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Yang KM, Garcia MR, Segal D. Isolated Cervical Cord Infarct in a Neonate. J Child Neurol 2024:8830738241273362. [PMID: 39175399 DOI: 10.1177/08830738241273362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Cases of isolated spinal cord ischemia resulting in symptoms in neonates are rare, and there are even fewer reported cases in atraumatic births. We present a case of a presumed isolated cervical cord ischemic injury, discuss differentials to consider when evaluating a neonatal spinal cord injury, and highlight the difficulties of diagnosing a spinal cord infarction.
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Affiliation(s)
- Kristen M Yang
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Mekka R Garcia
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Devorah Segal
- Department of Neurology, New York University Langone Health, New York, NY, USA
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2
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Haddad G, Moussalem C, Saade MC, El Hayek M, Massaad E, Gibbs WN, Shin J. Imaging of Adult Malignant Soft Tissue Tumors of the Spinal Canal: A Guide for Spine Surgeons. World Neurosurg 2024; 187:133-140. [PMID: 38428809 DOI: 10.1016/j.wneu.2024.02.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Malignant soft tissue spinal canal tumors compromise 20% of all spinal neoplasms. They may be primary or metastatic lesions, originating from a diverse range of tissues within and surrounding the spinal canal. These masses can present as diverse emergencies such as secondary cauda equina syndrome, vascular compromise, or syringomyelia. Interpretation of malignant soft tissue spinal canal tumors imaging is an essential for non-radiologists in the setting of emergencies. This task is intricate due to a great radiologic pattern overlap among entities. METHODS We present a step-by-step strategy that can guide nonradiologists identify a likely malignant soft tissue lesion in the spinal canal based on imaging features, as well as a review of the radiologic features of malignant soft tissue spinal canal tumors. RESULTS Diagnosis of soft tissue spinal canal malignancies starts with the identification of the lesion's spinal level and its relationship to the dura and medulla. The second step consists of characterizing it as likely-malignant based on radiological signs like a larger size, ill-defined margins, central necrosis, and/or increased vascularity. The third step is to identify additional imaging features such as intratumoral hemorrhage or cyst formation that can suggest specific malignancies. The physician can then formulate a differential diagnosis. The most encountered malignant soft tissue tumors of the spinal canal are anaplastic ependymomas, anaplastic astrocytomas, metastatic tumors, lymphoma, peripheral nerve sheath tumors, and central nervous system melanomas. A review of the imaging features of every type/subtype of lesion is presented in this work. Although magnetic resonance imaging remains the modality of choice for spinal tumor assessment, other techniques such as dynamic contrast agent-enhanced perfusion magnetic resonance imaging or diffusion-weighted imaging could guide diagnosis in specific situations. CONCLUSIONS In this review, diagnostic strategies for several spinal cord tumors were presented, including anaplastic ependymoma, metastatic spinal cord tumors, anaplastic and malignant astrocytoma, lymphoma, malignant peripheral nerve sheath tumors , and primary central nervous system melanoma. Although the characterization of spinal cord tumors can be challenging, comprehensive knowledge of imaging features can help overcome these challenges and ensure optimal management of spinal canal lesions.
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Affiliation(s)
- Gaelle Haddad
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Marie Christelle Saade
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mario El Hayek
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wende N Gibbs
- Department of Radiology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - John Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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3
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Schilling KG, Combes AJE, Ramadass K, Rheault F, Sweeney G, Prock L, Sriram S, Cohen-Adad J, Gore JC, Landman BA, Smith SA, O'Grady KP. Influence of preprocessing, distortion correction and cardiac triggering on the quality of diffusion MR images of spinal cord. Magn Reson Imaging 2024; 108:11-21. [PMID: 38309376 PMCID: PMC11218893 DOI: 10.1016/j.mri.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 02/05/2024]
Abstract
Diffusion MRI of the spinal cord (SC) is susceptible to geometric distortion caused by field inhomogeneities, and prone to misalignment across time series and signal dropout caused by biological motion. Several modifications of image acquisition and image processing techniques have been introduced to overcome these artifacts, but their specific benefits are largely unproven and warrant further investigations. We aim to evaluate two specific aspects of image acquisition and processing that address image quality in diffusion studies of the spinal cord: susceptibility corrections to reduce geometric distortions, and cardiac triggering to minimize motion artifacts. First, we evaluate 4 distortion preprocessing strategies on 7 datasets of the cervical and lumbar SC and find that while distortion correction techniques increase geometric similarity to structural images, they are largely driven by the high-contrast cerebrospinal fluid, and do not consistently improve the geometry within the cord nor improve white-to-gray matter contrast. We recommend at a minimum to perform bulk-motion correction in preprocessing and posit that improvements/adaptations are needed for spinal cord distortion preprocessing algorithms, which are currently optimized and designed for brain imaging. Second, we design experiments to evaluate the impact of removing cardiac triggering. We show that when triggering is foregone, images are qualitatively similar to triggered sequences, do not have increased prevalence of artifacts, and result in similar diffusion tensor indices with similar reproducibility to triggered acquisitions. When triggering is removed, much shorter acquisitions are possible, which are also qualitatively and quantitatively similar to triggered sequences. We suggest that removing cardiac triggering for cervical SC diffusion can be a reasonable option to save time with minimal sacrifice to image quality.
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Affiliation(s)
- Kurt G Schilling
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Anna J E Combes
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karthik Ramadass
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA; Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Francois Rheault
- Medical Imaging and Neuroinformatic (MINi) Lab, Department of Computer Science, University of Sherbrooke, Canada
| | - Grace Sweeney
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Logan Prock
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Subramaniam Sriram
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, QC, Canada; Mila - Quebec AI Institute, Montreal, QC, Canada; Centre de recherche du CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - John C Gore
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Bennett A Landman
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA; Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Seth A Smith
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Kristin P O'Grady
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
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4
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Oleson CV, Olsen AC, Shermon S. Spinal cord infarction attributed to SARS-CoV-2, with post-acute sequelae of COVID-19: A case report. World J Clin Cases 2023; 11:8542-8550. [PMID: 38188200 PMCID: PMC10768511 DOI: 10.12998/wjcc.v11.i36.8542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND While stroke and lower extremity venous thromboemboli have been commonly reported following acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spinal cord infarction or ischemia has been extremely rare. Findings of long coronavirus disease (COVID) in this select population have not been studied. CASE SUMMARY We present the case of a 70-year-old female with sudden onset of trunk and lower extremity sensorimotor loss due to spinal cord infarction, attributed to acute infection with SARS-CoV-2. Diagnostic work up confirmed a T3 complete (ASIA impairment Scale A) paraplegia resulting from a thrombotic infarct. Her reported myalgias, neuropathic pain, spasticity, bladder spasms, and urinary tract infections exceeded the frequency and severity of many spinal cord injury (SCI) individuals of similar age and degree of neurologic impairment. In her first year after contracting COVID-19, she underwent 2 separate inpatient rehabilitation courses, but also required acute hospitalization 6 additional times for subsequent infections or uncontrolled pain. Yet other complications of complete non-traumatic SCI (NTSCI), including neurogenic bowel and temperature hypersensitivity, were mild, and pressure injuries were absent. She has now transitioned from the acute to chronic phase of spinal cord injury care, with subsequent development of post-acute sequelae of SARS-CoV-2 infection (PASC). CONCLUSION This individual experienced significant challenges with the combined effects of acute T3 NTSCI and acute COVID-19, with subsequent progression to PASC.
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Affiliation(s)
- Christina V Oleson
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Rehabilitation Institute, Cleveland, OH 44109, United States
| | - Andrew C Olsen
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Rehabilitation Institute, Cleveland, OH 44109, United States
| | - Suzanna Shermon
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Rehabilitation Institute, Cleveland, OH 44109, United States
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Korkmazer B, Kemerdere R, Bas G, Arslan S, Demir B, Batkitar A, Kizilkilic O, Hanci MM. The efficacy of preoperative diffusion tensor tractography on surgical planning and outcomes in patients with intramedullary spinal tumor. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4321-4327. [PMID: 37530950 DOI: 10.1007/s00586-023-07872-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/14/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE The aim of this study was to investigate the efficacy of diffusion tensor tractography (DTT) of spinal cord on surgical planning and postoperative neurological outcomes in patients with spinal intramedullary tumors. METHODS The study was conducted retrospectively from the radiological and clinical data of our hospital database. Patients with intramedullary spinal cord tumors who underwent diffusion tensor imaging for spinal cord lesions were selected between 2019 and 2022. Demographic characteristics and intraoperative neurophysiological monitoring data were evaluated. The McCormick scale was used to grade the pre- and postoperative neurological status of the patients. The tumoral lesions were categorized into 3 types according to the fiber course on DTT. RESULTS Eleven patients were found to have radiological findings that were compatible with intramedullary tumor; eight (72.7%) of them ultimately underwent surgery following being approved as surgical candidates in the spinal diffusion tensor imaging studies. Six cases had Type 1, one case had Type 2, and 4 cases had Type 3 tumors according to the fiber course. All Type 1 tumors were classified as resectable and all of them were gross totally resected. Type 2 lesion that was rated as resectable by DTI was subtotally resected. Type 3 lesions were followed without surgery except the one with tumoral progression and neurological deficit. The postoperative neurological outcomes were compatible with intraoperative neurophysiological monitoring results. CONCLUSION Diffusion tensor imaging and tractography may be beneficial regarding the selection of patients suitable for surgery and in the subsequent surgical planning.
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Affiliation(s)
- Bora Korkmazer
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey.
| | - Rahsan Kemerdere
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Gulcin Bas
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Serdar Arslan
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Bilal Demir
- Department of Radiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Abdulmelik Batkitar
- Department of Radiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Mehmet Murat Hanci
- Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey
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Naser MA, Wahid KA, Ahmed S, Salama V, Dede C, Edwards BW, Lin R, McDonald B, Salzillo TC, He R, Ding Y, Abdelaal MA, Thill D, O'Connell N, Willcut V, Christodouleas JP, Lai SY, Fuller CD, Mohamed ASR. Quality assurance assessment of intra-acquisition diffusion-weighted and T2-weighted magnetic resonance imaging registration and contour propagation for head and neck cancer radiotherapy. Med Phys 2023; 50:2089-2099. [PMID: 36519973 PMCID: PMC10121748 DOI: 10.1002/mp.16128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND/PURPOSE Adequate image registration of anatomical and functional magnetic resonance imaging (MRI) scans is necessary for MR-guided head and neck cancer (HNC) adaptive radiotherapy planning. Despite the quantitative capabilities of diffusion-weighted imaging (DWI) MRI for treatment plan adaptation, geometric distortion remains a considerable limitation. Therefore, we systematically investigated various deformable image registration (DIR) methods to co-register DWI and T2-weighted (T2W) images. MATERIALS/METHODS We compared three commercial (ADMIRE, Velocity, Raystation) and three open-source (Elastix with default settings [Elastix Default], Elastix with parameter set 23 [Elastix 23], Demons) post-acquisition DIR methods applied to T2W and DWI MRI images acquired during the same imaging session in twenty immobilized HNC patients. In addition, we used the non-registered images (None) as a control comparator. Ground-truth segmentations of radiotherapy structures (tumour and organs at risk) were generated by a physician expert on both image sequences. For each registration approach, structures were propagated from T2W to DWI images. These propagated structures were then compared with ground-truth DWI structures using the Dice similarity coefficient and mean surface distance. RESULTS 19 left submandibular glands, 18 right submandibular glands, 20 left parotid glands, 20 right parotid glands, 20 spinal cords, and 12 tumours were delineated. Most DIR methods took <30 s to execute per case, with the exception of Elastix 23 which took ∼458 s to execute per case. ADMIRE and Elastix 23 demonstrated improved performance over None for all metrics and structures (Bonferroni-corrected p < 0.05), while the other methods did not. Moreover, ADMIRE and Elastix 23 significantly improved performance in individual and pooled analysis compared to all other methods. CONCLUSIONS The ADMIRE DIR method offers improved geometric performance with reasonable execution time so should be favoured for registering T2W and DWI images acquired during the same scan session in HNC patients. These results are important to ensure the appropriate selection of registration strategies for MR-guided radiotherapy.
