Utility of MR Tractography in Traumatic Cervical Spinal Cord Injuries: A Pilot Study

Introduction: Magnetic Resonance Imaging (MRI) is important in assessing ligamentous injury and spinal cord injuries in the setting of cervical spine trauma. The role of diffusion tensor imaging (DTI) and tractography, whilst clinically useful in cranial pathologies, is rarely used in the setting of spinal trauma. We present an optimized DTI protocol and tractography approach that can be readily implemented on most MRI scanners, aiming to enhance the diagnostic and prognostic capabilities of spinal imaging which can be used to correlate with clinical findings and hopefully help prognosticate.

Methods: Five adult cervical spinal cord injury patients were scanned using an integrated DTI sequence based on a spin-echo echo planar imaging technique on a 3 Tesla MRI scanner. The sequence parameters were as follows: axial plane, repetition time (TR) of 9,200 ms, echo time (TE) of 82 ms, 37 slices, slice thickness of 3 mm, matrix size of 128x128, 3 signal averages, b-values of 0 and 1000 s/mm² across 6 directions, with a total scan time of approximately 2 minutes. We employed DSI-Studio software to generate detailed tractography images. These images were color-coded to represent different diffusion directions: blue for inferior-superior, green for posterior-anterior, and red for left-right orientations.

Results: The tractography images yielded critical diagnostic directional information about the patients' spinal cords. They illustrated regions of cord compression and resulting nerve orientations which will not be seen in conventional MRI. This visualization underscores the utility of tractography in pinpointing specific areas of neural compromise, thereby enhancing diagnostic accuracy and guiding potential therapeutic interventions.

Conclusion : DTI provides additional information about spinal cord trauma without significantly increasing scan time. Tractography results depend on scan quality, tracking parameters implemented, and interpretation by specialized personnel to ensure accuracy and reliability. Further studies are necessary to evaluate it’s the utility in acute cervical spinal cord injuries.