Diffusion tensor imaging in unclear intramedullary tumor-suspected lesions allows separating tumors from inflammation

Abstract Design Prospective diagnostic study. Objectives Primary imaging-based diagnosis of spinal cord tumor-suspected lesions is often challenging. The identification of the definite entity is crucial for dedicated treatment and therefore reduction of morbidity. The aim of this trial was to investigate specific quantitative signal patterns to differentiate unclear intramedullary tumor-suspected lesions based on diffusion tensor imaging (DTI). Setting Medical Center - University of Freiburg, Germany. Methods Forty patients with an unclear tumor-suspected lesion of the spinal cord prospectively underwent DTI. Primary diagnosis was determined by histological or clinical work-up or remained indeterminate with follow-up. DTI metrics (FA/ADC) were evaluated at the central lesion area, lesion margin, edema, and normal spinal cord and compared between different diagnostic groups (ependymomas, other spinal cord tumors, inflammations). Results Mean DTI metrics for all spinal cord tumors (n = 18) showed significantly reduced FA and increased ADC values compared to inflammatory lesions (n = 8) at the lesion margin (p < 0.001, p = 0.001) and reduced FA at the central lesion area (p < 0.001). There were no significant differences comparing the neoplastic subgroups of ependymomas (n = 10) and other spinal cord tumors (n = 8), but remaining differences for both compared to the inflammation subgroup. We found significant higher ADC (p = 0.040) and a trend to decreased FA (p = 0.081) for ependymomas compared to inflammations at the edema. Conclusion Even if distinct differentiation of ependymomas from other spinal cord neoplasms was not possible based on quantitative DTI metrics, FA and ADC were feasible to separate inflammatory lesions. This may avoid unnecessary surgery in patients with unclear intramedullary tumor-suspected lesions.

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Diffusion tensor imaging to guide surgical planning in intramedullary spinal cord tumors in children

Neuroradiology ◽

10.1007/s00234-013-1316-9 ◽

2014 ◽

Vol 56 (2) ◽

pp. 169-174 ◽

Cited By ~ 31

Author(s):

Asim F. Choudhri ◽

Matthew T. Whitehead ◽

Paul Klimo ◽

Blake K. Montgomery ◽

Frederick A. Boop

Keyword(s):

Spinal Cord ◽

Diffusion Tensor Imaging ◽

Surgical Planning ◽

Diffusion Tensor ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord

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Application of multishot diffusion tensor imaging in spinal cord tumors

Brain Science Advances ◽

10.1177/2096595819896176 ◽

2019 ◽

Vol 5 (1) ◽

pp. 59-64

Author(s):

Jiefei Li ◽

Le He ◽

Yuqi Zhang

Keyword(s):

Spinal Cord ◽

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Preoperative Imaging ◽

Spinal Cord Tumors ◽

Intramedullary Tumors ◽

Routine Magnetic Resonance Imaging ◽

Relationship Of ◽

The Relationship ◽

Diffusion Tensor Imaging Dti

Objective: To explore the usefulness of multishot diffusion tensor imaging (DTI) for evaluating the neurological function of patients with spinal cord tumors Methods: Routine magnetic resonance imaging and multishot DTI were performed in five patients with spinal cord tumors. The values of fractional anisotropy (FA) and radial diffusivity (RD) were analyzed. Results: Multishot DTI of spinal cord tumors allowed for defining the margins of tumors and determining the relationship of tumors with the adjacent white matter structures of the spinal cord. Multishot DTI demonstrated significantly increased RD and decreased FA of spinal cord tumors compared with those of the normal spinal cord. Conclusions: Multishot DTI is a potentially useful modality for differentiating resectable tumors from nonresectable ones based on preoperative imaging alone as well as for differentiating intramedullary tumors from extramedullary ones. Further prospective studies are warranted to confirm these results.

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Role of Diffusion Tensor Imaging Parameters in the Characterization and Differentiation of Infiltrating and Non-Infiltrating Spinal Cord Tumors

Clinical Neuroradiology ◽

10.1007/s00062-019-00851-8 ◽

2019 ◽

Vol 30 (4) ◽

pp. 739-747

Author(s):

Edyta Maj ◽

Barbara Szemplińska ◽

Wojciech Szeszkowski ◽

Marek Prokopienko ◽

Andrzej Cieszanowski ◽

...