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Affiliation(s)
- Mohamed A Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kareem A Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sara Ahmed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vivian Salama
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cem Dede
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Benjamin W Edwards
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ruitao Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brigid McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Travis C Salzillo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Moamen Abobakr Abdelaal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | | | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Yamamoto H, Fukushima Y, Ikeda Y, Suda T, Goto M, Isogai J, Hashimoto T, Takahashi T, Ogino H. Decisive diagnostic clue for infectious abdominal aortic aneurysm caused by Arthrobacter russicus in a diabetic elderly woman with renal dysfunction: A case report and literature review. Front Cardiovasc Med 2022; 9:1007213. [PMID: 36386385 PMCID: PMC9650533 DOI: 10.3389/fcvm.2022.1007213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022] Open
Abstract
Infectious aortic aneurysm (IAA) can be a rare but potentially fatal sequela of infectious inflammatory disease of the aortic wall with a high incidence of rupture. The definitive diagnosis is based on vascular imaging of the aneurysm using contrast-enhanced computed tomography (CE-CT) and identification of the causative microorganism from positive blood cultures (BCs). However, IAA remains extremely difficult to diagnose and treat in patients with prior antimicrobial treatment or with renal dysfunction. Here we describe a case of an 85-year-old woman with IAA caused by Arthrobacter russicus presenting with abdominal pain and fever that was initially diagnosed as a presumptive urinary tract infection and treated with empiric antimicrobial therapy. However, persistent abdominal pain with increased serological inflammation necessitated further evaluation. Unenhanced multimodality imaging considering the renal dysfunction revealed infectious aortitis of the infrarenal abdominal aorta, together with the initial culture results, leading to the tentative diagnosis of Klebsiella pneumoniae aortitis. Thereafter, serial monitoring with unenhanced magnetic resonance angiography (MRA) using thin-slab maximum intensity projection (TS-MIP) revealed acute aortic expansion strongly suggestive of a pseudoaneurysm that was successfully treated with early surgical repair under adequate infection control. Despite negative Gram staining and tissue culture results for the excised aortic wall, a definitive diagnosis of IAA secondary to A. russicus rather than K. pneumoniae was finally made by confirming the histologic findings consistent with IAA and the identification of A. russicus 16S rRNA on the resected aortic wall. The patient also developed a vascular graft infection during the postoperative course that required long-term systemic antimicrobial therapy. This case highlights the value of unenhanced MRA in the early detection of IAA in patients with renal dysfunction and the importance of a molecular diagnosis for identifying the causative microorganism in cases of culture- or tissue-negative IAA.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- *Correspondence: Hiroyuki Yamamoto,
| | - Yasuto Fukushima
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoyuki Suda
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- Department of General Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Mieko Goto
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Asahi, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Takashi Takahashi
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
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Trò R, Roascio M, Tortora D, Severino M, Rossi A, Cohen-Adad J, Fato MM, Arnulfo G. Diffusion Kurtosis Imaging of Neonatal Spinal Cord in Clinical Routine. FRONTIERS IN RADIOLOGY 2022; 2:794981. [PMID: 37492682 PMCID: PMC10365122 DOI: 10.3389/fradi.2022.794981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/20/2022] [Indexed: 07/27/2023]
Abstract
Diffusion kurtosis imaging (DKI) has undisputed advantages over the more classical diffusion magnetic resonance imaging (dMRI) as witnessed by the fast-increasing number of clinical applications and software packages widely adopted in brain imaging. However, in the neonatal setting, DKI is still largely underutilized, in particular in spinal cord (SC) imaging, because of its inherently demanding technological requirements. 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, which are 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 the SC region and the brain above, managing to apply such a method to the neonatal cohort becomes of utmost importance. This study will (i) mention current methodological challenges associated with the application of advanced dMRI methods, like DKI, in early infancy, (ii) illustrate the first semi-automated pipeline built on Spinal Cord Toolbox for handling the DKI data of neonatal SC, from acquisition setting to estimation of diffusion measures, through accurate adjustment of processing algorithms customized for adult SC, and (iii) present results of its application in a pilot clinical case study. With the proposed pipeline, we preliminarily show that DKI is more sensitive than DTI-related measures to alterations caused by brain white matter injuries in the underlying cervical SC.
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Affiliation(s)
- Rosella Trò
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Monica Roascio
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | | | | | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
- Mila—Quebec AI Institute, Montreal, QC, Canada
| | - Marco Massimo Fato
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Gabriele Arnulfo
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
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9
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Puig I, Lisbona R, García-Gámez A, Martinez A, Ramos-Pachón A, Puyalto P, Arbex A. Anterior Spinal Cord Ischemia due to an Acute Aortic Intramural Type B Hematoma. Stroke 2022; 53:e200-e203. [PMID: 35259930 DOI: 10.1161/strokeaha.121.035679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Raquel Lisbona
- Radiology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (R.L., A.G.-G., A.M., P.P.)
| | - Andrés García-Gámez
- Radiology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (R.L., A.G.-G., A.M., P.P.)
| | - Angela Martinez
- Radiology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (R.L., A.G.-G., A.M., P.P.)
| | | | - Paloma Puyalto
- Radiology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (R.L., A.G.-G., A.M., P.P.).,Universitat Internacional de Catalunya, Barcelona, Spain (P.P.)
| | - Andrea Arbex
- Neurology Department (I.P., A.R.-P., A.A.).,Neurology Department, Badalona Municipal Hospital, Barcelona, Spain (A.A.)
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Abstract
This article discusses new diffusion-weighted imaging (DWI) sequences, diffusion tensor imaging (DTI), and fiber tractography (FT), as well as more advanced diffusion imaging in pediatric brain and spine. Underlying disorder and pathophysiology causing diffusion abnormalities are discussed. Multishot echo planar imaging (EPI) DWI and non-EPI DWI provide higher spatial resolution with less susceptibility artifact and distortion, which are replacing conventional single-shot EPI DWI. DTI and FT have established clinical significance in pediatric brain and spine. This article discusses advanced diffusion imaging, including diffusion kurtosis imaging, neurite orientation dispersion and density imaging, diffusion spectrum imaging, intravoxel incoherent motion, and oscillating-gradient spin-echo.
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Affiliation(s)
- Toshio Moritani
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, UH B2 A209K, Ann Arbor, MI 48109, USA.
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11
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Single shot zonal oblique multislice SE-EPI diffusion-weighted imaging with low to ultra-high b-values for the differentiation of benign and malignant vertebral spinal fractures. Eur J Radiol Open 2021; 8:100377. [PMID: 34611530 PMCID: PMC8476351 DOI: 10.1016/j.ejro.2021.100377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To investigate the diagnostic yield of low to ultra-high b-values for the differentiation of benign from malignant vertebral fractures using a state-of-the-art single-shot zonal-oblique-multislice spin-echo echo-planar diffusion-weighted imaging sequence (SShot ZOOM SE-EPI DWI). Materials and Methods 66 patients (34 malignant, 32 benign) were examined on 1.5 T MR scanners. ADC maps were generated from b-values of 0,400; 0,1000 and 0,2000s/mm2. ROIs were placed into the fracture of interest on ADC maps and trace images and into adjacent normal vertebral bodies on trace images. The ADC of fractures and the Signal-Intensity-Ratio (SIR) of fractures relative to normal vertebral bodies on trace images were considered quantitative metrics. The appearance of the fracture of interest was graded qualitatively as iso-, hypo-, or hyperintense relative to normal vertebrae. Results ADC achieved an area under the curve (AUC) of 0.785/0.698/0.592 for b = 0,400/0,1000/0,2000s/mm2 ADC maps respectively. SIR achieved an AUC of 0.841/0.919/0.917 for b = 400/1000/2000s/mm2 trace images respectively. In qualitative analyses, only b = 2000s/mm2 trace images were diagnostically valuable (sensitivity:1, specificity:0.794). Machine learning models incorporating all qualitative and quantitative metrics achieved an AUC of 0.95/0.98/0.98 for b-values of 400/1000/2000s/mm2 respectively. The model incorporating only qualitative metrics from b = 2000s/mm2 achieved an AUC of 0.97. Conclusion By using quantitative and qualitative metrics from SShot ZOOM SE-EPI DWI, benign and malignant vertebral fractures can be differentiated with high diagnostic accuracy. Importantly qualitative analysis of ultra-high b-value images may suffice for differentiation as well.
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Key Words
- ADC, Apparent Diffusion Coefficient
- AUC, Area Under the Curve
- DWI, Diffusion Weighted Imaging
- DXA, Dual Energy X-Ray Absorptiometry
- Diffusion magnetic resonance imaging
- FOV, Field of View
- MRI, Magnetic Resonance Imaging
- MShot, Multi Shot
- Magnetic resonance imaging
- PET-CT, Positron Emission Tomography – Computed Tomography
- ROC, Receiver Operating Characteristics
- SE-EPI, Spin Echo – Echo Planar Imaging
- SI, Signal Intensity
- SIR, Signal Intensity Ratio
- SShot, Single Shot
- STIR, Short Tau Inversion Recovery
- Spinal fractures
- T1w, T1-weighted
- T2w, T2-weighted
- TSE, Turbo Spin Echo
- Vertebral body
- ZOOM, Zonal Oblique Multislice
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12
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Meyer BP, Hirschler L, Lee S, Kurpad SN, Warnking JM, Barbier EL, Budde MD. Optimized cervical spinal cord perfusion MRI after traumatic injury in the rat. J Cereb Blood Flow Metab 2021; 41:2010-2025. [PMID: 33509036 PMCID: PMC8327111 DOI: 10.1177/0271678x20982396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/11/2020] [Accepted: 11/22/2020] [Indexed: 11/17/2022]
Abstract
Despite the potential to guide clinical management of spinal cord injury and disease, noninvasive methods of monitoring perfusion status of the spinal cord clinically remain an unmet need. In this study, we optimized pseudo-continuous arterial spin labeling (pCASL) for the rodent cervical spinal cord and demonstrate its utility in identifying perfusion deficits in an acute contusion injury model. High-resolution perfusion sagittal images with reduced imaging artifacts were obtained with optimized background suppression and imaging readout. Following moderate contusion injury, perfusion was clearly and reliably decreased at the site of injury. Implementation of time-encoded pCASL confirmed injury site perfusion deficits with blood flow measurements corrected for variability in arterial transit times. The noninvasive protocol of pCASL in the spinal cord can be utilized in future applications to examine perfusion changes after therapeutic interventions in the rat and translation to patients may offer critical implications for patient management.
