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      Correlation of diffusion tensor imaging parameters with neural status in Pott’s spine

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          Abstract

          Introduction: Diffusion tensor imaging (DTI) has been used in cervical trauma and spondylotic myelopathy, and it has been found to correlate with neural deficit and prognosticate neural recovery. Such a correlation has not been studied in Pott’s spine with paraplegia. Hence, this prospective study has been used to find correlation of DTI parameters with neural deficit in these patients.

          Methods: Thirty-four patients of spinal TB were enrolled and DTI was performed before the start of treatment and after six months. Fractional anisotropy (FA), Mean diffusivity (MD), and Tractography were studied. Neurological deficit was graded by the Jain and Sinha scoring. Changes in FA and MD at and below the site of lesion (SOL) were compared to above the SOL (control) using the unpaired t-test. Pre-treatment and post-treatment values were also compared using the paired t-test. Correlation of DTI parameters with neurological score was done by Pearson’s correlation. Subjective assessment of Tractography images was done.

          Results: Mean average FA was not significantly decreased at the SOL in patients with paraplegia as compared to control. After six months of treatment, a significant decrease ( p = 0.02) in mean average FA at the SOL compared to pre-treatment was seen. Moderate positive correlation ( r = 0.49) between mean average FA and neural score after six months of treatment was found. Tractography images were not consistent with severity of paraplegia.

          Conclusion: Unlike spondylotic myelopathy and trauma, epidural collection and its organized inflammatory tissue in Pott’s spine precludes accurate assessment of diffusion characteristics of the compressed cord.

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          Tuberculosis of spine: neurological deficit.

          Anil Jain, Jaswant Kumar (2013)
          The most dreaded neurological complications in TB spine occur in active stage of disease by mechanical compression, instability and inflammation changes, while in healed disease, these occur due to intrinsic changes in spinal cord secondary to internal salient in long standing kyphotic deformity. A judicious combination of conservative therapy and operative decompression when needed should form a comprehensive integrated course of treatment for TB spine with neurological complications. The patients showing relatively preserved cord with evidence of edema/myelitis with predominantly fluid collection in extradural space on MRI resolve on non-operative treatment, while the patients with extradural compression of mixed or granulomatous nature showing entrapment of spinal cord should be undertaken for early surgical decompression. The disease focus should be debrided with removal of pus caseous tissue and sequestra. The viable bone should only be removed to decompress the spinal cord and resultant gap should be bridged by bone graft. The preserved volume of spinal cord with edema/myelitis and wet lesion on MRI usually would show good neural recovery. The spinal cord showing myelomalacia with reduced cord volume and dry lesion likely to show a poor neural recovery. The internal kyphectomy is indicated for paraplegia with healed disease. These cases are bad risk for surgery and neural recovery. The best form of treatment of late onset paraplegia is the prevention of development of severe kyphosis in initial active stage of disease.
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            Diffusion tensor imaging correlates with the clinical assessment of disease severity in cervical spondylotic myelopathy and predicts outcome following surgery.

            J.G.A. Jones, S.Y. Cen, R.M. Lebel … (2013)
            CSM is a common neurologic disease that results in progressive disability and eventual paralysis without appropriate treatment. Imaging plays a significant role in the evaluation of CSM and has evolved with recent technical advances. We sought to systematically explore the relationship between clinical disease severity and DTI in CSM, and to investigate the potential use of DTI in surgical decision-making models. MR imaging studies and clinical assessments were prospectively collected on 30 patients with CSM. Spearman correlations were used to investigate associations between clinical disease severity and FA at the time of diagnosis. Clinical assessment was performed using mJOA, Nurick, Short Form-36, and NDI scores. Fifteen patients with CSM subsequently underwent decompressive surgery; Spearman correlation and logistic regression were applied to this cohort to study the relationship between baseline DTI measurements and postoperative outcome. Conventional imaging (spinal cord T2 signal intensity and degree of stenosis) was evaluated for comparison with DTI. At diagnosis, FA demonstrated a strong correlation with baseline mJOA (r = 0.62, P < .01) and Nurick (r = -0.46, P = .01) scores. After surgery, recovery of function demonstrated by improvement in NDI score was associated with higher FA values on preoperative DTI (r = -0.61, P = .04). Severely affected patients with CSM with disproportionately high FA tended to achieve greater mJOA scores after surgery compared with subjects with lower FA (P = .08). T2 signal intensity was associated with functional status at baseline but did not predict postoperative outcome; degree of stenosis lacked any significant correlation with clinical parameters. DTI may be a useful diagnostic tool for assessing disease severity in CSM. The predictive value of DTI regarding postoperative outcome may improve surgical decision-making and facilitate health care outcomes research.
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              MR diffusion tensor imaging and fiber tracking in spinal cord compression.

