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Indian Journal of Neurotrauma 2013; 10(02): 97-104
DOI: 10.1016/j.ijnt.2013.04.006
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Can diffusion tensor imaging predict outcome in acute traumatic deterioration of degenerative cervical spine disease

Jagathlal Gangadharan
a   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
,
G.G. Sharath Kumar
b   Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
,
Chandrajit Prasad
b   Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
,
Sampath Somanna
a   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
,
Bhagavatula Indira Devi
a   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
› Author Affiliations
Subject Editor:
Further Information

Publication History

06 December 2012

10 April 2013

Publication Date:
06 April 2017 (online)

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Abstract

Introduction

Patients with degenerative diseases of cervical spine are likely to develop acute cord injury following trivial trauma. However many of them can have a poor functional outcome. Routine MRI may not be helpful in accurately predicting the recovery in these cases. DTI of spinal cord is a promising tool in prognostication of various neurological diseases.

Materials and method

A prospective study was done to know the use of DTI in predicting outcome in acute deterioration of degenerative cervical spine disease. Cases presenting within 48 h of acute traumatic deterioration were included in the study. A screening MRI was done to know the extent of disease and cord damage. Using DTI, apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were calculated at the level of injury. 3D tractography was done using Label map seeding technique. Clinical correlation was done with ASIA and FIM scores.

Results

Five cases of cervical cord injury with a mean age of 46 ± 11 years were studied. The diffusion parameters were compared with three age matched controls. The cases were followed up prospectively. All the cases had a decrease in ADC values and increase in FA at the level of injury compared to other levels (p = 0.02) and to normal controls (p = 0.001). It was extending beyond the level of cord contusion identified by routine MRI.

Discussion

DTI is well suited for evaluating effects of spinal cord injury like cellular swelling and myelin membrane disruption which is not diagnosed using conventional MRI. ADC helps us to define the type and extent of spinal cord injury. 3D tractography delineates the fiber disruption.

Conclusion

ADC is a sensitive marker of acute cervical cord injury, in degenerative spine disease.3D tractography can help us to select the cases for early surgical intervention and to predict clinical outcome.

Keywords

Diffusion tensor imaging - Degenerative spine disease - Fractional anisotropy - Apparent diffusion coefficient - Acute cervical trauma
 

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