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Affiliation(s)
- Briana P Meyer
- Department of Neurosurgery, Medical College of Wisconsin,
Milwaukee, WI, USA
- Biophysics Graduate Program, Medical College of Wisconsin,
Milwaukee, WI, USA
- Neuroscience Doctoral Program, Medical College of Wisconsin,
Milwaukee, WI, USA
| | - Lydiane Hirschler
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut des
Neurosciences, Grenoble, France
- Department of Radiology, C.J. Gorter Center for High Field MRI,
Leiden University Medical Center, Leiden, the Netherlands
| | - Seongtaek Lee
- Department of Neurosurgery, Medical College of Wisconsin,
Milwaukee, WI, USA
- Biomedical Engineering Graduate Program, Marquette University
& Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin,
Milwaukee, WI, USA
| | - Jan M Warnking
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut des
Neurosciences, Grenoble, France
| | - Emmanuel L Barbier
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut des
Neurosciences, Grenoble, France
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin,
Milwaukee, WI, USA
- Clement J Zablocki Veteran's Affairs Medical Center, Milwaukee,
WI, USA
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13
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McEntire CR, Dowd RS, Orru' E, David C, Small JE, Cervantes-Arslanian A, Lerner DP. Acute Myelopathy: Vascular and Infectious Diseases. Neurol Clin 2021; 39:489-512. [PMID: 33896530 DOI: 10.1016/j.ncl.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular and infectious causes are rare but important causes of spinal cord injury. High suspicion for these processes is necessary, as symptoms may progress over hours to days, resulting in delayed presentation and diagnosis and worse outcomes. History and clinical examination findings can assist with localization of the affected vascular territory and spinal level, which will assist with focusing spinal imaging. Open and/or endovascular surgical management depends on the associated vascular abnormality. Infectious myelopathy treatment consists of targeted antimicrobial therapy when possible, infectious source control, and again, close monitoring for systemic complications.
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Affiliation(s)
- Caleb R McEntire
- Department of Neurology, Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard S Dowd
- Department of Neurosurgery, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Emanuele Orru'
- Department of Radiology, Neurointerventional Radiology Division, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Carlos David
- Department of Neurosurgery, Tufts University School of Medicine, Boston, MA 02111, USA; Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Juan E Small
- Department of Radiology, Neuroradiology Section, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | | | - David P Lerner
- Division of Neurology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; Department of Neurology, Tufts University School of Medicine, Boston, MA 02111, USA.
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14
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Agarwal V, Shah LM, Parsons MS, Boulter DJ, Cassidy RC, Hutchins TA, Jamlik-Omari Johnson, Kendi AT, Khan MA, Liebeskind DS, Moritani T, Ortiz AO, Reitman C, Shah VN, Snyder LA, Timpone VM, Corey AS. ACR Appropriateness Criteria® Myelopathy: 2021 Update. J Am Coll Radiol 2021; 18:S73-S82. [PMID: 33958120 DOI: 10.1016/j.jacr.2021.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 01/22/2023]
Abstract
Myelopathy is a clinical diagnosis with localization of the neurological findings to the spinal cord, rather than the brain or the peripheral nervous system, and then to a particular segment of the spinal cord. Myelopathy can be the result of primary intrinsic disorders of the spinal cord or from secondary conditions, which result in extrinsic compression of the spinal cord. While the causes of myelopathy may be multiple, the acuity of presentation and symptom onset frame a practical approach to the differential diagnosis. Imaging plays a crucial role in the evaluation of myelopathy with MRI the preferred modality. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Vikas Agarwal
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Vice Chair of Education, Department of Radiology, University of Pittsburgh Medical Center, Program Director, Neuroradiology Fellowship, University of Pittsburgh Medical Center.
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah, Chair, Committee on Appropriateness Criteria, Co-Chair, Neurological Imaging Panel, member of the ACR Commission on Neuroradiology
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky, American Academy of Orthopaedic Surgeons, Evidence Based Guideline Committee, North American Spine Society
| | | | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota, Director of Nuclear Medicine Therapies, Mayo Clinic Rochester
| | | | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California, American Academy of Neurology, President of SVIN
| | | | | | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina, North American Spine Society
| | - Vinil N Shah
- University of California San Francisco, San Francisco, California
| | - Laura A Snyder
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | - Vincent M Timpone
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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15
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Condette-Auliac S, Gratieux J, Boulin A, Di Maria F, Consoli A, Coskun O, Smajda S, Rodesch G. Imaging of vascular diseases of the spinal cord. Rev Neurol (Paris) 2021; 177:477-489. [PMID: 33902944 DOI: 10.1016/j.neurol.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Affiliation(s)
- S Condette-Auliac
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France.
| | - J Gratieux
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Boulin
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - F Di Maria
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Consoli
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - O Coskun
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - S Smajda
- Department of interventional Neuroradiology, Fondation Rotschild, Paris, France
| | - G Rodesch
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
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16
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Role of diffusion tensor imaging of sciatic nerve in symptomatic patients with inconclusive lumbar MRI. Eur J Radiol 2020; 131:109249. [DOI: 10.1016/j.ejrad.2020.109249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/08/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
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17
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Mai W. Reduced field-of-view diffusion-weighted MRI can identify restricted diffusion in the spinal cord of dogs and cats with presumptive clinical and high-field MRI diagnosis of acute ischemic myelopathy. Vet Radiol Ultrasound 2020; 61:688-695. [PMID: 32931630 DOI: 10.1111/vru.12907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022] Open
Abstract
Diffusion-weighted imaging MRI is the gold standard imaging technique for diagnosis of suspected acute brain ischemia in dogs and cats; however, it is technically challenging to apply to spinal cord imaging, due to its very small size, the inherent low spatial resolution of diffusion-weighted imaging, and the marked distortion resulting from magnetic field inhomogeneities caused by the osseous components of the vertebral column surrounding the spinal cord. Ischemic myelopathy is a common cause of acute non-compressive myelopathy in dogs and cats. Technological improvement in diffusion-weighted imaging pulse sequences allow imaging at smaller field of view with better spatial resolution and less image distortion. We sought to evaluate reduced field-of-view diffusion-weighted imaging MRI using a dedicated proprietary pulse sequence (FOCUS, General Electric) in a small sample of dogs and cats with a presumptive clinical and MRI diagnosis of acute ischemic myelopathy that were imaged with this pulse sequence. Five dogs and two cats fitted these inclusion criteria. In all of them, hyperintense spinal cord parenchyma signal was seen on diffusion-weighted imaging images corresponding to decreased signal on apparent diffusion coefficient map indicative of restricted diffusion, consistent with ischemia and cytotoxic edema. These areas matched the areas of abnormal T2-weighted signal and cord swelling observed on conventional spinal MRI. This small exploratory descriptive study indicates feasibility and possible usefulness of reduced field-of-view diffusion-weighted imaging MRI in dogs and cats with suspected acute ischemic myelopathy and that it may be added to the imaging protocol of the spine in such patients in an appropriate clinical setting.
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Affiliation(s)
- Wilfried Mai
- Department of Clinical Sciences and Advanced Medicine, Section of Radiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
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18
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Noguerol TM, Barousse R, Amrhein TJ, Royuela-del-Val J, Montesinos P, Luna A. Optimizing Diffusion-Tensor Imaging Acquisition for Spinal Cord Assessment: Physical Basis and Technical Adjustments. Radiographics 2020; 40:403-427. [DOI: 10.1148/rg.2020190058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Teodoro Martín Noguerol
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Rafael Barousse
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Timothy J. Amrhein
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Javier Royuela-del-Val
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Paula Montesinos
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Antonio Luna
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
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19
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Kanamoto H, Norimoto M, Eguchi Y, Oikawa Y, Orita S, Inage K, Abe K, Inoue M, Kinoshita H, Umimura T, Matsumoto K, Masuda Y, Furuya T, Koda M, Aoki Y, Watanabe A, Takahashi K, Ohtori S. Evaluating Spinal Canal Lesions Using Apparent Diffusion Coefficient Maps with Diffusion-Weighted Imaging. Asian Spine J 2020; 14:312-319. [PMID: 32050309 PMCID: PMC7280930 DOI: 10.31616/asj.2019.0266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/06/2019] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Observational study. PURPOSE To evaluate healthy volunteers and patients with spinal canal lesions using apparent diffusion coefficient (ADC) maps with diffusion-weighted imaging. OVERVIEW OF LITERATURE Decompression surgery for lumbar spinal stenosis (LSS) is selected on the basis of subjective assessment and cross-sectional magnetic resonance imaging (MRI). However, there is no objective standard for this procedure. METHODS We performed 3T MRI in 10 healthy volunteers and 13 patients with LSS. The ADC values in the spinal canal were evaluated at 46 vertebrae (L4/5 and L5/S1 for each participant), and the reduced and conventional fields of view were compared. RESULTS The ADC values were 2.72±0.12 at L4/5 in healthy volunteers, 2.76±0.19 at L5/S1 in healthy volunteers, 1.77±0.58 at L4/5 in patients with LSS, and 2.35±0.29 at L5/S1 in patients with LSS. The ADC value at L4/5 in patients with LSS was significantly lower than that at L5/S1 in patients with LSS and that at L4/5 and L5/S1 in healthy volunteers (p <0.05). With an ADC cutoff value of 2.46 to identify LSS, this approach provided an area under the curve of 0.81, sensitivity of 0.92, and specificity of 0.76 (p <0.05). CONCLUSIONS Preoperative examination using ADC maps permits visualization and quantification of spinal canal lesions, thus proving the utility of ADC maps in the selection of decompression surgery for LSS.
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Affiliation(s)
- Hirohito Kanamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Yasuhiro Oikawa
- Division of Orthopaedic Surgery, Chiba Children's Hospital, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideyuki Kinoshita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomotaka Umimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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20
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Fratini M, Abdollahzadeh A, DiNuzzo M, Salo RA, Maugeri L, Cedola A, Giove F, Gröhn O, Tohka J, Sierra A. Multiscale Imaging Approach for Studying the Central Nervous System: Methodology and Perspective. Front Neurosci 2020; 14:72. [PMID: 32116518 PMCID: PMC7019007 DOI: 10.3389/fnins.2020.00072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/20/2020] [Indexed: 12/11/2022] Open
Abstract
Non-invasive imaging methods have become essential tools for understanding the central nervous system (CNS) in health and disease. In particular, magnetic resonance imaging (MRI) techniques provide information about the anatomy, microstructure, and function of the brain and spinal cord in vivo non-invasively. However, MRI is limited by its spatial resolution and signal specificity. In order to mitigate these shortcomings, it is crucial to validate MRI with an array of ancillary ex vivo imaging techniques. These techniques include histological methods, such as light and electron microscopy (EM), which can provide specific information on the tissue structure in healthy and diseased brain and spinal cord, at cellular and subcellular level. However, these conventional histological techniques are intrinsically two-dimensional (2D) and, as a result of sectioning, lack volumetric information of the tissue. This limitation can be overcome with genuine three-dimensional (3D) imaging approaches of the tissue. 3D highly resolved information of the CNS achievable by means of other imaging techniques can complement and improve the interpretation of MRI measurements. In this article, we provide an overview of different 3D imaging techniques that can be used to validate MRI. As an example, we introduce an approach of how to combine diffusion MRI and synchrotron X-ray phase contrast tomography (SXRPCT) data. Our approach paves the way for a new multiscale assessment of the CNS allowing to validate and to improve our understanding of in vivo imaging (such as MRI).
