Chronic Cervical Spinal Cord Injury: DTI Correlates with Clinical and Electrophysiological Measures

Petersen, Jens A.; Wilm, Bertram J.; Meyenburg, Jan von; Schubert, Martin; Seifert, Burkhardt; Najafi, Yousef; Dietz, Volker; Kollias, Spyridon

doi:10.1089/neu.2011.2027

Cited by 113 publications

(108 citation statements)

References 47 publications

(40 reference statements)

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“…Few reports about the diffusion properties of the spinal cord in the chronic state of the injury have been published in the literature. [11][12][13] In those studies, DTI has been shown to estimate the total lesion load in the spinal cord better than conventional MRI. FA values have been proven to diminish in areas of the intact upper spinal cord after injury.…”

Section: Discussionmentioning

confidence: 99%

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Clinical correlates of cerebral diffusion tensor imaging findings in chronic traumatic spinal cord injury

et al. 2014

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Study design: Prospective clinical case-control study. Objectives: The aim of this study was to use diffusion tensor imaging (DTI) to assess the state of cerebral white matter tracts after spinal cord injury (SCI). The DTI metrics were evaluated in relation to neurological deficits and to the size and level of the spinal cord lesions. Setting: Tampere University Hospital, Tampere, Finland. Methods: Thirty-four patients (n ¼ 34) with clinically complete and incomplete SCI were evaluated using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). DTI metrics (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) were calculated for multiple levels along the course of the corticospinal tract. The state of the spinal cord after injury was assessed using conventional magnetic resonance imaging (MRI). DTI parameters were compared with 40 orthopedically injured control subjects. Results: Statistically significant differences in the DTI values between patients and controls were detected in the posterior area of the centrum semiovale. In this area, the FA values were lower in the patients compared with controls (P ¼ 0.008). For patients with clinically complete injury, the difference was even more significant (P ¼ 0.0005). Motor and sensory scores of the ISNCSCI correlated positively with FA and negatively with ADC values of the centrum semiovale. A moderate association was observed between the macroscopic changes in the spinal cord and the DTI abnormalities in the centrum semiovale. Conclusion: In patients with chronic SCI, DTI changes can be observed in the cerebral white matter. These alterations are associated with the clinical state of the patients.

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Section: Discussionmentioning

confidence: 99%

“…These results suggest secondary degeneration of the white matter tracts in the spinal cord. [11][12][13] Previously, abnormalities in DTI values of the cerebral corticospinal tract after SCI have also been reported. However, these studies consisted of relatively small samples and primarily included subjects with complete SCI.…”

Section: Introductionmentioning

confidence: 98%

Clinical correlates of cerebral diffusion tensor imaging findings in chronic traumatic spinal cord injury

et al. 2014

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“…For example, lower DTI parameters correlated with the clinical completeness of SCI and with SSEP amplitudes. 12 ASIA motor scores were correlated with DTI parameters in nonhemorrhagic SCI patients. 11 Although abnormal cervical levels detected on routine MRI did not correlate with clinical findings and DTI parameters, FAs on DTI correlated with motor function, as did the numbers of imaginary crossing fibers and the rates of connection of fiber tracks in patients with cervical SCI.…”

Section: Evoked Potentialsmentioning

confidence: 99%

“…Additional studies with more patients are needed to establish these correlations. Although previous studies 11,12,23 included patients with metal implants, the MRI signals around the implants might be altered, leading to image deterioration. Such deterioration is more severe in patients with posterior versus anterior implant fixation.…”

Section: Evoked Potentialsmentioning

confidence: 99%

“…11,12 Moreover, to the best of our knowledge, no study has examined the correlations of DTI parameters and peak CSF velocities with clinical findings in these patients. Therefore, this study characterized the diffusion properties across the spinal cord and CSF velocities in the stenotic cervical spinal canal of SCI patients, to compare these findings with those in normal subjects, and to determine the correlations between DTI results and clinical parameters, including neurological and electrophysiological findings.…”

