BACKGROUND AND PURPOSE:The purpose of the study is to characterize diffusion tensor imaging indices in the developing spinal cord, evaluating differences based on age and cord region. Describing the progression of DTI indices in the pediatric cord increases our understanding of spinal cord development. MATERIALS AND METHODS:A retrospective analysis was performed on DTI acquired in 121 pediatric patients (mean, 8.6 years; range, 0.3-18.0 years) at Monroe Carell Jr. Children's Hospital at Vanderbilt from 2017 to 2018. Diffusion-weighted images (15 directions; b ϭ 750 s/mm 2 ; slice thickness, 5 mm; in-plane resolution, 1.0 ϫ 1.0 mm 2 ) were acquired on a 3T scanner in the cervicothoracic and/or thoracolumbar cord. Manual whole-cord segmentation was performed. Images were masked and further segmented into cervical, upper thoracic, thoracolumbar, and conus regions. Analyses of covariance were performed for each DTI-derived index to investigate how age affects diffusion across cord regions, and 95% confidence intervals were calculated across age for each derived index and region. Post hoc testing was performed to analyze regional differences. RESULTS:Analyses of covariance revealed significant correlations of age with axial diffusivity, mean diffusivity, and fractional anisotropy (all, P Ͻ .001). There were also significant differences among cord regions for axial diffusivity, radial diffusivity, mean diffusivity, and fractional anisotropy (all, P Ͻ .001). CONCLUSIONS:This research demonstrates that diffusion evolves in the pediatric spinal cord during development, dependent on both cord region and the diffusion index of interest. Future research could investigate how diffusion may be affected by common pediatric spinal pathologies. ABBREVIATIONS: AD ϭ axial diffusivity; ANCOVA ϭ analyses of covariance; DTI ϭ diffusion tensor imaging; EPI ϭ echo planar imaging; FA ϭ fractional anisotropy;FOV ϭ field-of-view; GM ϭ gray matter; MD ϭ mean diffusivity; PMM ϭ population marginal means; RD ϭ radial diffusivity; SNR ϭ signal to noise ratio; WM ϭ white matter
Category: Ankle; Other Introduction/Purpose: As the American healthcare system evolves into a value-based reimbursement model, emphasis on tracking and reporting healthcare outcomes has expounded. Patient reported outcome Measures (PROMs) are exceedingly valuable to orthopedists as a means to measure improvement and satisfy regulatory requirements. The NIH Patient-Reported Outcomes Measurement Information System (PROMIS) surveys are favored due to their accessibility, efficiency, and minimal floor and ceiling effects. Furthermore, they have been shown to predict outcomes after orthopedic surgeries. Psychosocial factors have also become increasingly important in predicting surgical outcomes. We aim to report the development and implementation of an institutional PRO data collection platform, including PRO completion rates and improvements in PROs for patients undergoing orthopaedic surgery. Methods: We implemented a secure, HIPAA compliant, automated and EHR integrated, institutional platform to collect PROMs using a cloud-based tool. Patients undergoing surgery by sports medicine and foot and ankle surgeons were included and organized into four surgical pathways: (1) foot and ankle, (2) sports-knee, (3) sports-hip, and (4) sports-shoulder. PROMIS Physical Function (PF), PROMIS Pain interference (PI), site-specific (foot and ankle, knee, hip, and shoulder) Single Assessment Numeric Evaluation (SANE), and the brief resiliency scale (BRS) were collected at the patient's pre-operative visit. The PROMIS and SANE surveys were again collected at 3-, 6-, and 12-month post-operative visits. Surveys were disseminated automatically and patients were able to complete PROMs onsite on secure tablets or remotely through their personal device. Primary outcomes included compliance rates, baseline PRO scores, and change in scores at the various post-operative timepoints for patients in the four surgical pathways. Results: More than 6,000 patients were included, with majority of patients from the sports-knee (47%), followed by sports- shoulder (27%), foot and ankle (23%), and sports-hip (4%) pathways. Average completion rate was highest at the pre-operative timepoint for all pathways (81%), with completion rates of 62% at 50% at 6 months and 45% at 12MO. Compliance rates were lowest highest in the foot and ankle pathway at 12 months (62%). Average baseline scores for all patients were 40.8 for PROMIS PF, 61.1 PROMIS PI, 41 SANE, and 3.9 for BRS. Baseline scores didn't significantly vary between the surgical pathways. Scores improved for all patient pathways at all timepoints for PROMIS PF, PI and SANE PROMs (Table 1). No workflow disruptions were noted for survey administration. Conclusion: Tracking PROs using an automated platform is feasible in orthopaedic clinics. Compliance rates are very good and dependent on provider, staff, and patient buy-in. Patients undergoing surgery had an average baseline PROMIS PI scores >=1 standard deviation from the normal population and all scores improved after surgery. Importantly, statistical significance doesn't always reflect minimum clinically important differences (MCIDs). MCIDs for PROMIS PF and PI have been reported to fall between 5-10 points depending on range of values and methods of calculation. Further investigation into outcomes by procedure type and patient factors is warranted to identify predictive factors of surgical outcomes.
Central vein sign is believed to be a specific marker for the diagnosis of multiple sclerosis (MS) but has not yet been reported in the spine. This work used SWI in the cervical spinal cord of MS patients and healthy controls at 7T to look for evidence of central veins. SWI hypointensities were observed frequently around the cord periphery, between the white and grey matter within the cord, and along nerve roots. Hypointensities were also observed within spinal cord lesions, providing candidate evidence of central veins in lesions of the spinal cord.
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