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Affiliation(s)
- Michela Fratini
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Institute of Nanotechnology-CNR c/o Physics Department, Sapienza University of Rome, Rome, Italy
| | - Ali Abdollahzadeh
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Raimo A. Salo
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Alessia Cedola
- Institute of Nanotechnology-CNR c/o Physics Department, Sapienza University of Rome, Rome, Italy
| | - Federico Giove
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche Enrico Fermi, Rome, Italy
| | - Olli Gröhn
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jussi Tohka
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Alejandra Sierra
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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21
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Takeuchi M, Matsuzaki K, Bando Y, Harada M. Reduced field-of-view diffusion-weighted MR imaging for assessing the local extent of uterine cervical cancer. Acta Radiol 2020; 61:267-275. [PMID: 31154804 DOI: 10.1177/0284185119852733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Recently, the evaluation of the tumor size and local extension of early-stage uterine cervical cancer on magnetic resonance imaging is important for the accurate clinical staging and to determine the indication of less extensive surgery such as fertility sparing radical trachelectomy. Purpose To compare the diagnostic ability of reduced field-of-view diffusion-weighted imaging with those of three-dimensional (3D) contrast-enhanced T1-weighted imaging and T2-weighted imaging for assessing the tumor margin delineation and local extent of uterine cervical cancer. Material and Methods 3T magnetic resonance images, including T2-weighted imaging, reduced field-of-view diffusion-weighted imaging, and 3D contrast-enhanced T1-weighted imaging, in 27 women with surgically proven cervical cancer (19 FIGO stage IB1, 3 IB2, and 5 IIA1) were retrospectively evaluated. Tumor margins and local tumor extent, including the presence of invasion to parametrium and vagina were evaluated on both sagittal and oblique axial (short axis) images; the results were compared with histologically confirmed tumor extension. Results Reduced field-of-view diffusion-weighted imaging diagnosed the tumor margins, which was more accurate than T2-weighted imaging ( P<0.001) and slightly better than 3D contrast-enhanced T1-weighted imaging. Reduced field-of-view diffusion-weighted imaging could define the tumor margins well even in small lesions (≤ 20 mm). Histological examination revealed parametrial invasion in two cases (clinically under-staged) and vaginal invasion in four cases. Reduced field-of-view diffusion-weighted imaging could demonstrate local extension of all lesions, which was more accurate than clinical examination and T2-weighted imaging. Conclusion Addition of reduced field-of-view diffusion-weighted imaging may improve the staging accuracy of magnetic resonance imaging for cervical cancer in assessing the local tumor extent.
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Affiliation(s)
- Mayumi Takeuchi
- Department of Radiology, Tokushima University, Tokushima, Japan
| | - Kenji Matsuzaki
- Department of Radiological Technology, Tokushima Bunri University, Kagawa, Japan
| | - Yoshimi Bando
- Division of Pathology, Tokushima University Hospital, Tokushima, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University, Tokushima, Japan
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Borggreve AS, Goense L, van Rossum PSN, Heethuis SE, van Hillegersberg R, Lagendijk JJW, Lam MGEH, van Lier ALHMW, Mook S, Ruurda JP, van Vulpen M, Voncken FEM, Aleman BMP, Bartels-Rutten A, Ma J, Fang P, Musall BC, Lin SH, Meijer GJ. Preoperative Prediction of Pathologic Response to Neoadjuvant Chemoradiotherapy in Patients With Esophageal Cancer Using 18F-FDG PET/CT and DW-MRI: A Prospective Multicenter Study. Int J Radiat Oncol Biol Phys 2020; 106:998-1009. [PMID: 31987972 DOI: 10.1016/j.ijrobp.2019.12.038] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 11/06/2019] [Accepted: 12/26/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Accurate preoperative prediction of pathologic response to neoadjuvant chemoradiotherapy (nCRT) in patients with esophageal cancer could enable omission of esophagectomy in patients with a pathologic complete response (pCR). This study aimed to evaluate the individual and combined value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) during and after nCRT to predict pathologic response in patients with esophageal cancer. METHODS AND MATERIALS In this multicenter prospective study, patients scheduled to receive nCRT followed by esophagectomy for esophageal cancer underwent 18F-FDG PET/CT and DW-MRI scanning before the start of nCRT, during nCRT, and before esophagectomy. Response to nCRT was based on histopathologic evaluation of the resection specimen. Relative changes in 18F-FDG PET/CT and DW-MRI parameters were compared between patients with pCR and non-pCR groups. Multivariable ridge regression analyses with bootstrapped c-indices were performed to evaluate the individual and combined value of 18F-FDG PET/CT and DW-MRI. RESULTS pCR was found in 26.1% of 69 patients. Relative changes in 18F-FDG PET/CT parameters after nCRT (Δ standardized uptake value [SUV]mean,postP = .016, and Δ total lesion glycolysis postP = .024), as well as changes in DW-MRI parameters during nCRT (Δ apparent diffusion coefficient [ADC]duringP = .008) were significantly different between pCR and non-pCR. A c-statistic of 0.84 was obtained for a model with ΔADCduring, ΔSUVmean,post, and histology in classifying patients as pCR (versus 0.82 for ΔADCduring and 0.79 for ΔSUVmean,post alone). CONCLUSIONS Changes on 18F-FDG PET/CT after nCRT and early changes on DW-MRI during nCRT can help identify pCR to nCRT in esophageal cancer. Moreover, 18F-FDG PET/CT and DW-MRI might be of complementary value in the assessment of pCR.
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Affiliation(s)
- Alicia S Borggreve
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Lucas Goense
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Peter S N van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Sophie E Heethuis
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Jan J W Lagendijk
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marnix G E H Lam
- Department of Nuclear Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Astrid L H M W van Lier
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Stella Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Francine E M Voncken
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Annemarieke Bartels-Rutten
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Penny Fang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin C Musall
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gert J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands.
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Kim LH, Lee EH, Galvez M, Aksoy M, Skare S, O’Halloran R, Edwards MSB, Holdsworth SJ, Yeom KW. Reduced field of view echo-planar imaging diffusion tensor MRI for pediatric spinal tumors. J Neurosurg Spine 2019; 31:607-615. [PMID: 31277060 PMCID: PMC6942637 DOI: 10.3171/2019.4.spine19178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spine MRI is a diagnostic modality for evaluating pediatric CNS tumors. Applying diffusion-weighted MRI (DWI) or diffusion tensor imaging (DTI) to the spine poses challenges due to intrinsic spinal anatomy that exacerbates various image-related artifacts, such as signal dropouts or pileups, geometrical distortions, and incomplete fat suppression. The zonal oblique multislice (ZOOM)-echo-planar imaging (EPI) technique reduces geometric distortion and image blurring by reducing the field of view (FOV) without signal aliasing into the FOV. The authors hypothesized that the ZOOM-EPI method for spine DTI in concert with conventional spinal MRI is an efficient method for augmenting the evaluation of pediatric spinal tumors. METHODS Thirty-eight consecutive patients (mean age 8 years) who underwent ZOOM-EPI spine DTI for CNS tumor workup were retrospectively identified. Patients underwent conventional spine MRI and ZOOM-EPI DTI spine MRI. Two blinded radiologists independently reviewed two sets of randomized images: conventional spine MRI without ZOOM-EPI DTI, and conventional spine MRI with ZOOM-EPI DTI. For both image sets, the reviewers scored the findings based on lesion conspicuity and diagnostic confidence using a 5-point Likert scale. The reviewers also recorded presence of tumors. Quantitative apparent diffusion coefficient (ADC) measurements of various spinal tumors were extracted. Tractography was performed in a subset of patients undergoing presurgical evaluation. RESULTS Sixteen patients demonstrated spinal tumor lesions. The readers were in moderate agreement (kappa = 0.61, 95% CI 0.30-0.91). The mean scores for conventional MRI and combined conventional MRI and DTI were as follows, respectively: 3.0 and 4.0 for lesion conspicuity (p = 0.0039), and 2.8 and 3.9 for diagnostic confidence (p < 0.001). ZOOM-EPI DTI identified new lesions in 3 patients. In 3 patients, tractography used for neurosurgical planning showed characteristic fiber tract projections. The mean weighted ADCs of low- and high-grade tumors were 1201 × 10-6 and 865 × 10-6 mm2/sec (p = 0.002), respectively; the mean minimum weighted ADCs were 823 × 10-6 and 474 × 10-6 mm2/sec (p = 0.0003), respectively. CONCLUSIONS Diffusion MRI with ZOOM-EPI can improve the detection of spinal lesions while providing quantitative diffusion information that helps distinguish low- from high-grade tumors. By adding a 2-minute DTI scan, quantitative diffusion information and tract profiles can reliably be obtained and serve as a useful adjunct to presurgical planning for pediatric spinal tumors.
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Affiliation(s)
- Lily H. Kim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford
| | - Edward H. Lee
- Department of Electrical Engineering, Stanford University, Stanford, California
| | - Michelle Galvez
- Department of Radiology, Stanford University School of Medicine, Stanford
| | - Murat Aksoy
- Department of Radiology, Stanford University School of Medicine, Stanford
| | - Stefan Skare
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Rafael O’Halloran
- Hyperfine Research Inc., Guilford, Connecticut; University of Auckland, New Zealand
| | | | - Samantha J. Holdsworth
- Department of Anatomy and Medical Imaging & Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Kristen W. Yeom
- Department of Radiology, Stanford University School of Medicine, Stanford
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Chung HY, Chui ETF, Lee KH, Tsang HHL, Chan SCW, Lau CS. ASDAS is associated with both the extent and intensity of DW-MRI spinal inflammation in active axial spondyloarthritis. RMD Open 2019; 5:e001008. [PMID: 31452930 PMCID: PMC6691514 DOI: 10.1136/rmdopen-2019-001008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 01/27/2023] Open
Abstract
Objective To investigate the relationship between Ankylosing Spondylitis Disease Activity Score (ASDAS) and intensity of spinal inflammation measured by apparent diffusion coefficient (ADC) in MRI in participants with active axial spondyloarthritis (SpA). Methods Participants with axial SpA and back pain were recruited. Clinical, demographic, biochemical and imaging data were collected. ASDAS was calculated based on C reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Inflammatory lesions were identified in short tau inversion recovery images and the corresponding ADC maps to determine the maximum apparent diffusion coefficient (ADCmax), normalised maximum ADC, mean apparent diffusion coefficient (ADCmean) and normalised mean ADC by two independent readers. Spondyloarthritis Research Consortium of Canada (SPARCC) spine and sacroiliac (SI) joint MRI indexes were determined. Univariate and multivariate linear regression models were used to determine the associations between of ASDAS with ADC values, SPARCC spine and SI MRI scores. Results Eighty-two participants had identifiable ADC lesions. Multivariate analyses using ADCmax and SPARCC spine MRI as independent variables showed associations with ASDAS-CRP (ADCmax: B=0.27, p=0.02; SPARCC: B=0.32, p=0.01) and ASDAS-ESR (ADCmax: B=0.24, p=0.03; SPARCC: B=0.36, p<0.01); using ADCmean and SPARCC spine MRI as independent variables also showed an association with ASDAS-ESR (ADCmean: B=0.22, p=0.05; SPARCC: B=0.36, p<0.01) and a tendency to associate with ASDAS-CRP (ADCmean: B=0.21, p=0.07; SPARCC: B=0.34, p<0.01). Conclusion ASDAS is associated with both the extent and the intensity of spinal inflammation in patients with detectable inflammatory lesions. Our results showed that ASDAS is an objective disease assessment tool. Trial registration number HKUCTR-2087.
