The diffusion pattern of healthy and myelopathic cervical spinal cord: a template-based analysis

Abstract

INTRODUCTION: Diffusion tensor imaging (DTI) permits the detection of water molecular diffusion movement inside spinal cord parenchyma. This study aimed to evaluate the diffusion patterns in myelopathic cord under the external and/or internal pressures. PATIENTS (OR MATERIALS) AND METHODS: A total of 45 volunteers were recruited in this study with informed consent including 25 healthy subjects (46 ± 17), 1 syringomyelia patient (54 yrs), 13 cervical spondylotic myelopathy (CSM) patients (63 ± 12 yrs), 6 traumatic central cord syndrome (TCCS) patients (61 ± 21 yrs). The axial diffusion MR images of cervical spinal cord were taken from C1 to C7 using pulsed gradient spin-echo-echo-planar imaging sequence with a 3T MR system. The regions of interest were defined based on a template to cover the ventral, lateral, and posterior column of white matter as well as gray matter in FA maps of spinal cord, then FA values were generated for comparison. RESULTS: In healthy cord, FA values in posterior and lateral columns were significantly higher than ventral column and gray matter. Under slow and progressive external compression in CSM, FA of the posterolateral columns were mostly affected; in traumatic cases, FA of the ventral column and gray matter were more severely disturbed. In one case of syringomyelia, the lateral column and gray matter were involved. CONCLUSION: The diffusion patterns of myelopathic cord were specific to various types of external and/or internal pressures. A template-based analysis might delineate the injury patterns of myelopathic cord and contribute to the in-depth understanding of the underlying pathomechanism.