Diffusion Tensor MR Imaging in Cervical Spine Trauma

Shanmuganathan, Kathirkamanathan; Gullapalli, Rao P.; Zhuo, J.; Mirvis, Stuart E.

doi:10.3174/ajnr.a0916

Cited by 156 publications

(112 citation statements)

References 14 publications

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“…1,7 In the present report, both patients showed an increase in MD that may be attributed to progressive lesion growth, as described previously in animal SCI models. 8 This suggests a possible trend in DTI metrics associated with an evolving spinal cord lesion.…”

Section: Discussionsupporting

confidence: 64%

“…Both DTI metrics and tractography showed an asymmetry that corresponded to the neurological deficits exhibited by the patients. 1 We report the use of DTI and tractography to characterize two cases of Brown-Sequard syndrome (BSS) following penetrating cervical cord injury. We sought to determine whether DTI metrics show anatomical asymmetry that matches clinical presentation.…”

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confidence: 99%

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Diffusion tensor imaging and tractography in brown-sequard syndrome

et al. 2012

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Study design: Case report. Objective: To demonstrate the utility of diffusion tensor imaging (DTI) and tractography in two patients with Brown-Sequard syndrome after penetrating cervical cord injury. Setting: Milwaukee, WI, USA. Methods: Two patients, who presented with features of Brown-Sequard syndrome after sustaining stab wounds to the neck, underwent DTI and tractography of the cervical cord within a week of the injury. DTI metrics were measured within the left and right hemicord around the level of injury. Diffusion tensor tractography (DTT) was performed to visualize the site of injury and injured fiber tracts. Results: Axial fractional anisotropy (FA) maps at the site of injury showed unilateral damage to the cord structure, and FA was significantly reduced within the injured hemicord in both patients. Tractography allowed for visualization of the injured fiber tracts around the level of injury. Both DTI metrics and tractography showed an asymmetry that corresponded to the neurological deficits exhibited by the patients. 1 We report the use of DTI and tractography to characterize two cases of Brown-Sequard syndrome (BSS) following penetrating cervical cord injury. We sought to determine whether DTI metrics show anatomical asymmetry that matches clinical presentation. CASE REPORTS Patient 1A 51-year old male presented with stab wounds to the neck following assault. On examination, he had decreased motor strength in the left upper and lower limbs (MRC grades: elbow-4/5, wrist-4/5, hip/knee/ ankle-0/5). On the right side, he had 5/5 motor strength throughout. Sensory examination revealed impaired pinprick sensation only on the right side. Light touch and proprioception were intact bilaterally. On the left, knee jerk was absent and ankle jerk was diminished. Plantar reflexes were flexor bilaterally. Patient 2A 32-year old male presented to the ER following a stab wound to the neck. Motor examination revealed weakness on the right side (maximum MRC grade: upper limb-3/5, lower limb-3/5). Sensory examination showed absent pinprick sensation in the left upper and lower extremities and diminished sensation to light touch in the right upper and lower limb. CSF leakage was noted from the wound, which was closed primarily with deep subcutaneous sutures. Imaging protocolBoth patients underwent DTI using a 1.5T MR scanner within a week following injury (Patient 1-6 days, Patient 2-48 h). A single-shot, echo planar pulse sequence was used with a twice-refocused spin-echo diffusion preparation. Axial diffusion-weighted images (3 mm thick with a 0.5 mm gap between slices) were acquired along 15 distinct directions at a b-value of 600 s/mm 2 using a TR/TE of 5000/98.2 ms, matrix size of 128 Â 128, and FOV of 19 cm 2 .Images were processed using Analysis of Functional NeuroImages processing suite (AFNI, http://afni.nimh.nih.gov/afni/) and Matlab (MathWorks, Natick, MA, USA). Regions of interest within the whole cord, and right and left halves of the cord were drawn on axial fractional anisotropy (FA) maps by two investig...

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Section: Discussionsupporting

confidence: 64%

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Diffusion tensor imaging and tractography in brown-sequard syndrome

et al. 2012

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“…However, the translation of this technique for use in human SCI presents many challenges, including (1) the low signal-tonoise ratio and image resolution of human spinal MRI may prevent the accurate anatomical definition of the injured tissues; (2) the more challenging respiratory motion that complicates human spinal MRI, since the spine immobilization device used in rodents is not applicable in humans; (3) the severely degraded echo planar diffusion-weighted MRI quality due to severe susceptibility effects that prevent as high-quality spinal DTI in humans compared to that of rodents within a reasonable time period; and (4) the limited time frame to perform the acute MRI before stabilizing hardware placement in SCI patients. Despite these challenges, there have been some human spinal cord DTI reports in the literature (Ellingson et al, 2008a(Ellingson et al, , 2008bFacon et al, 2005;Guleria et al, 2008;Shanmuganathan et al, 2008;Yeatman et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Diffusion Tensor Imaging at 3 Hours after Traumatic Spinal Cord Injury Predicts Long-Term Locomotor Recovery