              David Facon, Augustin Ozanne, Pierre Fillard … (2005)
              Spinal cord damage can result in major functional disability. Alteration of the spinal cord structural integrity can be assessed by using diffusion tensor imaging methods. Our objective is to evaluate the diagnostic accuracy of apparent diffusion coefficient (ADC), fractional anisotropy (FA), and fiber tracking in both acute and slowly progressive spinal cord compressions. Fifteen patients with clinical symptoms of acute (n = 2) or slowly progressive (n = 13) spinal cord compression and 11 healthy volunteers were prospectively selected. We performed T2-weighted fast spin echo (FSE) and diffusion tensor imaging by using a 1.5-T MR scanner. ADC and FA maps were computed. Regions of interest were placed at the cervical, upper and lower thoracic cord levels for the healthy subjects and on the area with abnormal T2-weighted signal intensity in the patients with cord compression. In three patients, we used fiber tracking to locate the areas of cord compression precisely. Data were analyzed by using a mixed model. The sensitivity (SE) and specificity (sp) of imaging (T2, ADC, and FA maps) in the detection of spinal cord abnormality were statistically evaluated. For the healthy subjects, averaged ADC values ranged from 0.96 10(-3) mm(2)/s to 1.05 10(-3) mm(2)/s and averaged FA values ranged from 0.745 to 0.751. Ten patients had decreased FA (0.67 +/- 0.087), and one had increased FA values (0.831); only two patients had increased ADC values (1.03 +/- 0.177). There was a statistically significant difference in the FA values between volunteers and patients (P = .012). FA had a much higher sensitivity (SE = 73.3%) and specificity (sp = 100%) in spinal cord abnormalities detection compared with T2-weighted FSE imaging (se = 46.7%, sp = 100%) and ADC (SE = 13.4%, sp = 80%). FA has the highest sensitivity and specificity in the detection of acute spinal cord abnormalities. Spinal cord fiber tracking is a useful tool to focus measurements on the compressed spinal cord.
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                Author and article information

                Journal
                Journal ID (nlm-ta): SICOT J
                Journal ID (iso-abbrev): SICOT J
                Journal ID (publisher-id): sicotj
                Title: SICOT-J
                Publisher: EDP Sciences
                ISSN (Electronic): 2426-8887
                Publication date (Electronic, collection): 2016
                Publication date (Electronic, pub): 29 April 2016
                Volume: 2
                Issue: ( publisher-idID: sicotj/2016/01 )
                Electronic Location Identifier: 21
                Affiliations
                [1 ] University College of Medical Sciences & GTB Hospital 110095 Delhi India
                [2 ] Department of Radiology, Institute of Nuclear Medicine and Allied Sciences (INMAS) 110054 Delhi India
                [3 ] Sharda University 201306 Greater Noida India
                Author notes
                [* ]Corresponding author: nikhiljain23@ 123456hotmail.com
                Article
                Publisher ID: sicotj150163 Other ID: 10.1051/sicotj/2016014
                DOI: 10.1051/sicotj/2016014
                PMC ID: 4851726
                PubMed ID: 27163110
                SO-VID: a05ada41-c194-4540-95af-0a120f0f0982
                Copyright © © The Authors, published by EDP Sciences, 2016
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 October 2015
                Date accepted : 06 March 2016
                Page count
                Figures: 5, Tables: 3, Equations: 0, References: 25, Pages: 7
                Categories
                Subject: Spine
                Subject: Original Article

                Keywords: diffusion tensor imaging,dti,spinal tuberculosis,pott’s spine
                Data availability:
                Keywords: diffusion tensor imaging, dti, spinal tuberculosis, pott’s spine

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