Age related diffusion and tractography changes in typically developing pediatric cervical and thoracic spinal cord

Background and objective: Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) are two techniques that can measure white matter integrity of the spinal cord. Recently, DTI indices have been shown to change with age. The purpose of this study is (a) to evaluate the maturational states of the entire pediatric spinal cord using DTI and DTT indices including fractional anisotropy (FA), mean diffusivity (MD), mean length of white matter fiber tracts and tract density and (b) to analyze the DTI and DTT parameters along the entire spinal cord as a function of spinal cord levels and age. Method: A total of 23 typically developing (TD) pediatric subjects ranging in age from 6 to 16 years old (11.94 ± 3.26 (mean ± standard deviation), 13 females and 10 males) were recruited, and scanned using 3.0 T MR scanner. Reduced FOV diffusion tensor images were acquired axially in the same anatomical location prescribed for the T2-weighted images to cover the entire spinal cord (C1-mid L1 levels). To mitigate motion induced artifacts, diffusion directional images were aligned with the reference image (b0) using a rigid body registration algorithm performed by in-house software developed in Matlab (MathWorks, Natick, Massachusetts). Diffusion tensor maps (FA and MD) and streamline deterministic tractography were then generated from the motion corrected DTI dataset. DTI and DTT parameters were calculated by using ROIs drawn to encapsulate the whole cord along the entire spinal cord by an independent board certified neuroradiologist. These indices then were compared between two age groups (age group A = 6–11 years (n = 11) and age group B = 12–16 years (n = 12)) based on similar standards and age definitions used for reporting spinal cord injury in the pediatric population. Standard least squared linear regression based on a restricted maximum likelihood (REML) method was used to evaluate the relationship between age and DTI and DTT parameters. Results: An increase in FA (group A = 0.42 ± 0.097, group B = 0.49 ± 0.116), white matter tract density (group A = 368.01 ± 236.88, group B = 440.13 ± 245.24) and mean length of fiber tracts (group A = 48.16 ± 20.48 mm, group B = 60.28 ± 23.87 mm) and a decrease in MD (group A = 1.06 ± 0.23 × 10−3 mm2/s, group B = 0.82 ± 0.24 × 10−3 mm2/s) were observed with age along the entire spinal cord. Statistically significant increases have been shown in FA (p = 0.004, R2 = 0.57), tract density (p = 0.0004, R2 = 0.58), mean length of fiber tracts (p \u3c 0.001, R2 = 0.5) and a significant decrease has been shown in MD (p = 0.002, R2 = 0.59) between group A and group B. Also, it has been shown DTI and DTT parameters vary along the spinal cord as a function of intervertebral disk and mid-vertebral body level. Conclusion: This study provides an initial understanding of age related changes of DTI values as well as DTT metrics of the spinal cord. The results show significant differences in DTI and DTT parameters which may result from decreasing water content, myelination of fiber tracts, and the thickening diameter of fiber tracts during the maturation process. Consequently, when quantitative DTI and DTT of the spinal cord is undertaken in the pediatric population an age and level matched normative dataset should be used to accurately interpret the quantitative results. © 201

Advances in Functional Spine Neuroimaging

Several imaging modalities are currently being used to obtain diagnostic information in patient with spinal cord injuries. Among them, magnetic resonance imaging, computed tomography myelography, and plain radiography are the most widely used. Magnetic resonance imaging or MRI is a non-invasive imaging method that uses magnetic fields and radio frequency (RF) waves and provides soft tissue contrast of the spinal cord and surrounding tissues within the spinal canal. On the other hand, computed tomography or CT is based on x-rays, to provide excellent bone contrast, and is the first line of diagnostic imaging performed following a traumatic injury in both adults and kids to evaluate for fractures and spinal subluxation. Subsequently, MRI is performed to evaluate for the presence of spinal cord compression, spinal cord edema and/or hemorrhage, epidural/subdural hemorrhage, prevertebral edema, and ligamentous injury. Although still not widely available, in addition to providing good structural information, MRI has evolved in the recent years to provide functional characteristics of the spinal cord. These include information such as diffusion of the water molecules within the spinal cord providing functional information of white matter based on diffusion tensor imaging (DTI), and neuronal activation sites within the gray matter of the spinal cord based on Blood oxygenation level dependant (BOLD) imaging. In our center at Jefferson we are utilizing these functional neuroimaging biomarkers to potentially help us to understand the mechanisms of spinal cord injury (SCI) as well as guide and track changes of new therapeutic procedures. In the following sections we will discuss the methodologies underlying these techniques. Pages: 39-43