reference lists of related articles. This review has followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Risk of bias was evaluated with 13 criteria weighted toward methodological quality of reported studies using the QuADS assessment criteria. This assessment only included full-text articles written in English. RESULTS A total of 11 studies were included and assessed for different characteristics, including sample size,(3-34) re-test time interval (<1 h to >3 months), test-retest reproducibility scores and acquisition method. Six studies used ICC which ranged from poor (ICC<0.37) to excellent reproducibility (ICC 0.91-0.99). Four studies reported an overall CV lower than 40% for all DTI metrics. Three studies reported the Bland-Altman (BA) differences and reported a minimum percentage showing no strong differences between repeated measurements. Quantitative analysis was not undertaken due to heterogeneity of methods. Repeatability and reproducibility measures were generally found to be good. CONCLUSION This study revealed that the application of DTI and its related measures in a clinical setting in the assessment of cervical spinal cord changes is feasible and reproducible. However, cervical spinal cord DTI suffers from some existing limitations that prevent it from being routinely used in research and clinical settings. ADVANCES IN KNOWLEDGE DTI with its parametric maps provide broad evaluation of the tissue structure of axonal white matter and are being studied as a possible diagnostic and predictive tool for the assessment of cervical spinal cord (CSC) disease.
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Affiliation(s)
| | - Fulford J
- Medical Imaging Department, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Meertens R
- Medical Imaging Department, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Heales CJ
- Medical Imaging Department, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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Krisa L, Middleton DM, Saksena S, Faro SH, Leiby BE, Mohamed FB, Mulcahey MJ. Clinical Utility of Diffusion Tensor Imaging as a Biomarker to Identify Microstructural Changes in Pediatric Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:1-12. [PMID: 35521062 PMCID: PMC9009200 DOI: 10.46292/sci21-00048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Lack of clarity about the neurological consequence of spinal cord injury (SCI) in children causes speculation about diagnoses, recovery potential, and treatment effectiveness. Diffusion tensor imaging (DTI) has shown promising results as a biomarker to evaluate spinal cord integrity at a microstructural level. Objectives To look at the difference between pediatric participants with and without SCI to determine which DTI metrics best categorize spinal cord tissue damage and to correlate DTI metrics with two clinical measures: Capabilities of the Upper Extremity Test (CUE-T) and Spinal Cord Independence Measure version III (SCIM-III). Methods This single-site, prospective study included pediatric participants with SCI (n = 26) and typically developed (TD) control subjects (n = 36). All participants underwent two magnetic resonance imaging (MRI) scans on a 3T MR scanner. Participants with SCI also completed the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), CUE-T, and SCIM-III outcomes measures. Results This study found significant strength of association between fractional anisotropy (FA) and upper extremity muscle strength (UEMS) in participants with SCI. Most DTI parameters showed a significant difference between participants with SCI and TD participants and a moderate correlation with the CUE-T total score. Regional effects on group differences were found to be significant. Conclusion This study demonstrates the strength of association between DTI parameters and clinical measures in the pedantic SCI population. It illustrates DTI as a potential biomarker of SCI location and severity in the pediatric SCI population.
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Affiliation(s)
- Laura Krisa
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
,Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
,Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Devon M. Middleton
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sona Saksena
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Scott H. Faro
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin E. Leiby
- Department of Pharmacology & Experimental Therapeutics, Biostatistics Division, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Feroze B. Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - MJ Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
,Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
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Clinical application of diffusion tensor tractography to postoperative C5 palsy. Spinal Cord Ser Cases 2021; 7:83. [PMID: 34552046 DOI: 10.1038/s41394-021-00447-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Diagnostic study. OBJECTIVE Although C5 palsy is a well-known potential complication after cervical procedure, the exact pathophysiology remains uncertain. Diffusion tensor tractography (DTT) has recently been proposed as a useful tool to examine quantitatively and non-invasively the pathology of spinal cord disorders. The purpose of this study is to determine the clinical interest of DTT in patients with C5 palsy after cervical laminoplasty. SETTING Single university hospital. METHODS Five patients with C5 palsy out of 108 patients after cervical laminoplasty were subjected to DTT using a 1.5 Tesla magnetic resonance imaging in our hospital between 2010 and 2012. For the tractography, two regions of interest (ROI) were placed at the C5 segmental level and the bilateral C4/5 intervertebral foramen level. RESULTS The postoperative number of tract fibers at the C5 segmental spinal cord level was significantly increased compared to the preoperative number, despite the C5 palsy. Analyses of two ROIs (at the C5 segmental level and the C4/5 intervertebral foramen level) showed that the number of tract fibers at the palsy side was significantly decreased compared to the intact side. Furthermore, in the patient who spontaneously recovered from C5 palsy within postoperative 6 months, a gradual augmentation of tract fibers was identified at the palsy side. CONCLUSIONS Our findings suggest that DTT can document C5 palsy in detail, as the anatomical region between C5 segmental level and C4/5 intervertebral foramen level was potentially damaged in patients with C5 palsy after laminoplasty.