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Affiliation(s)
- Ho Yin Chung
- Department Rheumatology and Clinical Immunology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Eva Tsz Fung Chui
- Department Rheumatology and Clinical Immunology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kam Ho Lee
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Helen Hoi Lun Tsang
- Department Rheumatology and Clinical Immunology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Shirley Chiu Wai Chan
- Department Rheumatology and Clinical Immunology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chak Sing Lau
- Department Rheumatology and Clinical Immunology, The University of Hong Kong, Pokfulam, Hong Kong
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El Mendili MM, Querin G, Bede P, Pradat PF. Spinal Cord Imaging in Amyotrophic Lateral Sclerosis: Historical Concepts-Novel Techniques. Front Neurol 2019; 10:350. [PMID: 31031688 PMCID: PMC6474186 DOI: 10.3389/fneur.2019.00350] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/21/2019] [Indexed: 01/13/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common adult onset motor neuron disease with no effective disease modifying therapies at present. Spinal cord degeneration is a hallmark feature of ALS, highlighted in the earliest descriptions of the disease by Lockhart Clarke and Jean-Martin Charcot. The anterior horns and corticospinal tracts are invariably affected in ALS, but up to recently it has been notoriously challenging to detect and characterize spinal pathology in vivo. With recent technological advances, spinal imaging now offers unique opportunities to appraise lower motor neuron degeneration, sensory involvement, metabolic alterations, and interneuron pathology in ALS. Quantitative spinal imaging in ALS has now been used in cross-sectional and longitudinal study designs, applied to presymptomatic mutation carriers, and utilized in machine learning applications. Despite its enormous clinical and academic potential, a number of physiological, technological, and methodological challenges limit the routine use of computational spinal imaging in ALS. In this review, we provide a comprehensive overview of emerging spinal cord imaging methods and discuss their advantages, drawbacks, and biomarker potential in clinical applications, clinical trial settings, monitoring, and prognostic roles.
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Affiliation(s)
- Mohamed Mounir El Mendili
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France
| | - Giorgia Querin
- Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France.,Department of Neurology, Pitié-Salpêtrière University Hospital (APHP), Paris, France
| | - Peter Bede
- Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France.,Department of Neurology, Pitié-Salpêtrière University Hospital (APHP), Paris, France.,Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Pierre-François Pradat
- Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France.,Department of Neurology, Pitié-Salpêtrière University Hospital (APHP), Paris, France
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Lee KH, Chung HY, Xu X, Lau VWH, Lau CS. Apparent Diffusion Coefficient as an Imaging Biomarker for Spinal Disease Activity in Axial Spondyloarthritis. Radiology 2019; 291:121-128. [PMID: 30720403 DOI: 10.1148/radiol.2019180960] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background A quantifiable imaging measure to gauge the intensity of individual inflammatory lesions in axial spondyloarthritis (SpA) has not been well established. Previous studies have shown that diffusion-weighted (DW) MRI reflects disease activity in axial SpA. Purpose To determine the association between apparent diffusion coefficient (ADC) at MRI of discovertebral lesions and disease activity in individuals with axial SpA. Materials and Methods In this prospective study, 243 study participants (mean age ± standard deviation, 43.2 years ± 13.5) with back pain who fulfilled the Assessment of SpondyloArthritis International Society criteria for SpA were recruited from four rheumatology centers between April 2014 and March 2018. There were 132 men (mean age, 41.4 years ± 13.3) and 111 women (mean age, 45.3 years ± 13.4). Clinical, biochemical, and radiologic parameters were collected. All participants underwent whole-spine MRI by using a short inversion time inversion-recovery sequence and DW imaging. Two independent readers identified the presence of discovertebral lesions. ADCs were measured and normalized with normal bone marrow. Regression analysis was performed to determine association between the mean, maximum, and normalized mean and maximum ADCs of the discovertebral lesions and disease activity and functional parameters (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], and Bath Ankylosing Spondylitis Global Index [BASGI]). Results Ninety-one discovertebral lesions (five cervical, 61 thoracic, 25 lumbar) were present in 55 of the 243 study participants (22.6%). After adjusting for confounding factors, increased maximum ADC was independently associated with increased BASFI (regression coefficient [β] = 1.94 [×10-3 mm2/sec], P = .04). Increased normalized maximum ADC was independently associated with BASDAI question 2 (ie, back pain score) (β = 0.45, P = .01), mean stiffness score (β = 0.41, P = .04), and BASGI (β = 0.43, P = .04). Increased normalized mean ADC was independently associated with BASDAI question 2 (β = 0.61, P = .04). Conclusion Apparent diffusion coefficients at MRI of discovertebral lesions were associated with disease activity, functional impairment, and patient global assessment in axial spondyloarthritis. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Guermazi and Roemer in this issue.
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Affiliation(s)
- Kam Ho Lee
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Ho Yin Chung
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Xiaopei Xu
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Vince W H Lau
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
| | - Chak Sing Lau
- From the Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, HKSAR (K.H.L., V.W.H.L.); Division of Rheumatology and Clinical Immunology, Department of Medicine (H.Y.C., C.S.L.), and Department of Diagnostic Radiology (X.X.), University of Hong Kong, Pokfulam, Hong Kong, HKSAR
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Abstract
There are many ways to image the spine. Although there is not one correct and many incorrect ways, the choice of sequences and parameters allows optimization of the protocol to the particular question that is to be answered and also to the particular preferences of the Radiologist.
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Higaki T, Nakamura Y, Tatsugami F, Kaichi Y, Akagi M, Akiyama Y, Baba Y, Iida M, Awai K. Introduction to the Technical Aspects of Computed Diffusion-weighted Imaging for Radiologists. Radiographics 2018; 38:1131-1144. [DOI: 10.1148/rg.2018170115] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Toru Higaki
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Yuko Nakamura
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Fuminari Tatsugami
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Yoko Kaichi
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Motonori Akagi
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Yuij Akiyama
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Yasutaka Baba
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Makoto Iida
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Kazuo Awai
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
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Sartoretti T, Sartoretti E, Binkert C, Gutzeit A, Reischauer C, Czell D, Wyss M, Brüllmann E, Sartoretti-Schefer S. Diffusion-Weighted Zonal Oblique Multislice-EPI Enhances the Detection of Small Lesions with Diffusion Restriction in the Brain Stem and Hippocampus: A Clinical Report of Selected Cases. AJNR Am J Neuroradiol 2018; 39:1255-1259. [PMID: 29700045 DOI: 10.3174/ajnr.a5635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/05/2018] [Indexed: 12/30/2022]
Abstract
Diffusion restriction is the morphologic hallmark of acute ischemic infarcts and excitotoxic brain injury in various cerebral pathologies. Diffusion restriction is visible as hyperintensity on DWI and as hypointensity on ADC maps. Due to the vicinity of multiple anatomic structures in the brain stem and hippocampus, very small lesions with diffusion restriction may result in severe clinical symptomatology, but these small lesions easily go undetected on standard cerebral DWI due to insufficient spatial resolution, T2* blurring, and image artifacts caused by susceptibility-related image distortions. Diffusion-weighted zonal oblique multislice-EPI with reduced FOV acquisition permits a considerable increase in spatial resolution and enhances the visualization of very small pathologic lesions in the brain stem and hippocampus. Improved performance in the depiction of different pathologic lesions with diffusion restriction in the brain stem and hippocampus using this sequence compared with standard DWI in selected cases is presented.
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Affiliation(s)
- T Sartoretti
- From the Institut für Radiologie (T.S., E.S., C.B., M.W., S.S.-S.), Kantonsspital Winterthur, Winterthur, Switzerland
| | - E Sartoretti
- From the Institut für Radiologie (T.S., E.S., C.B., M.W., S.S.-S.), Kantonsspital Winterthur, Winterthur, Switzerland
| | - C Binkert
- From the Institut für Radiologie (T.S., E.S., C.B., M.W., S.S.-S.), Kantonsspital Winterthur, Winterthur, Switzerland
| | - A Gutzeit
- Institut für Radiologie und Nuklearmedizin (A.G., C.R.), Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - C Reischauer
- Institut für Radiologie und Nuklearmedizin (A.G., C.R.), Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - D Czell
- Medizinische Klinik (D.C.), Abteilung für Neurologie, Uznach, Switzerland
| | - M Wyss
- From the Institut für Radiologie (T.S., E.S., C.B., M.W., S.S.-S.), Kantonsspital Winterthur, Winterthur, Switzerland
- Philips HealthSystems (M.W., E.B.), Zürich, Switzerland
| | - E Brüllmann
- Philips HealthSystems (M.W., E.B.), Zürich, Switzerland
| | - S Sartoretti-Schefer
- From the Institut für Radiologie (T.S., E.S., C.B., M.W., S.S.-S.), Kantonsspital Winterthur, Winterthur, Switzerland
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Vargas MI, Delattre BMA, Boto J, Gariani J, Dhouib A, Fitsiori A, Dietemann JL. Advanced magnetic resonance imaging (MRI) techniques of the spine and spinal cord in children and adults. Insights Imaging 2018; 9:549-557. [PMID: 29858818 PMCID: PMC6108966 DOI: 10.1007/s13244-018-0626-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/19/2018] [Accepted: 04/05/2018] [Indexed: 12/14/2022] Open
Abstract
Abstract In this article, we illustrate the main advanced magnetic resonance imaging (MRI) techniques used for imaging of the spine and spinal cord in children and adults. This work focuses on daily clinical practice and aims to address the most common questions and needs of radiologists. We will also provide tips to solve common problems with which we were confronted. The main clinical indications for each MR technique, possible pitfalls and the challenges faced in spine imaging because of anatomical and physical constraints will be discussed. The major advanced MRI techniques dealt with in this article are CSF, (cerebrosopinal fluid) flow, diffusion, diffusion tensor imaging (DTI), MRA, dynamic contrast-enhanced T1-weighted perfusion, MR angiography, susceptibility-weighted imaging (SWI), functional imaging (fMRI) and spectroscopy. Teaching Points • DWI is essential to diagnose cord ischaemia in the acute stage. • MRA is useful to guide surgical planning or endovascular embolisation of AVMs. • Three Tesla is superior to 1.5 T for spine MR angiography and spectroscopy. • Advanced sequences should only be used together with conventional morphological sequences.
