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Assessment of acute traumatic cervical spinal cord injury using conventional magnetic resonance imaging in combination with diffusion tensor imaging–tractography: a retrospective comparative study

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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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Funding

This study was supported by National Natural Science Foundation of China (81873999, 81672158).

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Author notes

  1. Fengzhao Zhu, Yulong Wang and Xiangchuang Kong have contributed equally.

Authors and Affiliations

  1. Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China

    Fengzhao Zhu, Lian Zeng, Xirui Jing, Sheng Yao, Kaifang Chen & Xiaodong Guo

  2. Department of Orthopaedics, Xinqiao Hospital, Army Military University, Chongqing, China

    Fengzhao Zhu

  3. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China

    Xiangchuang Kong, Yuan Liu & Lian Yang

  4. Department of Orthopedics, Wuhan No. 1 Hospital, Wuhan Integrated TCM & Western Medicine Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Yulong Wang

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  1. Fengzhao Zhu
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Correspondence to Xiaodong Guo.

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Zhu, F., Wang, Y., Kong, X. et al. Assessment of acute traumatic cervical spinal cord injury using conventional magnetic resonance imaging in combination with diffusion tensor imaging–tractography: a retrospective comparative study. Eur Spine J 31, 1700–1709 (2022). https://doi.org/10.1007/s00586-022-07207-w

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  • DOI: https://doi.org/10.1007/s00586-022-07207-w

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