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Lee E, Lee JW, Bae YJ, Kim HJ, Kang Y, Ahn JM. Reliability of pre-operative diffusion tensor imaging parameter measurements of the cervical spine in patients with cervical spondylotic myelopathy. Sci Rep 2020; 10:17410. [PMID: 33060848 PMCID: PMC7566607 DOI: 10.1038/s41598-020-74624-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/08/2020] [Indexed: 11/17/2022] Open
Abstract
The present study assessed test–retest and inter-observer reliability of diffusion tensor imaging (DTI) in cervical spondylotic myelopathy (CSM), as well as the agreement among measurement methods. A total 34 patients (12 men, 22 women; mean age, 58.7 [range 45–79] years) who underwent surgical decompression for CSM, with pre-operative DTI scans available, were retrospectively enrolled. Four observers independently measured fractional anisotropy (FA) values twice, using three different measurement methods. Test–retest and inter-observer reliability was assessed using intraclass correlation coefficients (ICCs). Overall, inter-observer agreements varied according to spinal cord level and the measurement methods used, and ranged from poor to excellent agreement (ICC = 0.374–0.821), with relatively less agreement for the sagittal region of interest (ROI) method. The radiology resident and neuro-radiologist group showed excellent test–retest reliability at almost every spinal cord level (ICC = 0.887–0.997), but inter-observer agreements varied from fair to good (ICC = 0.404–0.747). Despite excellent test–retest reliability of the ROI measurements, FA measurements in patients with CSM varied widely in terms of inter-observer reliability. Therefore, DTI parameter data should be interpreted carefully when applied clinically.
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Affiliation(s)
- Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea.
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea
| | - Hyo Jin Kim
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea
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Smith SA. Invited Commentary on "Optimizing Diffusion-Tensor Imaging Acquisition for Spinal Cord Assessment," with Response from Dr Martín Noguerol et al. Radiographics 2020; 40:428-431. [PMID: 32125962 DOI: 10.1148/rg.2020190214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Seth A Smith
- Vanderbilt University Institute of Imaging Science and Department of Radiology and Radiological Sciences and Department of Biomedical Engineering, Vanderbilt University Medical Center Nashville, Tennessee
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Reynolds BB, By S, Weinberg QR, Witt AA, Newton AT, Feiler HR, Ramkorun B, Clayton DB, Couture P, Martus JE, Adams M, Wellons JC, Smith SA, Bhatia A. Quantification of DTI in the Pediatric Spinal Cord: Application to Clinical Evaluation in a Healthy Patient Population. AJNR Am J Neuroradiol 2019; 40:1236-1241. [PMID: 31196859 PMCID: PMC7048550 DOI: 10.3174/ajnr.a6104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/16/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of the study is to characterize diffusion tensor imaging indices in the developing spinal cord, evaluating differences based on age and cord region. Describing the progression of DTI indices in the pediatric cord increases our understanding of spinal cord development. MATERIALS AND METHODS A retrospective analysis was performed on DTI acquired in 121 pediatric patients (mean, 8.6 years; range, 0.3-18.0 years) at Monroe Carell Jr. Children's Hospital at Vanderbilt from 2017 to 2018. Diffusion-weighted images (15 directions; b = 750 s/mm2; slice thickness, 5 mm; in-plane resolution, 1.0 × 1.0 mm2) were acquired on a 3T scanner in the cervicothoracic and/or thoracolumbar cord. Manual whole-cord segmentation was performed. Images were masked and further segmented into cervical, upper thoracic, thoracolumbar, and conus regions. Analyses of covariance were performed for each DTI-derived index to investigate how age affects diffusion across cord regions, and 95% confidence intervals were calculated across age for each derived index and region. Post hoc testing was performed to analyze regional differences. RESULTS Analyses of covariance revealed significant correlations of age with axial diffusivity, mean diffusivity, and fractional anisotropy (all, P < .001). There were also significant differences among cord regions for axial diffusivity, radial diffusivity, mean diffusivity, and fractional anisotropy (all, P < .001). CONCLUSIONS This research demonstrates that diffusion evolves in the pediatric spinal cord during development, dependent on both cord region and the diffusion index of interest. Future research could investigate how diffusion may be affected by common pediatric spinal pathologies.