Keyword(s):

Spinal Cord ◽

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Statistical Significance ◽

Spinal Tumors ◽

Spinal Cord Tissue ◽

Peritumoral Edema ◽

Spinal Cord Tumors ◽

Tumor Mass ◽

Significant Difference

Abstract Background and Purpose Recent attempts to utilize diffusion tensor imaging (DTI) to identify the extent of microinfiltration of a tumor in the brain have been successful. It was therefore speculated that this technique could also be useful in the spinal cord. The aim of this study was to differentiate between infiltrating and noninfiltrating intramedullary spinal tumors using DTI-derived metrics. Material and Methods The study group consisted of 6 patients with infiltrating and 12 with noninfiltrating spinal cord tumors. Conventional magnetic resonance imaging (MRI) with gadolinium administration was performed followed by DTI. Fractional anisotropy (FA), diffusivity (TRACE) and apparent diffusion coefficient (ADC) were measured in the enhancing tumor mass, peritumoral margins, peritumoral edema and normal appearing spinal cord. The results were compared using non-parametric Mann–Whitney U test with statistical significance p < 0.05. Results In peritumoral margins the FA values were significantly higher in the noninfiltrating compared to the infiltrating tumors (p < 0.007), whereas TRACE values were significantly lower (p < 0.017). The results were similar in peritumoral edema. The FA values in the tumor mass showed no significant differences between the two groups while TRACE showed a statistically significant difference (p < 0.003). There was no statistical difference in any parameters in normal appearing spinal cord. Conclusion Quantitative analysis of DTI parameters of spinal cord tissue surroundings spinal masses can be useful for differentiation between infiltrating and non-infiltrating intramedullary spinal tumors.

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Diffusion tensor imaging tractography in patients with intramedullary tumors: comparison with intraoperative findings and value for prediction of tumor resectability

Journal of Neurosurgery Spine ◽

10.3171/2010.3.spine09399 ◽

2010 ◽

Vol 13 (3) ◽

pp. 371-380 ◽

Cited By ~ 51

Author(s):

Matthias Setzer ◽

Ryan D. Murtagh ◽

F. Reed Murtagh ◽

Mohammed Eleraky ◽

Surbhi Jain ◽

...

Keyword(s):

Spinal Cord ◽

Diffusion Tensor Imaging ◽

Interrater Reliability ◽

Diffusion Tensor ◽

Cleavage Plane ◽

Lesion Volume ◽

Spinal Cord Tumors ◽

Intramedullary Tumors ◽

Intramedullary Spinal Cord

Object The aim of this retrospective study was to evaluate the predictive value of diffusion tensor (DT) imaging with respect to resectability of intramedullary spinal cord tumors and to determine the concordance of this method with intraoperative surgical findings. Methods Diffusion tensor imaging was performed in 14 patients with intramedullary lesions of the spinal cord at different levels using a 3-T magnet. Routine MR imaging scans were also obtained, including unenhanced and enhanced T1-weighted images and T2-weighted images. Patients were classified according to the fiber course with respect to the lesion and their lesions were rated as resectable or nonresectable. These results were compared with the surgical findings (existence vs absence of cleavage plane). The interrater reliability was calculated using the κ coefficient of Cohen. Results Of the 14 patients (7 male, 7 female; mean age 49.2 ± 15.5 years), 13 had tumors (8 ependymomas, 2 lymphomas, and 3 astrocytoma). One lesion was proven to be a multiple sclerosis plaque during further diagnostic workup. The lesions could be classified into 3 types according to the fiber course. In Type 1 (5 cases) fibers did not pass through the solid lesion. In Type 2 (3 cases) some fibers crossed the lesion, but most of the lesion volume did not contain fibers. In Type 3 (6 cases) the fibers were completely encased by tumor. Based on these results, 6 tumors were considered resectable, 7 were not. During surgery, 7 tumors showed a good cleavage plane, 6 did not. The interrater reliability (Cohen κ) was calculated as 0.83 (p < 0.003), which is considered to represent substantial agreement. The mean duration of follow-up was 12.0 ± 2.9. The median McCormick grade at the end of follow-up was II. Conclusions These preliminary data suggest that DT imaging in patients with spinal cord tumors is capable of predicting the resectability of the lesion. A further prospective study is needed to confirm these results and any effect on patient outcome.

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