Abstract
Purpose
Diffusion tensor imaging (DTI) in flexion-extension may serve as a diagnostic tool to improve the sensitivity for detection of myelopathy. In this study, the feasibility and reproducibility of dynamic DTI in the cervical spinal cord was assessed in healthy volunteers and patients.
Methods
All subjects were examined in maximum neck flexion-extension in a 3T magnetic resonance imaging (MRI) scanner. Range of motion, space available for the spinal cord, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured and compared between the neck positions.
Results
Volunteers showed no variation in ADC and FA. In patients, extension produced higher ADC in the diseased than in the control segments (p = 0.0045). The ADC of the affected segments was higher in extension than in the neutral position (p = 0.0030) or in flexion (p = 0.0002). The FA was significantly lower in extension in patients at both the control level C2/3 (p = 0.0154) and the affected segment (p = 0.0187).
Conclusions
Dynamic DTI of the cervical spine is feasible and ADC increased in the patient group in extension. This finding may open a previously unexplored avenue to attempt an earlier identification of myelopathy.
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References
Demir A, Ries M, Moonen CT, Vital JM, Dehais J, Arne P, Caillé JM, Dousset V. Diffusion-weighted MR imaging with apparent diffusion coefficient and apparent diffusion tensor maps in cervical spondylotic myelopathy. Radiology. 2003;229:37–43.
Bartlett RJ, Hill CA, Rigby AS, Chandrasekaran S, Narayanamurthy H. MRI of the cervical spine with neck extension: is it useful? Br J Radiol. 2012;85:1044–51.
Zhang L, Zeitoun D, Rangel A, Lazennec JY, Catonné Y, Pascal-Moussellard H. Preoperative evaluation of the cervical spondylotic myelopathy with flexion-extension magnetic resonance imaging: about a prospective study of fifty patients. Spine (Phila Pa 1976). 2011;36:E1134–9.
Benzel EC, Lancon J, Kesterson L, Hadden T. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord. 1991;4:286–95.
Tullos H, Dale B, Bidwell G, Perkins E, Raucher D, Khan M, James J. Multi-shot RESOLVE compared to single-shot EPI diffusion-weighted MR imaging acquisition scheme. Med Phys. 2012;39:3640.
Basser PJ, Pajevic S, Pierpaoli C, Duda J, Aldroubi A. A in vivo fiber tractography using DT-MRI data. Magn Reson Med. 2000;44:625–32.
Jinkins JR, Dworkin JS, Damadian RV. Upright, weight-bearing, dynamic-kinetic MRI of the spine: initial results. Eur Radiol. 2005;15:1815–25.
Hagmann P, Jonasson L, Maeder P, Thiran JP, Wedeen VJ, Meuli R. Understanding diffusion MR imaging techniques: from scalar diffusion-weighted imaging to diffusion tensor imaging and beyond. Radiographics. 2006;26(Suppl 1):S205–23.
Basser PJ, Mattiello J, LeBihan D. MR diffusion tensor spectroscopy and imaging. Biophys J. 1994;66:259–67.
Endo T, Suzuki S, Inoue T, Utsunomiya A, Uenohara H, Tominaga T. Prediction of neurological recovery in spontaneous spinal epidural hematoma using apparent diffusion coefficient values. Spinal Cord. 2014;52:729–33.
Uda T, Takami T, Tsuyuguchi N, Sakamoto S, Yamagata T, Ikeda H, Nagata T, Ohata K. Assessment of cervical spondylotic myelopathy using diffusion tensor magnetic resonance imaging parameter at 3.0 tesla. Spine (Phila Pa 1976). 2013;38:407–14.
Rindler RS, Chokshi FH, Malcolm JG, Eshraghi SR, Mossa-Basha M, Chu JK, Kurpad SN, Ahmad FU. Spinal diffusion tensor imaging in evaluation of preoperative and postoperative severity of cervical spondylotic myelopathy: systematic review of literature. World Neurosurg. 2017;99:150–8.
