Spinal cord diffusion tensor imaging in patients with sensory neuronopathy
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We investigated whether MR diffusion tensor imaging (DTI) analysis of the cervical spinal cord could aid the (differential) diagnosis of sensory neuronopathies, an underdiagnosed group of diseases of the peripheral nervous system.
We obtained spinal cord DTI and T2WI at 3 T from 28 patients, 14 diabetic subjects with sensory-motor distal polyneuropathy, and 20 healthy controls. We quantified DTI-based parameters and looked at the hyperintense T2W signal at the spinal cord posterior columns. Fractional anisotropy and mean diffusivity values at C2–C3 and C3–C4 levels were compared between groups. We also compared average fractional anisotropy (mean of values at C2–C3 and C3–C4 levels). A receiver operating characteristic (ROC) curve was used to determine diagnostic accuracy of average fractional anisotropy, and we compared its sensitivity against the hyperintense signal in segregating patients from the other subjects.
Mean age and disease duration were 52 ± 10 and 11.4 ± 9.3 years in the patient group. Eighteen subjects had idiopathic disease and 6 dysimmune etiology. Fractional anisotropy at C3–C4 level and average fractional anisotropy were significantly different between patients and healthy controls (p < 0.001 and <0.001) and between patients and diabetic subjects (p = 0.019 and 0.027). Average fractional anisotropy presented an area under the curve of 0.838. Moreover, it had higher sensitivity than visual detection of the hyperintense signal (0.86 vs. 0.54), particularly for patients with short disease duration.
DTI-based analysis enables in vivo detection of posterior column damage in sensory neuronopathy patients and is a useful diagnostic test for this condition. It also helps the differential diagnosis between sensory neuronopathy and distal polyneuropathies.
KeywordsDiffusion tensor imaging (DTI) Sensory neuronopathy MRI Spinal cord Peripheral neuronopathy
We thank Brunno Machado de Campos, Benílton de Sá Carvalho and biomedical technicians for their help in MRI discussions, statistical analysis and data acquisition, respectively. We thank FAPESP (Sao Paulo Research Foundation - Grants 2013/01766-7, 2013/07559-3 – Brazilian governmental agency) for financial support.
Compliance with ethical standards
We declare that all human studies have been approved by the research ethics committee of the School of Medical Sciences - UNICAMP and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.
Conflict of interest
We declare that we have no conflict of interest.
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