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Affiliation(s)
- M I Vargas
- Division of Neuroradiology, DISIM, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
| | - B M A Delattre
- Division of Radiology, DISIM, Geneva University Hospitals, Geneva, Switzerland
| | - J Boto
- Division of Neuroradiology, DISIM, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - J Gariani
- Division of Radiology, DISIM, Geneva University Hospitals, Geneva, Switzerland
| | - A Dhouib
- Division of Radiology, DISIM, Geneva University Hospitals, Geneva, Switzerland
| | - A Fitsiori
- Division of Neuroradiology, DISIM, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - J L Dietemann
- Division of Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
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Alizadeh M, Fisher J, Saksena S, Sultan Y, Conklin CJ, Middleton DM, Krisa L, Finsterbusch J, Flanders AE, Faro SH, Mulcahey MJ, Mohamed FB. Age related diffusion and tractography changes in typically developing pediatric cervical and thoracic spinal cord. Neuroimage Clin 2018; 18:784-792. [PMID: 29876264 PMCID: PMC5988463 DOI: 10.1016/j.nicl.2018.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 03/02/2018] [Accepted: 03/14/2018] [Indexed: 12/14/2022]
Abstract
Background and objective Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) are two techniques that can measure white matter integrity of the spinal cord. Recently, DTI indices have been shown to change with age. The purpose of this study is (a) to evaluate the maturational states of the entire pediatric spinal cord using DTI and DTT indices including fractional anisotropy (FA), mean diffusivity (MD), mean length of white matter fiber tracts and tract density and (b) to analyze the DTI and DTT parameters along the entire spinal cord as a function of spinal cord levels and age. Method A total of 23 typically developing (TD) pediatric subjects ranging in age from 6 to 16 years old (11.94 ± 3.26 (mean ± standard deviation), 13 females and 10 males) were recruited, and scanned using 3.0 T MR scanner. Reduced FOV diffusion tensor images were acquired axially in the same anatomical location prescribed for the T2-weighted images to cover the entire spinal cord (C1-mid L1 levels). To mitigate motion induced artifacts, diffusion directional images were aligned with the reference image (b0) using a rigid body registration algorithm performed by in-house software developed in Matlab (MathWorks, Natick, Massachusetts). Diffusion tensor maps (FA and MD) and streamline deterministic tractography were then generated from the motion corrected DTI dataset. DTI and DTT parameters were calculated by using ROIs drawn to encapsulate the whole cord along the entire spinal cord by an independent board certified neuroradiologist. These indices then were compared between two age groups (age group A = 6-11 years (n = 11) and age group B = 12-16 years (n = 12)) based on similar standards and age definitions used for reporting spinal cord injury in the pediatric population. Standard least squared linear regression based on a restricted maximum likelihood (REML) method was used to evaluate the relationship between age and DTI and DTT parameters. Results An increase in FA (group A = 0.42 ± 0.097, group B = 0.49 ± 0.116), white matter tract density (group A = 368.01 ± 236.88, group B = 440.13 ± 245.24) and mean length of fiber tracts (group A = 48.16 ± 20.48 mm, group B = 60.28 ± 23.87 mm) and a decrease in MD (group A = 1.06 ± 0.23 × 10-3 mm2/s, group B = 0.82 ± 0.24 × 10-3 mm2/s) were observed with age along the entire spinal cord. Statistically significant increases have been shown in FA (p = 0.004, R2 = 0.57), tract density (p = 0.0004, R2 = 0.58), mean length of fiber tracts (p < 0.001, R2 = 0.5) and a significant decrease has been shown in MD (p = 0.002, R2 = 0.59) between group A and group B. Also, it has been shown DTI and DTT parameters vary along the spinal cord as a function of intervertebral disk and mid-vertebral body level. Conclusion This study provides an initial understanding of age related changes of DTI values as well as DTT metrics of the spinal cord. The results show significant differences in DTI and DTT parameters which may result from decreasing water content, myelination of fiber tracts, and the thickening diameter of fiber tracts during the maturation process. Consequently, when quantitative DTI and DTT of the spinal cord is undertaken in the pediatric population an age and level matched normative dataset should be used to accurately interpret the quantitative results.
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Affiliation(s)
- Mahdi Alizadeh
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States; Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Joshua Fisher
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Sona Saksena
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Yusra Sultan
- Department of Biology, Drexel University, Philadelphia, PA, United States
| | - Chris J Conklin
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Devon M Middleton
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Laura Krisa
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jürgen Finsterbusch
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adam E Flanders
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Scott H Faro
- Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - M J Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Feroze B Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States.
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Chowdhary AS, Durai B, Mohanty J. MRI EVALUATION OF SPINAL CORD TUMOURS WITH HISTOPATHOLOGICAL CORRELATION. ACTA ACUST UNITED AC 2017. [DOI: 10.18410/jebmh/2017/1206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Xu X, Geng H, Zhang Q, Yu J, Chu Y, Dong G, Wu J. Investigation of 3D reduced field of view carotid atherosclerotic plaque imaging. Magn Reson Imaging 2017; 49:10-15. [PMID: 28958875 DOI: 10.1016/j.mri.2017.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/19/2017] [Accepted: 09/23/2017] [Indexed: 11/25/2022]
Abstract
To investigate the feasibility of using CUBE based reduced field of view imaging in atherosclerotic plaque imaging. Twenty-four patients were enrolled in this prospective study (13 males, 11 females, age 63±10). All patients underwent MRI exams consisting of 3D TOF, MPRAGE, iMSDE, DANTE, full FOV and reduced FOV CUBE imaging; 18 patients under went contrast enhanced imaging. The resulting images from different imaging sequences were assessed in terms of blood suppression, SNR, motion artifacts and vascular clarity. Reduced field of view CUBE outperformed MPRAGE, iMSDE and full FOV CUBE in blood suppression (P<0.05); outperformed MPRAGE, iMSDE and DANTE in SNR(P<005); outperformed MPRAGE and iMSDE in motion artifacts (P<005); outperformed MPRAGE and iMSDE in vascular clarity (P<0.05). The identifications of hemorrhage and calcification components were consistent between full FOV CUBE and reduced FOV CUBE (P<0.05). Overall, CUBE combined with reduced field of view imaging would be a promising method in atherosclerotic plaque imaging.
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Affiliation(s)
- Xueyan Xu
- Weifang People's Hospital, Weifang, Shandong, China
| | - Hai Geng
- Weifang People's Hospital, Weifang, Shandong, China
| | - Qiang Zhang
- Weifang People's Hospital, Weifang, Shandong, China
| | - Jianmin Yu
- Weifang People's Hospital, Weifang, Shandong, China
| | - Yujing Chu
- Weifang People's Hospital, Weifang, Shandong, China
| | - Guang Dong
- Weifang People's Hospital, Weifang, Shandong, China
| | - Jun Wu
- Weifang People's Hospital, Weifang, Shandong, China.
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Rutman AM, Peterson DJ, Cohen WA, Mossa-Basha M. Diffusion Tensor Imaging of the Spinal Cord: Clinical Value, Investigational Applications, and Technical Limitations. Curr Probl Diagn Radiol 2017; 47:257-269. [PMID: 28869104 DOI: 10.1067/j.cpradiol.2017.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022]
Abstract
Although diffusion-weighted imaging (DWI) has become a mainstay in modern brain imaging, it remains less utilized in the evaluation of the spinal cord. Many studies have shown promise in using DWI and diffusion-tensor imaging (DTI) for evaluation of the spinal cord; however, application has been stalled by technical obstacles and artifacts, and questions remain regarding its clinical utility on an individual examination level. This review discusses the background, concepts, and technical aspects of DWI and DTI, specifically for imaging of the spinal cord. The clinical and investigational applications of spinal cord DTI, as well as the practical difficulties and limitations of DWI and DTI for the evaluation of the spinal cord are examined.
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Affiliation(s)
- Aaron M Rutman
- Department of Radiology, University of Washington, Seattle, WA.
| | | | - Wendy A Cohen
- Department of Radiology, University of Washington, Seattle, WA
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Panara V, Navarra R, Mattei PA, Piccirilli E, Cotroneo AR, Papinutto N, Henry RG, Uncini A, Caulo M. Spinal cord microstructure integrating phase-sensitive inversion recovery and diffusional kurtosis imaging. Neuroradiology 2017; 59:819-827. [PMID: 28676888 DOI: 10.1007/s00234-017-1864-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/13/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of this prospective study was to determine the feasibility in terms of repeatability and reproducibility of diffusional kurtosis imaging (DKI) for microstructural assessment of the normal cervical spinal cord (cSC) using a phase-sensitive inversion recovery (PSIR) sequence as the anatomical reference for accurately defining white-matter (WM) and gray-matter (GM) regions of interests (ROIs). METHODS Thirteen young healthy subjects were enrolled to undergo DKI and PSIR sequences in the cSC. The repeatability and reproducibility of kurtosis metrics and fractional anisotropy (FA) were calculated in GM, WM, and cerebral-spinal-fluid (CSF) ROIs drawn by two independent readers on PSIR images of three different levels (C1-C4). The presence of statistically significant differences in DKI metrics for levels, ROIs (GM, WM, and CSF) repeatability, reproducibility, and inter-reader agreement was evaluated. RESULTS Intra-class correlation coefficients between the two readers ranged from good to excellent (0.75 to 0.90). The inferior level consistently had the highest concordance. The lower values of scan-rescan variability for all DKI parameters were found for the inferior level. Statistically significant differences in kurtosis values were not found in the lateral white-matter bundles of the spinal cord. CONCLUSION The integration of DKI and PSIR sequences in a clinical MR acquisition to explore the regional microstructure of the cSC in healthy subjects is feasible, and the results obtainable are reproducible. Further investigation will be required to verify the possibility to translate this method to a clinical setting to study patients with SC involvement especially in the absence of MRI abnormalities on standard sequences.
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Affiliation(s)
- V Panara
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. "D'Annunzio", Chieti, Italy. .,ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy.
| | - R Navarra
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. "D'Annunzio", Chieti, Italy.,ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy
| | - P A Mattei
- ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy.,Department of Medicine and Science of Aging, Ophthalmology Clinic, University "G. d'Annunzio", Chieti, Italy
| | - E Piccirilli
- ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy
| | - A R Cotroneo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. "D'Annunzio", Chieti, Italy
| | - N Papinutto
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - R G Henry
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - A Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. "D'Annunzio", Chieti, Italy
| | - M Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. "D'Annunzio", Chieti, Italy.,ITAB Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Via Luigi Polacchi, 11 66100, Chieti, Italy
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Clinical utility for diffusion MRI sequence in emergency and inpatient spine protocols. Clin Imaging 2017; 45:37-50. [PMID: 28601735 DOI: 10.1016/j.clinimag.2017.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/10/2017] [Accepted: 05/30/2017] [Indexed: 11/20/2022]
Abstract
Diffusion imaging of the spine has the potential to change clinical management, but is challenging due to the small size of the cord and susceptibility artifacts from adjacent structures. Reduced field-of-view (rFOV) diffusion can improve image quality by decreasing the echo train length. Over the past 2 years, we have acquired a rFOV diffusion sequence for MRI spine protocols on most inpatients and emergency room patients. We provide selected imaging diagnoses to illustrate the utility of including diffusion spine MRI in clinical practice. Our experiences support using diffusion MRI to improve diagnostic certainty and facilitate prompt treatment or clinical management.
