Characterization of spinal cord diffusion tensor imaging metrics in clinically asymptomatic pediatric subjects with incidental congenital lesions

Saksena, Sona; Alizadeh, Mahdi; Middleton, Devon M.; Conklin, Chris J.; Krisa, Laura; Flanders, Adam E.; Mulcahey, M J; Mohamed, Feroze B.; Faro, Scott H.

doi:10.1038/s41394-018-0073-8

Cited by 6 publications

(13 citation statements)

References 18 publications

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“…MD, AD and RD values are higher while FA values are lower compared to equivalent measures on older cohorts of patients (i.e. children/ adolescents, (Alizadeh et al, 2018b; Mulcahey et al, 2013; Saksena et al, 2018a, 2016)). This trend is in line with the simultaneous age-related decrease in MD, AD and RD and increase in FA metrics reflecting progressive maturation, myelination and fiber packing and thickening within the SC, similar to that observed in the brain (Pierpaoli et al, 1996; Pierpaoli and Basser, 1996).…”

Section: Resultsmentioning

confidence: 79%

“…MD, AD and RD values are higher while FA values are lower compared to equivalent measures on older cohorts of patients (i.e. children/ adolescents, (22,23,25,26)). This may be partially due to sensitivity of FA to denoising, which can imply a reduction in this metric.…”

Section: Trend Of Diffusion Measuresmentioning

confidence: 75%

“…If extension of DTI to the pediatric SC has shown promising results in a wide range of clinical conditions, as evidenced by the increasing number of works on the topic (Alizadeh et al, 2018b(Alizadeh et al, , 2018aAntherieu et al, 2019;Mohamed et al, 2011;Mulcahey et al, 2013;Reynolds et al, 2019;Saksena et al, 2018aSaksena et al, , 2018bSaksena et al, , 2016Singhi et al, 2012), what immediately stands out while reviewing literature on pediatric SC is the absence of studies concerning DKI and particularly applied to the neonatal period (0-1 month).…”

Section: Introductionmentioning

confidence: 99%

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Diffusion Kurtosis Imaging of neonatal Spinal Cord in clinical routine

Trò

Roascio

Tortora

et al. 2021

Preprint

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Diffusion Kurtosis Imaging (DKI) has undisputed advantages over more classical diffusion Magnetic Resonance Imaging (dMRI), as witnessed by a fast-increasing number of clinical applications and software packages widely adopted in brain imaging domain. Despite its power in probing tissue microstructure compared to conventional MRI, DKI is still largely underutilized in Spinal Cord (SC) imaging because of its inherently demanding technological requirements. If state-of-the-art hardware advancements have recently allowed to make great strides in applying this emerging method to adult and child SC, the same does not apply to neonatal setting. Indeed, amplified technical issues related to SC district in this age range have made this field still unexplored. However, results arising from recent application of DKI to adult and child SC are promising enough to suggest how informative this technique would be in investigating newborns, too. Due to its extreme sensitivity to non-gaussian diffusion, DKI proves particularly suitable for detecting complex, subtle, fast microstructural changes occurring in this area at this early and critical stage of development, and not identifiable with only DTI. Given the multiplicity of congenital anomalies of the spinal canal, their crucial effect on later developmental outcome, and the close interconnection between SC region and the above brain, managing to apply such a method to neonatal cohort becomes of utmost importance. In this work, we illustrate the first semi-automated pipeline for handling with DKI data of neonatal SC, from acquisition setting to estimation of diffusion (DTI & DKI) measures, through accurate adjustment of processing algorithms customized for adult SC. Each processing step of this pipeline, built on Spinal Cord Toolbox (SCT) software, has undergone Quality Control check by supervision of an expert pediatric neuroradiologist, and the overall procedure has preliminarily been tested in a pilot clinical case study. Results of this application agree with findings achieved in a corresponding adult survey, thus confirming validity of adopted pipeline and diagnostic value of DKI in pediatrics. This novel tool hence paves the wave for extending its application also to other promising advanced dMRI models, such as Neurite Orientation Dispersion and Density Imaging (NODDI), and to a wider range of potential clinical applications concerning neonatal period.