Section: Introductionmentioning

confidence: 99%

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Correlation of diffusion tensor imaging and phase-contrast MR with clinical parameters of cervical spinal cord injuries

Chang

et al. 2015

Spinal Cord

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Study design: This is a cross-sectional study. Objectives: The goal of this study was to characterize the diffusion properties across segments of the spinal cord and peak cerebrospinal fluid (CSF) velocities in the stenotic spinal canal, and to determine the correlation between these properties and clinical and electrophysiological parameters in patients with cervical spinal cord injury (SCI). Setting: This study was conducted in the University teaching hospital. Methods: The study involved 17 patients with cervical SCI. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of the spinal cord and peak systolic and diastolic velocities of CSF were measured at the level of maximum compression (region 1) and at the levels above (region 2) and below (region 3) the level of injury with no signal change in conventional magnetic resonance imaging. Neurological and electrophysiological parameters were measured, including American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA motor score, ASIA sensory score, Modified Barthel Index, Spinal Cord Independence Measure III (SCIM III), somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP). Results: The ADC was significantly higher and the FA was significantly lower in regions 1, 2 and 3 of the SCI patients than in the normal controls (Po0.05 each). FA of the level below correlated with AIS, ASIA sensory score and SCIM III score, and FA of the level above correlated with SSEP latencies and MEP amplitudes (Po0.05 each). The reductions in FA correlated with CSF flow, functional measurements and evoked potentials. INTRODUCTIONOwing to its high soft-tissue resolution, conventional magnetic resonance imaging (MRI) is used routinely in the diagnosis of spinal cord injury (SCI). However, conventional MRI has low sensitivity for diffusion abnormalities in the white matter, limiting the associations between MRI results and clinical status. 1,2 Diffusion tensor imaging (DTI) with fiber tractography provides a threedimensional model of water diffusion for longitudinal evaluations of the central nervous system. 3 Although the application of DTI to the human spinal cord is challenging technically, owing to the small cross-sectional area of the spinal cord, cardiac and respiratory motion, and widely varying magnetic susceptibility, 4 recent developments in magnetic resonance (MR) pulse sequence design have greatly reduced these problems. Moreover, phase-contrast MRI (PC-MRI) is a noninvasive technique that can be used to quantify variations in the flow of the cerebrospinal fluid (CSF) gated with the cardiac cycle. 5 CSF flow can be influenced by stenotic lesions in the brain and spinal cord. 6,7 Initially, SCI results in the physical disruption of structures in the spinal cord (primary insult), and it might also induce secondary events that injure intact, neighboring tissues in the epidural, subdural,

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Spinal diffusion tensor imaging: A comprehensive review with emphasis on spinal cord anatomy and clinical applications

et al. 2014

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Magnetic resonance imaging technology allows for in vivo visualization of fiber tracts of the central nervous system using diffusion-weighted imaging sequences and data processing referred to as "diffusion tensor imaging" and "diffusion tensor tractography." While protocols for high-fidelity diffusion tensor imaging of the brain are well established, the spinal cord has proven a more difficult target for diffusion tensor methods. Here, we review the current literature on spinal diffusion tensor imaging and tractography with special emphasis on neuroanatomical correlations and clinical applications.

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Chronic Cervical Spinal Cord Injury: DTI Correlates with Clinical and Electrophysiological Measures

Cited by 113 publications

References 47 publications

Clinical correlates of cerebral diffusion tensor imaging findings in chronic traumatic spinal cord injury

Clinical correlates of cerebral diffusion tensor imaging findings in chronic traumatic spinal cord injury

Correlation of diffusion tensor imaging and phase-contrast MR with clinical parameters of cervical spinal cord injuries

Spinal diffusion tensor imaging: A comprehensive review with emphasis on spinal cord anatomy and clinical applications

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