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Abdelgawad MS, Reda MIS, El-Maaboud NAEMA. Diffusion tensor MR fiber tractography in assessment of inflammatory processes and neoplasms of the cervical cord. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Wang LL, Bierbrauer KS. Congenital and Hereditary Diseases of the Spinal Cord. Semin Ultrasound CT MR 2017; 38:105-125. [PMID: 28347415 DOI: 10.1053/j.sult.2016.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Congenital anomalies of the spinal cord can pose a diagnostic dilemma to the radiologist. Several classification systems of these anomalies exist. Antenatal ultrasound and fetal magnetic resonance imaging is playing an increasingly important role in the early diagnosis and management of patients. Understanding the underlying anatomy as well as embryology of these disorders can be valuable in correctly identifying the type of spinal cord dysraphic defect. Hereditary spinal cord diseases are rare but can be devastating. When the onset is in adulthood, delay in diagnosis is common. Although the spine findings are nonspecific, some imaging features combined with brain imaging findings can be distinctive. Sometimes, the radiologist may be the first to raise the possibility of these disorders.
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Affiliation(s)
- Lily L Wang
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Karin S Bierbrauer
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Cuvinciuc V, Viallon M, Barnaure I, Vargas MI, Lovblad KO, Haller S. Dynamic Contrast-Enhanced MR Perfusion of Intradural Spinal Lesions. AJNR Am J Neuroradiol 2017; 38:192-194. [PMID: 27856434 DOI: 10.3174/ajnr.a4995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/03/2016] [Indexed: 11/07/2022]
Abstract
Fifteen patients with intradural spinal lesions were examined with an optimized dynamic contrast-enhanced MR perfusion sequence at 1.5T and 3T. SNR and mean contrast-to-noise ratio were better on 3T compared with 1.5T (P ≤ .05). The goodness of fit of the Tofts and Tofts extended pharmacokinetic models was similar between 1.5T and 3T. Thus, dynamic contrast-enhanced MR perfusion of intradural spinal canal lesions is technically feasible at 1.5T and 3T, with better image quality at 3T.
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Affiliation(s)
- V Cuvinciuc
- From the Departments of Neuroradiology (V.C., I.B., M.I.V., K.-O.L., S.H.)
- Centre d'Imagerie Rive Droite (V.C.), Geneva, Switzerland
| | - M Viallon
- Radiology (M.V.), Geneva University Hospitals, Geneva, Switzerland
- Université de Lyon, INSA de Lyon, Université Jean-Monnet, CHU de Saint-Etienne, CREATIS CNRS 5220, INSERM 1206, F-42055, Saint-Etienne, France (M.V.)
| | - I Barnaure
- From the Departments of Neuroradiology (V.C., I.B., M.I.V., K.-O.L., S.H.)
| | - M I Vargas
- From the Departments of Neuroradiology (V.C., I.B., M.I.V., K.-O.L., S.H.)
| | - K-O Lovblad
- From the Departments of Neuroradiology (V.C., I.B., M.I.V., K.-O.L., S.H.)
| | - S Haller
- From the Departments of Neuroradiology (V.C., I.B., M.I.V., K.-O.L., S.H.)
- Affidea Centre de Diagnostique Radiologique de Carouge (S.H.), Geneva, Switzerland
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Backens M. [Basic principles and technique of diffusion-weighted imaging and diffusion tensor imaging]. Radiologe 2016; 55:762-70. [PMID: 26330214 DOI: 10.1007/s00117-015-0004-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Due to their thermal energy, water molecules in tissue are in continuous random motion called diffusion. Water diffusion in pathologically modified tissue (e. g. ischemia, inflammation and neoplasia) is different from normal conditions. Diffusion-weighted magnetic resonance (MR) imaging (DWI) can measure the local strength and main direction of the diffusional motion in any picture element, thus providing diagnostic tissue information exceeding the morphological depiction. METHODS Diffusion-weighted MR sequences are based on the echo planar imaging (EPI) technique which is very rapid but also susceptible to artefacts. Using especially strong magnetic field gradient pulses the MR signal is sensitized to microscopic motion of water molecules resulting in a unique image contrast in addition to T1 and T2. Local deviations of the diffusion strength from normal values indicate pathological processes. The DWI sequences can measure diffusion along any direction; however, in the clinical routine only directionally averaged DWI images (trace maps) are used. Diffusion tensor imaging (DTI) represents an advanced DWI method which specifically explores diffusional anisotropy in order to obtain additional information about tissue microstructure. CONCLUSION Diffusion-weighted MRI is an established technique for the assessment of pathological processes. Although DWI is mainly applied in stroke diagnostics, it is increasingly being used to detect and characterize various lesions in the brain as well as in the whole body. With new sequence techniques imaging artefacts can be significantly reduced. In addition, DTI allows the reconstruction and 3-dimensional visualization of tissue fibre structure. This method has proven to be clinically important primarily for the depiction of nerve tracts in the brain and spinal cord when planning surgical interventions and radiation therapy.
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Affiliation(s)
- M Backens
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Deutschland.
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Role of Diffusion Tensor MR Imaging in Degenerative Cervical Spine Disease: a Review of the Literature. Clin Neuroradiol 2015; 26:265-76. [DOI: 10.1007/s00062-015-0467-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/10/2015] [Indexed: 12/13/2022]
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Shi Y, Zong M, Xu X, Zou Y, Feng Y, Liu W, Wang C, Wang D. Diffusion tensor imaging with quantitative evaluation and fiber tractography of lumbar nerve roots in sciatica. Eur J Radiol 2015; 84:690-5. [DOI: 10.1016/j.ejrad.2015.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/03/2015] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
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Zhang D, Li XH, Zhai X, He XJ. Feasibility of 3.0 T diffusion-weighted nuclear magnetic resonance imaging in the evaluation of functional recovery of rats with complete spinal cord injury. Neural Regen Res 2015; 10:412-8. [PMID: 25878589 PMCID: PMC4396103 DOI: 10.4103/1673-5374.153689] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 12/14/2022] Open
Abstract
Diffusion tensor imaging is a sensitive way to reflect axonal necrosis and degeneration, glial cell regeneration and demyelination following spinal cord injury, and to display microstructure changes in the spinal cord in vivo. Diffusion tensor imaging technology is a sensitive method to diagnose spinal cord injury; fiber tractography visualizes the white matter fibers, and directly displays the structural integrity and resultant damage of the fiber bundle. At present, diffusion tensor imaging is restricted to brain examinations, and is rarely applied in the evaluation of spinal cord injury. This study aimed to explore the fractional anisotropy and apparent diffusion coefficient of diffusion tensor magnetic resonance imaging and the feasibility of diffusion tensor tractography in the evaluation of complete spinal cord injury in rats. The results showed that the average combined scores were obviously decreased after spinal cord transection in rats, and then began to increase over time. The fractional anisotropy scores after spinal cord transection in rats were significantly lower than those in normal rats (P < 0.05); the apparent diffusion coefficient was significantly increased compared with the normal group (P < 0.05). Following spinal cord transection, fractional anisotropy scores were negatively correlated with apparent diffusion coefficient values (r = -0.856, P < 0.01), and positively correlated with the average combined scores (r = 0.943, P < 0.01), while apparent diffusion coefficient values had a negative correlation with the average combined scores (r = -0.949, P < 0.01). Experimental findings suggest that, as a non-invasive examination, diffusion tensor magnetic resonance imaging can provide qualitative and quantitative information about spinal cord injury. The fractional anisotropy score and apparent diffusion coefficient have a good correlation with the average combined scores, which reflect functional recovery after spinal cord injury.
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Affiliation(s)
- Duo Zhang
- Second Department of Orthopedics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xiao-hui Li
- Department of Radiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xu Zhai
- Second Department of Orthopedics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xi-jing He
- Second Department of Orthopedics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
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Leone A, Rigante D, Amato DZ, Casale R, Pedone L, Magarelli N, Colosimo C. Spinal involvement in mucopolysaccharidoses: a review. Childs Nerv Syst 2015; 31:203-12. [PMID: 25358811 DOI: 10.1007/s00381-014-2578-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mucopolysaccharidoses (MPS) represent a group of inheritable lysosomal storage diseases caused by mutations in the genes coding for enzymes involved in catabolism of different glycosaminoglycans (GAGs). They are clinically heterogeneous multisystemic diseases, often involving the spine. Bony abnormalities of the spine included in the so-called dysostosis multiplex and GAG deposits in the dura mater and supporting ligaments can result in spinal cord compression, which can lead to compressive myelopathy. Spinal involvement is a major cause of morbidity and mortality in some MPS (e.g., MPS IVA, VI, and I), and early radiological diagnosis is critical in preventing or arresting neurological deterioration and loss of function. DISCUSSION Management of MPS, however, requires a multidisciplinary approach because of the multiorgan nature of the disease. Indeed in order to appreciate the relevance and nuances of each other's specialty, radiologists and clinicians need to have a background of common knowledge, rather than a merely compartmentalized point of view. In the interest of the management of spinal involvement in MPS, this review article aims on one hand to provide radiologists with important clinical knowledge and on the other hand to equip clinicians with relevant radiological semiotics.
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Affiliation(s)
- Antonio Leone
- Department of Radiological Sciences, Catholic University, School of Medicine, Largo A. Gemelli, 1-00168, Rome, Italy,
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Lorbergs AL, Noseworthy MD, MacIntyre NJ. Age-related differences in the response of leg muscle cross-sectional area and water diffusivity measures to a period of supine rest. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2014; 28:279-90. [PMID: 25316318 DOI: 10.1007/s10334-014-0464-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 09/18/2014] [Accepted: 09/23/2014] [Indexed: 11/30/2022]
Abstract
OBJECT The object was to assess whether cross-sectional area (CSA) and water diffusion properties of leg muscles in young and older women change with increased time spent in supine rest. MATERIALS AND METHODS Healthy young (n = 9, aged 20-30 years) and older (n = 9, aged 65-75 years) women underwent MRI scanning of the right leg at baseline, 30 and 60 min of supine rest. Muscle CSA was derived from proton density images. Water diffusion properties [apparent diffusion coefficient (ADC) and fractional anisotropy (FA)] of the tibialis anterior and posterior, soleus, and medial and lateral heads of the gastrocnemius were derived from diffusion tensor imaging (DTI). Repeated measures ANOVAs and Bonferroni post hoc tests determined the effects of time and group on each muscle outcome. RESULTS In both groups, muscle CSA and FA did not significantly change over time, whereas ADC significantly decreased. A greater decline at 30 min for young women was only observed for ADC in the medial gastrocnemius. CONCLUSION Regardless of age, ADC values decreased with fluid shift associated with time spent supine, whereas CSA and FA were not affected. For leg muscle assessment in young and older women, DTI scanning protocols should consider the amount of time spent in a recumbent position.
