Noriko Salamon MD, Presenter: Nothing to Disclose

Benjamin Ellingson MD, Abstract Co-Author: Research Consultant, Agios Pharmaceuticals Research Consultant, MedQIA, LLC

John Grinstead PhD, Abstract Co-Author: Employee, Siemens AG

Josef Pfeuffer PhD, Abstract Co-Author: Employee, Siemens AG

Langston Holly, Abstract Co-Author: Nothing to Disclose

Cervical spondylotic myelopathy (CSM) is a common disorder. Although spinal canal stenosis can be diagnosed by traditional MRI techniques, the degree of abnormality does not correlate with neurological symptoms. Therefore, an imaging biomarker sensitive to the degree of neurological impairment is highly desired. Diffusion-sensitive MR techniques have shown better sensitivity to spinal cord dysfunction than traditional MR techniques. Despite these promising initial results, human spinal cord DTI using spin-echo echoplanar imaging (EPI) suffers from many artifacts including susceptibility-related distortions, motion artifact, and low spatial resolution. We hypothesized a custom 2D spatially selective RF excitation pulse combined with a reduced field-of-view single-shot echoplanar readout (Zoomed-EPI) could provide superior DTI image quality of the human spinal cord for assessment of CSM.  

A total of n = 9 neurologically intact and n = 13 patients with mild CSM were enrolled in the current prospective, institutional review board-approved study. The Zoomed-EPI DTI technique using a custom 2D spatially selective RF excitation pulse provided superior image quality to single-shot, twice-refocused spin echo echoplanar preparation in clinically relevant scan times and with minimal artifacts, so long as the region of interest is placed within the center of the FOV.

Regions away from the center slices had greater distortions and signal drop out from B1 inhomogeneities. For each metric, the three most distal slices rostral and caudal from central slices varied significantly from other slices. Central slices had diffusivity values and variability consistent with the literature. Patients with CSM showed classic signs of chronic compression and cord ischemia, including high FA at the level of compressions, indicative of compressed axon fibers, but low FA in spinal segments between these areas of compression, suggestive of long-term damage. Patients with the lowest FA at the compression site had the lowest mJO Aneurological score.

DTI can be used to provide sensitive biomarker of the spinal cord in CSM patient.

CSM is a common disease which requires better imaging biomarker to assess condition of the cervical cord. DTI will be used as objective decision making tool for surgical intervention and follow up.

Salamon, N, Ellingson, B, Grinstead, J, Pfeuffer, J, Holly, L, Diffusion Tensor Imaging (DTI) in Human Cervical Spondylotic Myelopathy Using a 2D RF Excitation Pulse Combined with a Reduced Field-of-View Single-shot Echoplanar Readout (Zoomed-EPI).  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034609.html