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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
slide2

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.
slide3

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

slide4
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
slide5
30 patients

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

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

slide7
Diffusion Hypothesis:

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

slide8

Results

FA maps

Fiber mapping

ADC Maps

results
Results

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
  • :FA : normal values range from 0.6 - 0.55
  • Same results in axial and sagittal acquisition
situation 1 adc cartography
Situation 1- ADC Cartography
  • Normal ranged from (0,9 – 1,20). 10-9
  • Same results in axial and sagittal acquisition
slide13
Situation 2 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 2Mr foug NCB . canal stenosis . No signal abnormalities

normal ADC and FA values

situation 3 canal stenosis and spinal signal abnormality
Situation 3 Canal stenosis and spinal signal abnormality

FA: 0.650

ADC= 1.1

ADC= 1.40

decreasedFA: 0.32

situation 3
Situation 3

FA:0.6

ADC:1.25

FA: 0.4

ADC: 1.45

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

FA: 0.65

ADC:1.23

FA:0.4

ADC:1.50

conclusion
Conclusion

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

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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