Qian W, Chan Q, Mak H, Zhang Z, Anthony MP, Yau KK, Khong PL, Chan KH, Kim M. Quantitative assessment of the cervical spinal cord damage in neuromyelitis optica using diffusion tensor imaging at 3 Tesla. J Magn Reson Imaging. 2011;33:1312–20.
Ellingson BM, Kurpad SN, Schmit BD. Functional correlates of diffusion tensor imaging in spinal cord injury. Biomed Sci Instrum. 2008;44:28–33.
Kerkovský M, Bednarík J, Dušek L, Sprláková-Puková A, Urbánek I, Mechl M, Válek V, Kadanka Z. Magnetic resonance diffusion tensor imaging in patients with cervical spondylotic spinal cord compression: correlations between clinical and electrophysiological findings. Spine (Phila Pa 1976). 2012;37:48–56.
Budzik JF, Balbi V, Le Thuc V, Duhamel A, Assaker R, Cotten A. Diffusion tensor imaging and fibre tracking in cervical spondylotic myelopathy. Eur Radiol. 2011;21:426–33.
Chang Y, Jung TD, Yoo DS, Hyun JK. Diffusion tensor imaging and fiber tractography of patients with cervical spinal cord injury. J Neurotrauma. 2010;27:2033–40.
Wang K, Chen Z, Zhang F, Song Q, Hou C, Tang Y, Wang J, Chen S, Bian Y, Hao Q, Shen H. Evaluation of DTI parameter ratios and diffusion tensor tractography grading in the diagnosis and prognosis prediction of cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2017;42:E202–10.
Taylor M, Hipp JA, Gertzbein SD, Gopinath S, Reitman CA. Observer agreement in assessing flexion-extension X‑rays of the cervical spine, with and without the use of quantitative measurements of intervertebral motion. Spine J. 2007;7:654–8.
Ishida Y, Suzuki K, Ohmori K. Dynamics of the spinal cord: an analysis of functional myelography by CT scan. Neuroradiology. 1988;30:538–44.
Xu N, Wang S, Yuan H, Liu X, Liu Z. Does dynamic supine magnetic resonance imaging improve the diagnostic accuracy of cervical spondylotic myelopathy? A review of the current evidence. World Neurosurg. 2017;100:474–9.
Shanmuganathan K, Gullapalli RP, Zhuo J, Mirvis SE. Diffusion tensor MR imaging in cervical spine trauma. AJNR Am J Neuroradiol. 2008;29:655–9.
Agosta F, Absinta M, Sormani MP, Ghezzi A, Bertolotto A, Montanari E, Comi G, Filippi M. In vivo assessment of cervical cord damage in MS patients: a longitudinal diffusion tensor MRI study. Brain. 2007;130:2211–9.
Ducreux D, Lepeintre JF, Fillard P, Loureiro C, Tadié M, Lasjaunias P. MR diffusion tensor imaging and fiber tracking in 5 spinal cord astrocytomas. AJNR Am J Neuroradiol. 2006;27:214–6.
Stroman PW, Wheeler-Kingshott C, Bacon M, Schwab JM, Bosma R, Brooks J, Cadotte D, Carlstedt T, Ciccarelli O, Cohen-Adad J, Curt A, Evangelou N, Fehlings MG, Filippi M, Kelley BJ, Kollias S, Mackay A, Porro CA, Smith S, Strittmatter SM, Summers P, Tracey I. The current state-of-the-art of spinal cord imaging: methods. Neuroimage. 2014;84:1070–81.
Kharbanda HS, Alsop DC, Anderson AW, Filardo G, Hackney DB. Effects of cord motion on diffusion imaging of the spinal cord. Magn Reson Med. 2006;56:334–9.
