Jalal Badi Andre MD, Presenter: Nothing to Disclose

Emine Ulku Saritas PhD, Abstract Co-Author: Nothing to Disclose

Sirisha Komakula MBBS, Abstract Co-Author: Nothing to Disclose

Jarrett Rosenberg PhD, Abstract Co-Author: Nothing to Disclose

Dwight G Nishimura PhD, Abstract Co-Author: Stockholder, General Electric Company

Greg Zaharchuk MD, PhD, Abstract Co-Author: Advisory Board, General Electric Company Research support, General Electric Company

Nancy Jane Fischbein MD, Abstract Co-Author: Nothing to Disclose

To evaluate the added contribution of reduced field-of-view (rFOV) spinal cord diffusion-weighted imaging (DWI) to routine MR examination in a clinical population.

Consecutive patients undergoing clinically indicated cervical, thoracic, or lumbar spine imaging received standard anatomic sequences supplemented with an additional rFOV DWI scan (Saritas et al., MRM 2008), acquired in the sagittal plane at 1.5 T using a b-value of 500 s/mm2. Standard anatomic sequences included: 3 plane localizer ssFSE T2, sagittal FSE T2, sagittal T1 SE, sagittal STIR, and axial T2 FSE weighted images, with additional axial gradient echo images for cervical spine examinations. Two neuroradiologists evaluated the standard anatomic sequences for the presence of typical spinal pathologies within the extradural, intradural extramedullary, or intramedullary spaces, and were asked to state a level of confidence in their diagnosis on a 3-point scale. Readers were then asked to re-score the examinations after reviewing the rFOV DWI sequence. Additionally, they were asked whether the rFOV DWI sequence was of added clinical utility, and if so, whether it supported or excluded a suggested pathology.

230 patients were included in this study. 182 patient scans demonstrated at least one pathology determined by consensus read and correlated with prior study interpretation and retrospective patient chart review. Interobserver agreement was substantial in identifying pathology (unweighted k = 0.77), and in assessing added value of the rFOV DWI sequence (k = 0.76). In the setting of possible pathology, the rFOV DWI sequence was found to be of added clinical utility in 32.6% of cases (Fisher’s exact test p < 0.0001). Among specific pathologies, the rFOV DWI sequence was found to be most helpful in the evaluation of acute infarction, demyelination, infection, neoplasm, and intradural and epidural collections (Chi square p < 0.001), and was found to provide statistically significant increase in clinical confidence in evaluation of 11 of the 15 pathologic subtypes (one-sided paired Wilcoxon test p < 0.05).

rFOV DWI of the spinal cord is feasible in a clinical population, and is a beneficial adjunct to routine imaging of the human spinal column.

Spinal cord DWI may further assist in characterizing pathology, including demyelinating disease, acute infarction, infection, traumatic injury, and neoplasm.

Andre, J, Saritas, E, Komakula, S, Rosenberg, J, Nishimura, D, Zaharchuk, G, Fischbein, N, Clinical Evaluation of Reduced Field of View Diffusion-weighted Imaging of the Human Spinal Cord.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11010711.html