Name: diffusion tensor magnetic resonance imaging in chronic spinal cord compression
Uploaded: 2019-05-07T13:00:00
Description: Watch this Scientific Journal Video about Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression at JoVE.com

This study was supported by Guangzhou Science and Technology Project of China (No. 201607010021) and the Nature Science Foundation of JiangXi (No. 20142BAB205065)

The study was approved by the local Medical Ethics Committee in Guangzhou First People&#8217;s Hospital in China. Signed informed consent forms were received from healthy volunteers and participants prior to participation. All of the studies were conducted in accordance with the World Medical Association Declaration of Helsinki.
1. Subject Preparation
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	<li>Ensure that each participant meets the following criteria for chronic spinal cord compression: a) a history of loss of significant n...

<ol>
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Conventional MRI is usually utilized to assess the prognosis of patients with various spine conditions. However, this imaging modality provides macroscopic anatomic detail rather than microstructure evaluation14, which limits the prediction of neurological function. Furthermore, traditional MRI may underestimate the severity and extent of spinal cord damage. The emergence of DTI can help surgeons to evaluate spinal cord function more accurately by providing quantitative information on water molecu...

Chronic spinal cord compression is the most common cause of spinal cord impairment1. This condition can be due to posterior longitudinal ligament ossification, hematoma, cervical disc herniation, vertebral degeneration, or intraspinal tumors2,3. Chronic spinal cord compression can lead to various degrees of functional deficits; however, there are clinical cases with serious spinal cord compression without any neurological symptoms and signs, as well as patients with mild spinal cord compression but serious neurological deficits4. Under these circumstances, sensitive imaging is essential to evaluate compression severity and identify the range of damage.
Conventional MRI plays a significant role in elucidating spinal cord anatomy. This technique is usually utilized to evaluate the compression degree because of its sensitivity to soft tissues5. Many parameters can be measured from MRI, such as MR signal intensity, cord morphology, and spinal canal area. However, MRI has some limitations and only provides qualitative information rather than quantitative results6. Patients with chronic spinal cord compression often have abnormal signal changes of MRI intensity. However, discrepancies between clinical symptoms and MRI intensity changes make it hard to diagnose a functional condition based solely on MRI characteristics7. Previous studies highlight this controversy in terms of the prognostic value of MRI T2 hyperintensity in the spinal cord8. Two groups reported that T2 hyperintensity of the spinal cord is a poor prognostic parameter after surgery for chronic spinal cord compression8,9. In contrast, some authors found no significant association between T2 signal changes and prognosis8,9. Chen et al. and Vedantam et al. divided MRI T2 hyperintensities into two categories corresponding to different prognostic outcomes10,11. Type 1 showed faint, fuzzy, indistinct borders, and this category demonstrated reversible histologic changes. Type 2 images presented intense, well-defined borders, which corresponded to irreversible pathologic damage. Conventional T1/T2 MRI techniques do not provide adequate information to identify these two categories and evaluate patient prognosis. By contrast, DTI, a more sophisticated imaging technique, may help obtain more specific prognostic information by quantitatively detecting microstructural changes in tissues via water molecule diffusion.
In recent years, DTI has garnered increasing attention due to its ability to describe spinal cord microarchitecture. DTI can measure the direction and magnitude of water molecule diffusion in tissues. DTI parameters can quantitatively evaluate neural damage in patients with chronic spinal cord compression. FA and the ADC are the most commonly applied parameters during spinal cord evaluation. The FA value reveals the degree of anisotropy to orientate surrounding axonal fibers and describe anatomic boundaries12,13. The ADC value provides information on the characteristics of molecular motion in many directions in a three-dimensional space and reveals the mean of diffusivities along the three principal axes6,12. Changes in these parameters are associated with microstructural alterations that influence water molecule diffusion. Therefore, surgeons can utilize/measure DTI parameters to identify spinal cord pathology. The present study provides DTI methods and processes that provide more detailed prognostic information to treat patients with chronic spinal cord compression.

<table border="0" cellpadding="0" cellspacing="0" style="width:849px;" width="849">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">3-Tesla MRI scanner</td>
			<td style="width:123px;">Siemens</td>
			<td align="right" style="width:344px;">40708</td>
			<td style="width:167px;">Software: NUMARIS/4</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Syngo MR B17</td>
			<td>Siemens</td>
			<td align="right">40708</td>
			<td>Software: NUMARIS/4</td>
		</tr>
	</tbody>
</table>

diffusion tensor magnetic resonance imaging in chronic spinal cord compression

Chronic spinal cord compression is the most common cause of spinal cord impairment in patients with nontraumatic spinal cord damage. Conventional magnetic resonance imaging (MRI) plays an important role in both confirming the diagnosis and evaluating the degree of compression. However, the anatomical detail provided by conventional MRI is not sufficient to accurately estimate neuronal damage and/or assess the possibility of neuronal recovery in chronic spinal cord compression patients. In contrast, diffusion tensor imaging (DTI) can provide quantitative results according to the detection of water molecule diffusion in tissues. In the present study, we develop a methodological framework to illustrate the application of DTI in chronic spinal cord compression disease. DTI fractional anisotropy (FA), apparent diffusion coefficients (ADCs), and eigenvector values are useful for visualizing microstructural pathological changes in the spinal cord. Decreased FA and increases in ADCs and eigenvector values were observed in chronic spinal cord compression patients compared to healthy controls. DTI could help surgeons understand spinal cord injury severity and provide important information regarding prognosis and neural functional recovery. In conclusion, this protocol provides a sensitive, detailed, and noninvasive tool to evaluate spinal cord compression.

This is a summary of results obtained from healthy volunteers and patients with cervical spondylotic myelopathy. The protocol enabled the physician to view DTI maps. This technology could serve as an objective measure to measure functional status in myelopathic conditions. DTI maps of healthy volunteers are shown in Figure 3. The DTI parameters of healthy volunteers were as follows: FA = 0.661; ADC = 1.006 x 10-3 mm2/s; E1 = 1.893 x 10-3 mm2/s; E2 ...

Watch this Scientific Journal Video about Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression at JoVE.com

Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression

Here, we present a protocol for the application of diffusion tensor imaging parameters to evaluate spinal cord compression.

Chronic spinal cord compression is the most common cause of spinal cord impairment in patients with nontraumatic spinal cord damage. Conventional magnetic ...

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