Segmented quantitative diffusion tensor imaging evaluation of acute traumatic cervical spinal cord injury

Br J Radiol, 2020 · DOI: 10.1259/bjr.20201000 · Published: November 10, 2020

Spinal Cord Injury Trauma Medical Imaging

Simple Explanation

Diffusion tensor imaging (DTI) is a technique that provides micro-structural evaluation not afforded by conventional MRI techniques. DTI provides various quantitative metrics including mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD), and fractional anisotropy (FA). This technique has been applied to spinal cord disease and has shown the ability to detect spinal cord abnormalities in demyelinating disease, spinal cord injury, HIV myelopathy, spondylotic myelopathy, and various inflammatory and vascular myelopathies. In the setting of traumatic cervical spinal cord injury (CSCI), DTI has shown the ability to detect abnormalities in regions of normal appearing spinal cord, detect abnormalities in asymptomatic spinal cord compression, significantly correlate with degree of injury better than conventional MRI.

Study Duration

5/2016 and 3/2017

Participants

15 patients with acute CSCI and 12 control subjects

Evidence Level

Not specified

Key Findings

1
There were significant differences in FA between the level of injury and controls for total white matter (0.65 ± .09 vs 0.68 ± .07; p = .044), motor tracts (0.64 ± .07 vs 0.7 ± .09; p = .006), and combined motor/sensory tracts (0.63 ± .09 vs 0.69 ± .08; p = .022).
2
In addition, there were significant FA differences between the level of injury and one level caudal to the injury for combined motor tracts (0.64 ± .07 vs 0.69 ± .05; p = .002) and combined motor/sensory tracts (0.63 ± .09 vs 0.7 ± .07; p = .011).
3
There were no significant differences for MD between the level of injury and one level caudal to the injury or normal controls.

Research Summary

Abnormalities in DTI metrics of DTI-segmented white matter tracts were detected at the neurological level of injury relative to normal controls and levels remote from the injury site, confirming its value in CSCI assessment. Segmented DTI analysis can help identify microstructural spinal cord abnormalities in the setting of traumatic cervical spinal cord injury. We found significant differences in DTI metrics (FA) between CSCI patients at the level of clinical injury and normal control patients for total white matter (p = .044), motor tracts (lateral and ventral corticospinal tracts; p = .006), and combined sensory and motor tracts (spinal lemniscal tracts and corticospinal tracts; p = .022).

Practical Implications

Improved Diagnosis

Segmented DTI analysis can help identify microstructural spinal cord abnormalities in the setting of traumatic CSCI, potentially improving diagnostic accuracy.

Treatment Stratification

Quantitative DTI metrics could be used as biomarkers to stratify patients in randomized control trials, accelerating treatment development.

Prognostic Value

DTI biomarkers could help identify patients likely to respond to therapy, allowing for tailored treatment approaches.

Study Limitations

1
The number of CSCI subjects included is relatively small
2
This is a single center study at a level I trauma center, which may bias the types of injuries evaluated.
3
The current study also excluded symptomatic spine trauma patients with normal conventional MRI.

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