Shen H, Tang Y, Huang L, Yang R, Wu Y, Wang P, Shi Y, He X, Liu H, Ye J. Applications of diffusion-weighted MRI in thoracic spinal cord injury without radiographic abnormality. Int Orthop. 2007;31:375–83.
Thurnher MM, Bammer R. Diffusion-weighted MR imaging (DWI) in spinal cord ischemia. Neuroradiology. 2006;48:795–801.
Cohen-Adad J, El Mendili MM, Lehéricy S, Pradat PF, Blancho S, Rossignol S, Benali H. Demyelination and degeneration in the injured human spinal cord detected with diffusion and magnetization transfer MRI. Neuroimage. 2011;55:1024–33.
Ellingson BM, Ulmer JL, Kurpad SN, Schmit BD. Diffusion tensor MR imaging in chronic spinal cord injury. AJNR Am J Neuroradiol. 2008;29:1976–82.
Kim JH, Loy DN, Liang HF, Trinkaus K, Schmidt RE, Song SK. Noninvasive diffusion tensor imaging of evolving white matter pathology in a mouse model of acute spinal cord injury. Magn Reson Med. 2007;58:253–60.
Smith SA, Jones CK, Gifford A, Belegu V, Chodkowski B, Farrell JA, Landman BA, Reich DS, Calabresi PA, McDonald JW, van Zijl PC. Reproducibility of tract-specific magnetization transfer and diffusion tensor imaging in the cervical spinal cord at 3 tesla. NMR Biomed. 2010;23:207–17.
Wilm BJ, Gamper U, Henning A, Pruessmann KP, Kollias SS, Boesiger P. Diffusion-weighted imaging of the entire spinal cord. NMR Biomed. 2009;22:174–81.
Clark CA, Barker GJ, Tofts PS. Improved reduction of motion artifacts in diffusion imaging using navigator echoes and velocity compensation. J Magn Reson. 2000;142:358–63.
Nunes RG, Jezzard P, Behrens TE, Clare S. Self-navigated multishot echo-planar pulse sequence for high-resolution diffusion-weighted imaging. Magn Reson Med. 2005;53:1474–8.
Heidemann RM, Ozsarlak O, Parizel PM, Michiels J, Kiefer B, Jellus V, Müller M, Breuer F, Blaimer M, Griswold MA, Jakob PM. A brief review of parallel magnetic resonance imaging. Eur Radiol. 2003;13:2323–37.
Jones DK, Williams SC, Gasston D, Horsfield MA, Simmons A, Howard R. Isotropic resolution diffusion tensor imaging with whole brain acquisition in a clinically acceptable time. Hum Brain Mapp. 2002;15:216–30.
Jones DK. The effect of gradient sampling schemes on measures derived from diffusion tensor MRI: a Monte Carlo study. Magn Reson Med. 2004;51:807–15.
Agosta F, Benedetti B, Rocca MA, Valsasina P, Rovaris M, Comi G, Filippi M. Quantification of cervical cord pathology in primary progressive MS using diffusion tensor MRI. Neurology. 2005;64:631–5.
Elshafiey I, Bilgen M, He R, Narayana PA. In vivo diffusion tensor imaging of rat spinal cord at 7 T. Magn Reson Imaging. 2002;20:243–7.
Petersen JA, Wilm BJ, von Meyenburg J, Schubert M, Seifert B, Najafi Y, Dietz V, Kollias S. Chronic cervical spinal cord injury: DTI correlates with clinical and electrophysiological measures. J Neurotrauma. 2012;29:1556–66.
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B. Schatlo, L. Remonda, P. Gruber, J. Fandino, V. Rohde, A.-R Fathi and J Berberat declare that they have no competing interests.
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Schatlo, B., Remonda, L., Gruber, P. et al. Cervical Spine Prospective Feasibility Study. Clin Neuroradiol 29, 523–532 (2019). https://doi.org/10.1007/s00062-018-0686-0
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DOI: https://doi.org/10.1007/s00062-018-0686-0