Magnetic resonance tractography of the cervical spine: A rapid diffusion tensor imaging protocol to serve as a clinical evaluation tool.

Background: Spinal cord injury can lead to long-term disability, but current imaging methods are limited in predicting outcomes. Rapid diffusion tensor imaging (DTI) has shown promise, yet its clinical utility remains underexplored.

Aim: To evaluate the potential applications of a short DTI sequence, incorporated into a cervical spine magnetic resonance imaging (MRI) protocol, for characterizing a range of symptomatic spinal cord pathologies. We propose that cervical spine tractography can provide essential diagnostic information beyond what is currently available from conventional MRI.

Methods: We utilized a quick DTI sequence to create tractography models of the cervical spinal cord in four patients with distinct pathologies of various etiologies: Cord contusion, metastasis, myelopathy, and multiple sclerosis. We used DSI Studio software for post-processing of tractography cases. Fiber tract findings for each pathology case were compared to five control cases from the same scanner by looking for individual differences in white matter tract integrity based on the fractional anisotropy (FA) and mean diffusivity (MD) of the regions of interest from controls. These correlated with clinical presentations and conventional MRI findings.

Results: Control cases showed consistent and intact tract patterns with stable FA and MD values. In pathological cases, abnormalities in fiber orientation and tract continuity correlated with clinical symptoms and lesion locations.

Conclusion: The tractography models can provide additional information on white matter disruption that was not discernible on standard MRI sequences. However, its clinical use remains limited due to the need for specialized imaging protocols and complex post-processing, restricting its use to mostly academic settings.