Abstract：Objective: To study the clinical value of DTI in acute spinal cord injury(SCI) with different ASIA grades. Methods: A retrospective analysis of 34 acute SCI patients with conventional MRI T2WI hyperintensity was made. All patients underwent MR-DTI examination in 48 hours. According to ASIA grades, we measured the values of FA, ADC, λ∥, λ⊥in the injury area. We recruited 15 healthy volunteers of matched ages, and measured the same parameters in the corresponding level of C3/4~C5/6 intervertebral disc plane. Single factor analysis of variance(ANOVA) was applied to analyze the difference in DTI parameters in ASIA grade A to D. Independent sample t test was used to analyze DTI parameters in DWI image matching area(hyperintense on both DWI and T2WI) and mismatch area(isointense on DWI but hyperintense on T2WI) in the same patients. Results: The number of patients is 7 in grade A, 5 in grade B, 19 in grade C, and 13 in grade D. Compared with the healthy group, the A～D groups showed significant differences in FA, ADC, λ∥ and λ⊥(F=51.90, 13.30, 24.70, 13.01, P<0.001). Compared with grade B, C and D, the values of FA, ADC and λ∥ in grade A were significantly reduced by pairwise comparison(P<0.05). FA and λ∥ showed a downward trend as ASIA grade was reduced. ADC values increased in grade A, however decreased in grade B to D. As for λ⊥ elevation, by pairwise comparison, grade B showed significant difference from grade A, C and D(P<0.05). There was no significant difference between grade A, C or D in λ⊥ by pairwise comparison(P>0.05). DTT showed in injured area nerve fiber bundle swelling, distortion and interruption in grade A. The nerve fiber bundles were swelling, coarse and partially interrupted in grade B. Integrated nerve fiber bundles could be found in grade C and D. Comparing DWI match area with mismatch area, ADC, λ∥ decreased and λ⊥ increased significantly(P<0.05), whereas the changes of FA value had no difference(P＞0.05). DTT demonstrated that the nerve fiber bundle in DWI match area was interrupted. Conclusion: FA value and λ∥ value are sensitive indexes among different AISA grades in acute SCI. The lower the ADC value is, the more serious the injury is. DTT can display the position and injury extent of nerve fiber bundles, and provide more imaging evidence for clinical treatment.
邹志孟1，都美玲1，李 军1，曹庆勇1，连慧秀1，沈晓君1，王 滨2. DTI对急性颈髓损伤ASIA不同残损等级的研究[J]. 中国临床医学影像杂志, 2017, 28(1): 8-11.
ZOU Zhi-meng1, DU Mei-ling1, LI Jun1, CAO Qing-yong1, LIAN Hui-xiu1, SHEN Xiao-jun1, WANG Bin2. The study of DTI in acute cervical spinal injury with different ASIA grades. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(1): 8-11.
[1]Kim J, Song SK, Darlene A, et al. Comprehensive Locomotor Outcomes Correlate to Hyperacute Diffusion Tensor Measures After Spinal Cord Injury in the Adult Rat[J]. Exp Neurol, 2012, 235(1): 188-196.
[2]Ellingson BM, Ulmer JL, Schmit BD, et al. Morphology and Morphometry of Human Chronic Spinal Cord Injury Using Diffusion Tensor Imaging and Fuzzy Logic[J]. Ann Biomed Eng, 2008, 36(2): 224-236.
[3]Chang YM, Jung TD, Yoo DS, et al. Diffusion Tensor Imaging and Fiber Tractography of Patients with Cervical Spinal Cord Injury[J]. J Neurotrauma, 2010, 27(11): 2033-2040.
[4]Petersen JA, Wilm BJ, von Meyenburg J, et al. Chronic Cervical Spinal Cord Injury: DTI Correlate with Clinical and Electrophysiological Measures[J]. J Neurotrauma, 2012, 29(8): 1556-1566.
[5]Bosma RL, Stroman PW. Characterization of DTI Indices in the Cervical, Thoracic, and Lumbar Spinal Cord in Healthy Humans[J]. Radiol Res Pract, 2012, 2012: 143705.
[6]Xiangshui M, Xiangjun C, Xiaoming Z, et al. 3T magnetic resonance diffusion tensor imaging and fibre tracking in cervical myelopathy[J]. Clin Radiol, 2010, 65(6): 465-473.
[7]Lee JW, Kim JH, Park JB, et al. Diffusion tensor imaging and fiber tractography in cervical compressive myelopathy: preliminary results[J]. Skelet Radiol, 2011, 40(12): 1543-1551.
[8]Fang W, Sheng-Li H, Xi-Jing H, et al. Determination of the ideal rat model for spinal cord injury by diffusion tensor imaging[J]. Neuro Report, 2014, 25(17): 1386-1392.
[9]Brennan FH, Cowin GJ, Kurniawan ND, et al. Longitudinal assessment of white matter pathology in the injured mouse spinal cord through ultra-high field(16.4 T) in vivo diffusion tensor imaging[J]. Neuroimage, 2013, 82: 574-585.
[10]Mori S, Zhang J. Principles of diffusion tensor imaging and its applications to basic neuroscience research[J]. Neuron, 2006, 51(5): 527-539.
[11]Klawiter EC, Schmidt RE, Trinkaus K, et al. Radial Diffusivity Predicts Demyelination in ex-vivo Multiple Sclerosis Spinal Cords[J]. Neuroimage, 2011, 55(4): 1454-1460.
[12]Lentz MR, Peterson KL, Ibrahim WG, et al. Diffusion Tensor and Volumetric Magnetic Resonance Measures as Biomarkers of Brain Damage in a Small Animal Model of HIV[J]. PLoS One, 2014, 9(8): 1-7.
[13]Cheran S, Shanmuganathan K, Jiachen Zh, et al. Correlation of MR Diffusion Tensor Imaging Parameters with ASIA Motor Scores in Hemorrhagic and Nonhemorrhagic Acute Spinal Cord Injury[J]. J Neurotrauma, 2011, 28(9): 1881-1892.
[14]Zhang Z, Wang H, Zhou Y, et al. Computed tomographic angiography of anterior spinal artery in acute cervical spinal cord injury[J]. Spinal Cord, 2013, 51(6): 442-447.
[15]Pouw MH, van der Vliet AM, van Kampen A, et al. Diffusion-weighted MR imaging within 24 h post-injury after traumatic spinal cord injury: a qualitative meta-analysis between T2-weighted imaging and diffusion-weighted MR imaging in 18 patients[J]. Spinal Cord, 2012, 50(6): 426-431.
2017, Vol. 28 