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Affiliation(s)
- B B Reynolds
- Institute of Imaging Science (B.B.R., S.B., Q.R.W., A.A.W., A.T.N., H.R.F., B.R., S.A.S., A.B.), Vanderbilt University, Nashville, Tennessee
| | - S By
- Institute of Imaging Science (B.B.R., S.B., Q.R.W., A.A.W., A.T.N., H.R.F., B.R., S.A.S., A.B.), Vanderbilt University, Nashville, Tennessee
| | - Q R Weinberg
- Institute of Imaging Science (B.B.R., S.B., Q.R.W., A.A.W., A.T.N., H.R.F., B.R., S.A.S., A.B.), Vanderbilt University, Nashville, Tennessee
| | - A A Witt
- Institute of Imaging Science (B.B.R., S.B., Q.R.W., A.A.W., A.T.N., H.R.F., B.R., S.A.S., A.B.), Vanderbilt University, Nashville, Tennessee
| | - A T Newton
- From the Department of Radiology and Radiological Sciences (A.T.N., P.C., S.A.S., A.B.).,Pediatrics (A.T.N.).,Institute of Imaging Science (B.B.R., S.B., Q.R.W., A.A.W., A.T.N., H.R.F., B.R., S.A.S., A.B.), Vanderbilt University, Nashville, Tennessee
| | - H R Feiler
- Institute of Imaging Science (B.B.R., S.B., Q.R.W., A.A.W., A.T.N., H.R.F., B.R., S.A.S., A.B.), Vanderbilt University, Nashville, Tennessee
| | - B Ramkorun
- Institute of Imaging Science (B.B.R., S.B., Q.R.W., A.A.W., A.T.N., H.R.F., B.R., S.A.S., A.B.), Vanderbilt University, Nashville, Tennessee
| | | | - P Couture
- From the Department of Radiology and Radiological Sciences (A.T.N., P.C., S.A.S., A.B.)
| | - J E Martus
- Division of Pediatric Orthopaedics (J.E.M.), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | | | - J C Wellons
- From the Department of Radiology and Radiological Sciences (A.T.N., P.C., S.A.S., A.B.).,Department of Ophthalmology (S.A.S., J.C.W. III), Vanderbilt University Medical Center, Nashville, Tennessee
| | - S A Smith
- From the Department of Radiology and Radiological Sciences (A.T.N., P.C., S.A.S., A.B.).,Department of Biomedical Engineering (S.A.S.).,Institute of Imaging Science (B.B.R., S.B., Q.R.W., A.A.W., A.T.N., H.R.F., B.R., S.A.S., A.B.), Vanderbilt University, Nashville, Tennessee.,Department of Ophthalmology (S.A.S., J.C.W. III), Vanderbilt University Medical Center, Nashville, Tennessee
| | - A Bhatia
- From the Department of Radiology and Radiological Sciences (A.T.N., P.C., S.A.S., A.B.) .,Institute of Imaging Science (B.B.R., S.B., Q.R.W., A.A.W., A.T.N., H.R.F., B.R., S.A.S., A.B.), Vanderbilt University, Nashville, Tennessee
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Evaluation of Reproducibility of Diffusion Tensor Imaging in the Brachial Plexus at 3.0 T. Invest Radiol 2018; 52:482-487. [PMID: 28291025 DOI: 10.1097/rli.0000000000000363] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the reproducibility of 3 T magnetic resonance imaging diffusion tensor imaging (DTI) of the brachial plexus in healthy subjects. METHODS Ten healthy volunteers were included, and morphological and DTI sequences of the nerve roots of the brachial plexus from C5 to T1 of both sides were repeatedly acquired on a 3 T magnetic resonance system (MAGNETOM Skyra; Siemens Healthcare, Erlangen, Germany). A prototype diffusion-weighted single-shot echo-planar imaging sequence-enabling slice-specific shim adjustments was performed with b-values of 0 and 800 s/mm in 30 gradient directions, resulting in an acquisition time of about 6 minutes each in axial orientation. Between scans, subjects were moved and repositioned in the scanner, coils were reinserted, and new localizers were acquired. Image analysis was performed using MITK Diffusion software toolkit. Two independent readers performed diffusion data postprocessing, and regions of interest (ROIs) were set on the proximal postganglionic trunk at each spinal level, bilaterally to obtain values for fractional anisotropy (FA) and mean diffusivity (MD). Interreader and intrareader agreement as well as test-retest reproducibility of DTI metrics were assessed. RESULTS Intraclass correlation coefficients (ICCs) for interreader and intrareader agreement did not differ significantly between measurements for FA and MD. In particular, ICCs for interreader agreement of FA ranged from 0.741 to 0.961 and that of MD ranged from 0.802 to 0.998, and ICCs for intrareader agreement of FA ranged from 0.759 to 0.949 and that of MD ranged from 0.796 to 0.998. The test-retest reproducibility of DTI metrics showed an overall moderate to strong correlation (r > 0.707), with few minor exceptions, for both FA and MD values. CONCLUSIONS Diffusion tensor imaging metrics in the brachial plexus are reproducible. Future applications of DTI for a possible clinical use should be further investigated.
