Application of multishot diffusion tensor imaging in spinal cord tumors

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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Diffusion tensor imaging of the spinal cord: a review

Coluna/Columna ◽

10.1590/s1808-18512013000100014 ◽

2013 ◽

Vol 12 (1) ◽

pp. 64-69 ◽

Cited By ~ 1

Author(s):

Aditya Vedantam ◽

Michael Jirjis ◽

Gerald Eckhardt ◽

Abhishiek Sharma ◽

Brian D. Schmit ◽

...

Keyword(s):

Spinal Cord ◽

Diffusion Tensor Imaging ◽

Cervical Spondylotic Myelopathy ◽

Diffusion Tensor ◽

Traumatic Spinal Cord Injury ◽

Intramedullary Tumors ◽

Cord Injury ◽

Magnetic Resonance Technique ◽

Spinal Cord Disorders ◽

Diffusion Tensor Imaging Dti

Diffusion tensor imaging (DTI) is a magnetic resonance technique capable of measuring the magnitude and direction of water molecule diffusion in various tissues. The use of DTI is being expanded to evaluate a variety of spinal cord disorders both for prognostication and to guide therapy. The purpose of this article is to review the literature on spinal cord DTI in both animal models and humans in different neurosurgical conditions. DTI of the spinal cord shows promise in traumatic spinal cord injury, cervical spondylotic myelopathy, and intramedullary tumors. However, scanning protocols and image processing need to be refined and standardized.

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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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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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Advanced MR diffusion tensor imaging and perfusion weighted imaging of intramedullary tumors and tumor like lesions in the cervicomedullary junction region and the cervical spinal cord

Journal of Neuro-Oncology ◽

10.1007/s11060-013-1323-z ◽

2013 ◽

Vol 116 (3) ◽

pp. 559-566 ◽

Cited By ~ 19

Author(s):

Xiang Liu ◽

Wei Tian ◽

Balasubramanya Kolar ◽

Rui Hu ◽

Yuqing Huang ◽

...

Keyword(s):

Spinal Cord ◽

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Cervical Spinal Cord ◽

Junction Region ◽

Intramedullary Tumors ◽

Perfusion Weighted Imaging ◽

Mr Diffusion ◽

Tumor Like Lesions ◽

Mr Diffusion Tensor Imaging

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

Spinal Cord ◽

10.1038/s41393-021-00741-2 ◽

2021 ◽

Author(s):

Marc Hohenhaus ◽

Yorn Merz ◽

Jan-Helge Klingler ◽

Christoph Scholz ◽

Ulrich Hubbe ◽

...

Keyword(s):

Spinal Cord ◽

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Spinal Cord Tumor ◽

Intramedullary Tumor ◽

Diagnostic Study ◽

Spinal Cord Tumors ◽

Lesion Area ◽

Inflammatory Lesions ◽

Central Lesion

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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Delineation of the Safe Zone in Surgery of Sylvian Insular Triangle: Morphometric Analysis and Magnetic Resonance Imaging Study

Operative Neurosurgery ◽

10.1227/neu.0b013e3182315112 ◽

2011 ◽

Vol 70 (suppl_2) ◽

pp. ons290-ons299 ◽

Cited By ~ 1

Author(s):

Nobuyuki Kaneko ◽

Warren W. Boling ◽

Takaharu Shonai ◽

Kazumi Ohmori ◽

Yoshiaki Shiokawa ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Corticospinal Tract ◽

Diffusion Tensor ◽

Significant Risk ◽

Imaging Study ◽

Internal Capsule ◽

Posterior Limb ◽

3.0 T ◽

Relationship Of ◽

The Relationship

ABSTRACT BACKGROUND: Surgery within the insula carries significant risk of morbidity, particularly hemiparesis, because of the difficulty in detecting the internal capsule boundaries. OBJECTIVE: We analyzed the anatomy of the insula and identified landmarks anticipated to facilitate surgery for intrinsic insular lesions. METHODS: Insular region anatomy was studied in 11 cadaveric brains harvested within 72 hours postmortem. MRI of the specimens was acquired using 3.0 T with T2-weighting and 25 directions of diffusion tensor imaging. Landmarks easily recognizable during surgery were identified on the surface of the insula. The interrelationships between surface landmarks and critical structures were analyzed. RESULTS: The posterior inferior insular point (PIIP) and the upper central insular point (UCIP) were newly established as landmarks on the insula. The PIIP corresponded to the obvious bend in the posterior long insular gyrus. The UCIP is the meeting point between the central insular sulcus and superior peri-insular sulcus. The corticospinal tract was identified as a high-intensity area in the posterior limb of the internal capsule on T2-weighted imaging and its course confirmed with diffusion tensor imaging tractography. The corticospinal tract took a course deep to the posterosuperior insula on T2-weighted imaging, 4.8 mm from the UCIP and 6.2 mm from the PIIP. CONCLUSION: The posterosuperior part of the insula forms the region at greatest risk to corticospinal tract injury. The PIIP and UCIP are crucial to understanding the relationship of the insula with the posterior limb of the internal capsule including the corticospinal tract.

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