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F. Gelbert A. Henon, J.B. Gayet, N. Bouzar M. Perrin, L. Balabaud C. Mazel, R. Palau PARIS (France). DIFFUSION TENSOR TRACTOGRAPHY OF THE SPINAL CORD. Cervical spondylolis is found in 75% of patients over 65 years.

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F gelbert a henon j b gayet n bouzar m perrin l balabaud c mazel r palau paris france

F. Gelbert

A. Henon, J.B. Gayet, N. Bouzar

M. Perrin, L. Balabaud

C. Mazel, R. Palau

PARIS (France)

DIFFUSION TENSOR TRACTOGRAPHY OF THE SPINAL CORD


  • Cervical spondylolis is found in 75% of patients over 65 years.

  • The most seriouscomplication is cervical myelopathy, in 5% of patients suffering of spondylolis

  • The best treatment is surgerybut clinical symptoms are at first discret.

  • MR T2 hyperintensity is observed often late in the course of the desease.


Cervical Myelopathy

Cervical myelopathy is caused by chronic segmental compression of the spinal cord because of spondylotic changes.

The initial cause is thought to be a continuous or intermittent compression or pinching of the cord, which results in chronic hypoperfusion.

Spondylotic

changes

Chronic

segmental

compression

Chronic

hypoperfusion

T2 hypersignal

vacuolization


  • Several study have assessed the feasability of diffusion techniques in spinal cord

  • In the spinal cord, white matter tracts are strongly organised in the cranio caudal direction so diffusion of water molecules is anisotropically oriented

  • The situation of the spinal cord in the spinal canal induce CSF and carotid flow artefacts and magnetic susceptibility artifacts cause by bone structures


30 patients techniques in spinal cord

15 males/15 females;

Age ranged from 34 to 79 years - mean age 50-65;

16 patients presented

with cervical and/or cervico brachial pain

14 presented

with walking impairement

and clinical suspicion of cervical myelopathy


Mr protocol
MR Protocol techniques in spinal cord

Signa GE 1.5T HDxt MRI scanner

CTL coil in SAG T1, SAG T2 , AX T2

Diffusion protocolwasperformedusing a SE EPI sequence in both

Sagittal and Axial plans

b value of 750 s/mm2

9 encoding directions


Diffusion techniques in spinal cordHypothesis:

In microscopicscale, water moleculesrandomly diffuses in isotropicenvironment (brownian motion) and in spinal cord water molecules diffuses mainlyalongfibers.

Method

Knowing diffusion direction itis possible to reconstructfiber bundle of the spinal cord.

Post-Processing


Results techniques in spinal cord

FA maps

Fiber mapping

ADC Maps


Results
Results techniques in spinal cord

3 situations

Normal examination : 9 patients

Focal cervical stenosiswithout spinal signal abnormality : 14 patients

Cervical stenosis and spinal signal abnormality: 6 patients

Otherdiagnosis: 1 SEP,1 syrinx


Situation 1 fa cartography
Situation 1- FA Cartography techniques in spinal cord

  • :FA : normal values range from 0.6 - 0.55

  • Same results in axial and sagittal acquisition


Situation 1 adc cartography
Situation 1- ADC Cartography techniques in spinal cord

  • Normal ranged from (0,9 – 1,20). 10-9

  • Same results in axial and sagittal acquisition


Fiber tracking
Fiber tracking techniques in spinal cord


Situation 2 techniques in spinal cord Ms A . 63 y.Upper limb paresis and cervical painCervical canal stenosis No signal abnormality

  • FA : 0.571-0.610

  • ADC: 0.9


Situation 2 mr foug ncb canal stenosis no signal abnormalities
Situation 2 techniques in spinal cordMr foug NCB . canal stenosis . No signal abnormalities

normal ADC and FA values


Situation 3 canal stenosis and spinal signal abnormality
Situation 3 techniques in spinal cordCanal stenosis and spinal signal abnormality

FA: 0.650

ADC= 1.1

ADC= 1.40

decreasedFA: 0.32


Situation 3
Situation 3 techniques in spinal cord

FA:0.6

ADC:1.25

FA: 0.4

ADC: 1.45


Situation 31
Situation 3 techniques in spinal cord


Situation 4 patient with arms weakness no t2 signal changes fa and adc abnormal values
Situation …..4 techniques in spinal cordPatient witharmsweakness. No T2 signal changesFA and ADC « abnormal values »

FA: 0.65

ADC:1.23

FA:0.4

ADC:1.50


Conclusion
Conclusion techniques in spinal cord

The calculation of FA and ADC was possible in all patients.

ADC and FA measurements were reproductible in a same patients with different reviewers and we obtained a constant average of value in normal spinal cord

We observed ADC and FA abnormal values in all cases of signal abnormalities


Conclusion1
Conclusion techniques in spinal cord

We also observed ADC and FA abnormal values in 5 patients with clinincal symptoms and no signal abnormality

This focuse the potential interest of this methods to detect earlier stages of spinal cord suffering

These preliminary results must encourage us to include this sequence in the MR protocol of potential spinal cord lesions

Axial or sagittal ? Both!!


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