Kim

Loy

Wang

et al. 2010

Journal of Neurotrauma

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Accurate diagnosis of spinal cord injury (SCI) severity must be achieved before highly aggressive experimental therapies can be tested responsibly in the early phases after trauma. These studies demonstrate for the first time that axial diffusivity (ljj), derived from diffusion tensor imaging (DTI) within 3 h after SCI, accurately predicts long-term locomotor behavioral recovery in mice. Female C57BL=6 mice underwent sham laminectomy or graded contusive spinal cord injuries at the T9 vertebral level (5 groups, n ¼ 8 for each group). In-vivo DTI examinations were performed immediately after SCI. Longitudinal measurements of hindlimb locomotor recovery were obtained using the Basso mouse scale (BMS). Injured and spared regions of ventrolateral white matter (VLWM) were reliably separated in the hyperacute phase by threshold segmentation. Measurements of ljj were compared with histology in the hyperacute phase and 14 days after injury. The spared normal VLWM determined by hyperacute ljj and 14-day histology correlated well (r ¼ 0.95). A strong correlation between hindlimb locomotor function recovery and ljj-determined spared normal VLWM was also observed. The odds of significant locomotor recovery increased by 18% with each 1% increase in normal VLWM measured in the hyperacute phase (odds ratio ¼ 1.18, p ¼ 0.037). The capability of measuring subclinical changes in spinal cord physiology and murine genetic advantages offer an early window into the basic mechanisms of SCI that was not previously possible. Although significant obstacles must still be overcome to derive similar data in human patients, the path to clinical translation is foreseeable and achievable.

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“…The dramatic visual interruption of white matter tracts and glial scar shown by spinal cord diffusion tensor imaging 58 may enable us to monitor recovery patterns in the future. diffusion tensor imaging has also shown quantitative changes based on the severity of SCI, 59 which have been correlated with the ASIA Impairment Grades. 60 Although WISCI and 10-meter walking test are recommended 42,49 as the best-validated measures of walking capacity today, this does not mean that they will be so tomorrow, as we learned from FIM in 1997 (Table 2).…”

Section: Evolution Of Outcome Measures In Randomized Multicenter Clinmentioning

confidence: 99%

Outcome measures: evolution in clinical trials of neurological/functional recovery in spinal cord injury

Ditunno

2010

Spinal Cord

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The need to determine the beneficial effect of the treatment of spinal cord injury (SCI) requires clearly defined standardized measures of the severity of injury and how well the function is restored. Improved neurological recovery should be linked to increased capacity to perform tasks such as walking, reaching and grasping, which results in meaningful gains in mobility and self-care. Measurements of recovery, capacity, mobility and self-care are the outcomes used to determine the benefits from the treatment and have evolved over the last century with contributions by the mentors and protégés of Sir Ludwig Guttmann, whom we honor today. Randomized clinical trials in the past 20 years have taught us many lessons as to which outcome measures have the greatest validity and reliability. The International Standards for Neurological Classification of SCI have become the clinical gold standard for measurement of severity, but would benefit from pathophysiological surrogates to better understand the mechanisms of recovery. Measurements of walking capacity have emerged as valid/reliable/ responsive and upper extremity measures are in development, which help distinguish neurological improvement from rehabilitation adaptation. Performance of self-care and mobility has been linked to capacity and severity outcomes. In addition, new partnerships between clinical trial entities, professional societies, industry and federal agencies should facilitate identification of priorities and uniformity of measurement standards. Our ultimate goal is to improve the quality of life of those individuals with SCI whom we serve, but we must focus our investigative efforts carefully, systematically and rigorously as clinical scientists.

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Diffusion Tensor MR Imaging in Cervical Spine Trauma

Abstract: BACKGROUND AND PURPOSE: Our aim was to investigate the extent and severity of changes in spinal cord diffusion tensor imaging (DTI) parameters in patients with cervical cord injury.

Cited by 156 publications

References 14 publications

Diffusion tensor imaging and tractography in brown-sequard syndrome

Diffusion tensor imaging and tractography in brown-sequard syndrome

Diffusion Tensor Imaging at 3 Hours after Traumatic Spinal Cord Injury Predicts Long-Term Locomotor Recovery

Outcome measures: evolution in clinical trials of neurological/functional recovery in spinal cord injury

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