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Wang K, Wang WT, Wang J, Chen Z, Song QX, Chen SY, Hao Q, He DW, Shen HX. Compared study of routine magnetic resonance imaging and diffusion tensor tractography on the predictive value of diagnosis and prognosis in acute cervical spinal cord injury. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Conklin CJ, Middleton DM, Alizadeh M, Finsterbusch J, Raunig DL, Faro SH, Shah P, Krisa L, Sinko R, Delalic JZ, Mulcahey MJ, Mohamed FB. Spatially selective 2D RF inner field of view (iFOV) diffusion kurtosis imaging (DKI) of the pediatric spinal cord. NEUROIMAGE-CLINICAL 2016; 11:61-67. [PMID: 26909329 PMCID: PMC4735660 DOI: 10.1016/j.nicl.2016.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/24/2015] [Accepted: 01/09/2016] [Indexed: 11/24/2022]
Abstract
Magnetic resonance based diffusion imaging has been gaining more utility and clinical relevance over the past decade. Using conventional echo planar techniques, it is possible to acquire and characterize water diffusion within the central nervous system (CNS); namely in the form of Diffusion Weighted Imaging (DWI) and Diffusion Tensor Imaging (DTI). While each modality provides valuable clinical information in terms of the presence of diffusion and its directionality, both techniques are limited to assuming an ideal Gaussian distribution for water displacement with no intermolecular interactions. This assumption neglects pathological processes that are not Gaussian therefore reducing the amount of potentially clinically relevant information. Additions to the Gaussian distribution measured by the excess kurtosis, or peakedness, of the probabilistic model provide a better understanding of the underlying cellular structure. The objective of this work is to provide mathematical and experimental evidence that Diffusion Kurtosis Imaging (DKI) can offer additional information about the micromolecular environment of the pediatric spinal cord. This is accomplished by a more thorough characterization of the nature of random water displacement within the cord. A novel DKI imaging sequence based on a tilted 2D spatially selective radio frequency pulse providing reduced field of view (FOV) imaging was developed, implemented, and optimized on a 3 Tesla MRI scanner, and tested on pediatric subjects (healthy subjects: 15; patients with spinal cord injury (SCI):5). Software was developed and validated for post processing of the DKI images and estimation of the tensor parameters. The results show statistically significant differences in mean kurtosis (p < 0.01) and radial kurtosis (p < 0.01) between healthy subjects and subjects with SCI. DKI provides incremental and novel information over conventional diffusion acquisitions when coupled with higher order estimation algorithms. Diffusion Kurtosis Imaging (DKI) was performed on pediatric subjects using a tilted 2D RF reduced field of view sequence. Results show statistically significant differences in FA, MK, Krad, and Drad between healthy subjects and patients with SCI. DKI provides additional structural information that when paired with DTI metrics could be used as a novel imaging biomarker.
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Affiliation(s)
- Chris J Conklin
- Electrical Engineering, Temple University, Philadelphia, PA, United States; Radiology, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Devon M Middleton
- Radiology, Temple University, Philadelphia, PA, United States; Bioengineering, Temple University, Philadelphia, PA, United States
| | - Mahdi Alizadeh
- Radiology, Temple University, Philadelphia, PA, United States; Bioengineering, Temple University, Philadelphia, PA, United States
| | - Jürgen Finsterbusch
- Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Scott H Faro
- Radiology, Temple University, Philadelphia, PA, United States; Bioengineering, Temple University, Philadelphia, PA, United States
| | - Pallav Shah
- Radiology, Temple University, Philadelphia, PA, United States
| | - Laura Krisa
- Physical Therapy, Thomas Jefferson University, Philadelphia, PA, United States; Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Rebecca Sinko
- Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Joan Z Delalic
- Electrical Engineering, Temple University, Philadelphia, PA, United States
| | - M J Mulcahey
- Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Feroze B Mohamed
- Bioengineering, Temple University, Philadelphia, PA, United States; Radiology, Thomas Jefferson University, Philadelphia, PA, United States
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