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Section: Resultsmentioning

confidence: 79%

Section: Trend Of Diffusion Measuresmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Diffusion Kurtosis Imaging of neonatal Spinal Cord in clinical routine

Trò

Roascio

Tortora

et al. 2021

Preprint

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“…Using DTI techniques in the spinal cord is crucial for discerning specific fibre tracts. This application could provide a particular assessment for identifying damage of spinal tracts as well as a better understanding of how tissue damage causes clinical deficits and why clinical symptoms can be present prior to neuro-radiological imaging 6,8,13 . In clinical practice, syringomyelia does not need to be treated for patients with no neurological symptoms or signs, even if the syringomyelia is very large.…”

Section: Discussionmentioning

confidence: 99%

“…However, following repair of the spinal cord injury, even if a spinal cavity appeared, the FA values increased notably; additionally, there was no obvious change in the ADC values. Saksena et al 13 performed spinal DTI scans in four patients with cavities and found that FA values at the level of the cavity were considerably lower compared to normal controls; however, the ADC values were higher. Moreover, the authors found that the DTI parameters of the spinal cord above or below the cavity level were not significantly different from the normal population.…”

Section: Discussionmentioning

confidence: 99%

Specific microstructural changes of the cervical spinal cord in syringomyelia estimated by diffusion tensor imaging

Li²,

Zong

et al. 2021

Sci Rep

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The microstructure of the spinal cord in syringomyelia has not been well studied. The aim of this study was to evaluate the microstructure of the cervical cord in patients with syringomyelia using diffusion tensor imaging (DTI) and to investigate the association between DTI parameters and the size of the syrinx cavity. Thirty patients with syringomyelia and 11 age-matched controls were included in this study. DTI and T1/T2-weighted MRI were used to estimate spinal microstructure. The patients were divided into a clinical symptom group (group A) and a non-clinical symptom group (group B) according to ASIA assessments. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values (mm2/s) were measured and compared between patients and controls. Correlation between FA/ADC and the size of the syrinx cavity was examined with a bivariate analysis. FA values were lower (P < 0.000) and ADC values were higher (P < 0.000) compared to the controls at the level of all syrinxes examined in patients with syringomyelia; both FA values and ADC values reached normal values either above or below the syrinx levels (all P > 0.05). FA values and ADC values at all cervical levels were not significantly different either in controls or outside of the syrinx (all P > 0.05). FA values of group A was significantly lower than those of group B (P < 0.000). There was a negative association between FA values and the size of syrinx cavity, and a positive association between ADC values and the size of syrinx cavity (FA: P < 0.05, ADC: P < 0.05). The microstructure of the cervical spinal cord is different across all patients with syringomyelia. DTI is a promising tool for estimating quantitative pathological characteristics that are not visible with general MRI.

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DTI of chronic spinal cord injury in children without MRI abnormalities (SCIWOMR) and with pathology on MRI and comparison to severity of motor impairment

et al. 2022

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Characterization of spinal cord diffusion tensor imaging metrics in clinically asymptomatic pediatric subjects with incidental congenital lesions

Abstract: This study demonstrates that DTI has the potential to be used as an imaging biomarker to evaluate SC above and below the congenital lesion in syringohydromyelia subjects.

Cited by 6 publications

References 18 publications

Diffusion Kurtosis Imaging of neonatal Spinal Cord in clinical routine

Diffusion Kurtosis Imaging of neonatal Spinal Cord in clinical routine

Specific microstructural changes of the cervical spinal cord in syringomyelia estimated by diffusion tensor imaging

DTI of chronic spinal cord injury in children without MRI abnormalities (SCIWOMR) and with pathology on MRI and comparison to severity of motor impairment

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