An alternative imaging technique called diffusion tensor imaging (DTI) shows promise in forecasting, evaluating and monitoring patients with spinal cord injury and disease. The technique uses magnetic resonance—MRI—to measure the magnitude and direction of diffusion of water molecules in the tissue.
Researchers at the Medical College of Wisconsin (MCW) have been working to refine this technique, which has been used in brain imaging, for spinal cord imaging to evaluate injury, to prognosticate disease, and monitor patients who have spinal cord disease. A review of that work is published in Neurosurgery http://www.ncbi.nlm.nih.gov/pubmed/24064483 (full text available upon request). Shekar Kurpad, MD, PhD, associate professor of neurosurgery at MCW, is the corresponding author.
The researchers found that DTI provides good contrast between gray and white regions, and is sensitive to degenerative changes in the spinal cord that are not provided by a conventional MRI scan. In traumatic spinal cord injury, cervical spondolytic myelopathy, and spinal cord tumors, DTI shows great promise.
“DTI provides unique insight into the pathophysiology and microstructural alterations associated with spinal cord disorders. There are still some limitations, but we are making advances with this technique that establish DTI as a promising biomarker for spinal cord disorders,” said Dr. Kurpad.
One of the challenges has been the existence of artifacts, particularly after spinal cord surgery in which instruments have been implanted. The researchers, led by Dr. Kurpad and Dr. Schmit have tackled this challenge by coming up with a unique solution: Using DTI to image a remote part of the spinal cord away from the injury. Drs. Kurpad and Schmit’s group was the first to suggest remote DTI imaging as a feasible technique for imaging spinal cord injury and cervical spondylotic myelopathy; this has since been validated by another group in Europe. Additionally, the authors found standardized software to process tensor images is essential to make DTI a feasible option for routine clinical use.
Other authors of the paper are Aditya Vedantam, MD; Marjorie Wang, MD, MPH; and John Ulmer, MD; the Medical College of Wisconsin; Michael Jirjis, BS; and Brian Schmit, PhD; Marquette University.
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