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Affiliation(s)
- Amanda L Lorbergs
- School of Rehabilitation Science, McMaster University, IAHS 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada,
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Lin E, Long H, Li G, Lei W. Does diffusion tensor data reflect pathological changes in the spinal cord with chronic injury. Neural Regen Res 2014; 8:3382-90. [PMID: 25206660 PMCID: PMC4146007 DOI: 10.3969/j.issn.1673-5374.2013.36.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/17/2013] [Indexed: 11/29/2022] Open
Abstract
Magnetic resonance diffusion tensor imaging has been shown to quantitatively measure the early pathological changes in chronic cervical spondylotic myelopathy. In this study, a novel spongy polyurethane material was implanted in the rat C3–5 epidural space to establish a rat model of chronic cervical spondylotic myelopathy. Diffusion tensor data were used to predict pathological changes. Results revealed that the fractional anisotropy value gradually decreased at 4, 24, and 72 hours and 1 week after injury in rat spinal cord, showing a time-dependent manner. Average diffusion coefficient increased at 72 hours and 1 week after implantation. Hematoxylin-eosin staining and Luxol-fast-blue staining exhibited that the number of neurons in the anterior horn of the spinal cord gray matter and the nerve fiber density of the white matter gradually reduced with prolonged compression time. Neuronal loss was most significant at 1 week after injury. Results verified that the fractional anisotropy value and average diffusion coefficient reflected the degree of pathological change in the site of compression in rat models at various time points after chronic spinal cord compression injury, which potentially has a reference value in the early diagnosis of chronic cervical spondylotic myelopathy.
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Affiliation(s)
- Erjian Lin
- Department of Radiology, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510700, Guangdong Province, China
| | - Houqing Long
- Department of Spinal Surgery, Huangpu Branch, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510700, Guangdong Province, China
| | - Guangsheng Li
- Department of Orthopedics, Affiliated Hospital of Guangdong Medical College, Zhanjiang 524001, Guangdong Province, China
| | - Wanlong Lei
- Department of Human Anatomy and Histoembryology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510086, Guangdong Province, China
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47
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Chen T, Wu T, Tsui Y, Chen H, Lin C, Lee H, Wu T. Diffusion‐Weighted Magnetic Resonance Imaging and Apparent Diffusion Coefficient Mapping for Diagnosing Infectious Spondylodiscitis: A Preliminary Study. J Neuroimaging 2014; 25:482-7. [DOI: 10.1111/jon.12145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 03/11/2014] [Accepted: 04/26/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tai‐Yuan Chen
- Section of Neuroradiology, Department of Medical Imaging Chi‐Mei Medical Center Tainan Taiwan
- Central Taiwan University of Science and Technology Taichung Taiwan
- Chia Nan University of Pharmacy and Science Tainan Taiwan
- Shu Zen College of Medicine and Management Kaohsiung Taiwan
| | - Te‐Chang Wu
- Section of Neuroradiology, Department of Medical Imaging Chi‐Mei Medical Center Tainan Taiwan
| | - Yu‐Kun Tsui
- Section of Neuroradiology, Department of Medical Imaging Chi‐Mei Medical Center Tainan Taiwan
| | - Hou‐Hsun Chen
- Section of Neuroradiology, Department of Medical Imaging Chi‐Mei Medical Center Tainan Taiwan
| | - Chien‐Jen Lin
- Section of Neuroradiology, Department of Medical Imaging Chi‐Mei Medical Center Tainan Taiwan
| | - Huey‐Jen Lee
- Departments of Radiology and Neuroradiology University Hospital, University of Medicine and Dentistry of New Jersey Newark NJ
| | - Tai‐Ching Wu
- Section of Neuroradiology, Department of Medical Imaging Chi‐Mei Medical Center Tainan Taiwan
- Chia Nan University of Pharmacy and Science Tainan Taiwan
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48
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Moritani T, Kim J, Capizzano AA, Kirby P, Kademian J, Sato Y. Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections. Br J Radiol 2014; 87:20140011. [PMID: 24999081 DOI: 10.1259/bjr.20140011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The incidence of spinal infections has increased in the past two decades, owing to the increasing number of elderly patients, immunocompromised conditions, spinal surgery and instrumentation, vascular access and intravenous drug use. Conventional MRI is the gold standard for diagnostic imaging; however, there are still a significant number of misdiagnosed cases. Diffusion-weighted imaging (DWI) with a b-value of 1000 and apparent diffusion coefficient (ADC) maps provide early and accurate detection of abscess and pus collection. Pyogenic infections are classified into four types of extension based on MRI and DWI findings: (1) epidural/paraspinal abscess with spondylodiscitis, (2) epidural/paraspinal abscess with facet joint infection, (3) epidural/paraspinal abscess without concomitant spondylodiscitis or facet joint infection and (4) intradural abscess (subdural abscess, purulent meningitis and spinal cord abscess). DWI easily detects abscesses and demonstrates the extension, multiplicity and remote disseminated infection. DWI is often a key image in the differential diagnosis. Important differential diagnoses include epidural, subdural or subarachnoid haemorrhage, cerebrospinal fluid leak, disc herniation, synovial cyst, granulation tissue, intra- or extradural tumour and post-surgical fluid collections. DWI and the ADC values are affected by susceptibility artefacts, incomplete fat suppression and volume-averaging artefacts. Recognition of artefacts is essential when interpreting DWI of spinal and paraspinal infections. DWI is not only useful for the diagnosis but also for the treatment planning of pyogenic and non-pyogenic spinal infections.
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Affiliation(s)
- T Moritani
- 1 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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49
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Chan RW, von Deuster C, Giese D, Stoeck CT, Harmer J, Aitken AP, Atkinson D, Kozerke S. Characterization and correction of eddy-current artifacts in unipolar and bipolar diffusion sequences using magnetic field monitoring. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2014; 244:74-84. [PMID: 24880880 DOI: 10.1016/j.jmr.2014.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 04/25/2014] [Accepted: 04/30/2014] [Indexed: 06/03/2023]
Abstract
Diffusion tensor imaging (DTI) of moving organs is gaining increasing attention but robust performance requires sequence modifications and dedicated correction methods to account for system imperfections. In this study, eddy currents in the "unipolar" Stejskal-Tanner and the velocity-compensated "bipolar" spin-echo diffusion sequences were investigated and corrected for using a magnetic field monitoring approach in combination with higher-order image reconstruction. From the field-camera measurements, increased levels of second-order eddy currents were quantified in the unipolar sequence relative to the bipolar diffusion sequence while zeroth and linear orders were found to be similar between both sequences. Second-order image reconstruction based on field-monitoring data resulted in reduced spatial misalignment artifacts and residual displacements of less than 0.43 mm and 0.29 mm (in the unipolar and bipolar sequences, respectively) after second-order eddy-current correction. Results demonstrate the need for second-order correction in unipolar encoding schemes but also show that bipolar sequences benefit from second-order reconstruction to correct for incomplete intrinsic cancellation of eddy-currents.
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Affiliation(s)
- Rachel W Chan
- Centre for Medical Imaging, University College London, London, United Kingdom.
| | - Constantin von Deuster
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Daniel Giese
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Christian T Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Jack Harmer
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Andrew P Aitken
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
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50
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El Mendili MM, Cohen-Adad J, Pelegrini-Issac M, Rossignol S, Morizot-Koutlidis R, Marchand-Pauvert V, Iglesias C, Sangari S, Katz R, Lehericy S, Benali H, Pradat PF. Multi-parametric spinal cord MRI as potential progression marker in amyotrophic lateral sclerosis. PLoS One 2014; 9:e95516. [PMID: 24755826 PMCID: PMC3995720 DOI: 10.1371/journal.pone.0095516] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/27/2014] [Indexed: 12/11/2022] Open
Abstract
Objective To evaluate multimodal MRI of the spinal cord in predicting disease progression and one-year clinical status in amyotrophic lateral sclerosis (ALS) patients. Materials and Methods After a first MRI (MRI1), 29 ALS patients were clinically followed during 12 months; 14/29 patients underwent a second MRI (MRI2) at 11±3 months. Cross-sectional area (CSA) that has been shown to be a marker of lower motor neuron degeneration was measured in cervical and upper thoracic spinal cord from T2-weighted images. Fractional anisotropy (FA), axial/radial/mean diffusivities (λ⊥, λ//, MD) and magnetization transfer ratio (MTR) were measured within the lateral corticospinal tract in the cervical region. Imaging metrics were compared with clinical scales: Revised ALS Functional Rating Scale (ALSFRS-R) and manual muscle testing (MMT) score. Results At MRI1, CSA correlated significantly (P<0.05) with MMT and arm ALSFRS-R scores. FA correlated significantly with leg ALFSRS-R scores. One year after MRI1, CSA predicted (P<0.01) arm ALSFSR-R subscore and FA predicted (P<0.01) leg ALSFRS-R subscore. From MRI1 to MRI2, significant changes (P<0.01) were detected for CSA and MTR. CSA rate of change (i.e. atrophy) highly correlated (P<0.01) with arm ALSFRS-R and arm MMT subscores rate of change. Conclusion Atrophy and DTI metrics predicted ALS disease progression. Cord atrophy was a better biomarker of disease progression than diffusion and MTR. Our study suggests that multimodal MRI could provide surrogate markers of ALS that may help monitoring the effect of disease-modifying drugs.
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Affiliation(s)
- Mohamed-Mounir El Mendili
- Sorbonne Universités, UPMC Univ Paris 06, UM CR 2, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- CNRS, UMR 7371, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- INSERM, U 1146, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
| | - Julien Cohen-Adad
- Ecole Polytechnique de Montréal, Département de Génie Électrique, Montréal, Québec, Canada
| | - Mélanie Pelegrini-Issac
- Sorbonne Universités, UPMC Univ Paris 06, UM CR 2, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- CNRS, UMR 7371, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- INSERM, U 1146, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
| | - Serge Rossignol
- Université de Montréal, GRSNC, Faculty de Médecine, Montréal, Québec, Canada
| | - Régine Morizot-Koutlidis
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département d’Explorations Fonctionnelles Neurologiques, Paris, Île-de-France, France
| | - Véronique Marchand-Pauvert
- Sorbonne Universités, UPMC Univ Paris 06, UM CR 2, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- CNRS, UMR 7371, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- INSERM, U 1146, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
| | - Caroline Iglesias
- Sorbonne Universités, UPMC Univ Paris 06, UM CR 2, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- CNRS, UMR 7371, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- INSERM, U 1146, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
| | - Sina Sangari
- Sorbonne Universités, UPMC Univ Paris 06, UM CR 2, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- CNRS, UMR 7371, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- INSERM, U 1146, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
| | - Rose Katz
- Sorbonne Universités, UPMC Univ Paris 06, UM CR 2, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- CNRS, UMR 7371, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- INSERM, U 1146, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
| | - Stéphane Lehericy
- Inserm U975, UPMC Univ Paris 6, UMR-S975, CNRS UMR7225, Centre de recherche de l’Institut du Cerveau et de la Moelle épinière – CRICM, Centre de Neuroimagerie de Recherche – CENIR, Paris, Île-de-France, France
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neuroradiologie, Paris, Île-de-France, France
| | - Habib Benali
- Sorbonne Universités, UPMC Univ Paris 06, UM CR 2, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- CNRS, UMR 7371, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- INSERM, U 1146, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
| | - Pierre-François Pradat
- Sorbonne Universités, UPMC Univ Paris 06, UM CR 2, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- CNRS, UMR 7371, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- INSERM, U 1146, Laboratoire d’Imagerie Biomédicale, Paris, Île-de-France, France
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Département des Maladies du système Nerveux, Paris, Île-de-France, France
- * E-mail:
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