High-Resolution Diffusion Tensor Imaging (DTI) of the Cervical Spinal Cord in the Setting of Spinal Cord Injury (SCI)
Condition: Spinal Cord Injury; Cervical Spondylosis With Myelopathy; Degenerative Disorder
MeSH terms: Spondylosis; Spinal Cord Injuries; Spinal Cord Diseases; Wounds and Injuries
Study type: Observational

Summary: 
      The investigators propose a prospective study, designed to analyze the efficacy of
      High-Resolution Diffusion Tensor Imaging for accurately sensing white matter tracts in
      subjects with spinal cord injury. Study subjects will not be randomized, as treatment will
      follow the doctor's "standard of care." Patients will be selected and offered enrollment
      based upon the clinical diagnosis of spinal cord injury, either due to degenerative disease
      or trauma. Enrollment will be based on the chronology of patient presentation.
    

Detailed description: 
      Spinal cord injury (SCI) can result from trauma as well as degenerative conditions, such as
      cervical spondylotic myelopathy (CSM). Both have a profound impact on the physical and mental
      health of the affected individual. The symptoms of CSM can include weakness in the arms or
      legs, difficulty with walking and balance, loss of dexterity in the hands, and bowel or
      bladder dysfunction. Traumatic spinal cord injury often includes damage to white matter
      tracts resulting in irreversible functional deficits such as paraplegia or quadriplegia.

      Although current diagnostic imaging can reveal highly specific parameters of spinal canal
      anatomy, the functional anatomy of the spinal cord remains unknown. Patients with similar
      diagnostic findings can vary clinically with many patients having minimal to no symptoms
      while others may be severely incapacitated. Conventional MRI methods, such as T1/T2 weighted
      MRI, may easily identify the region of the damage and may depict permanent changes in the
      spinal cord tissue. However, conventional MRI methods are limited in their ability to
      correlate imaging findings with short and long term functional outcomes from spinal cord
      injury. DTI has the potential to improve upon conventional MRI imaging by providing
      information about tissue microstructure and may be particularly well suited for assessing the
      integrity of fiber tracts in SCI.

      Diffusion tensor magnetic resonance imaging (DTI) is a new technique that is highly sensitive
      in detecting the integrity of white matter tracts. Although information obtained from DTI has
      been utilized for white matter abnormalities in the brain, DTI of the spinal cord in vivo has
      provided many challenges. The small size of the spinal cord and the close packing of its
      white matter tracts require a very high image resolution to visualize these individual
      tracts. The resolution required to image the small cross sectional area of the spinal cord
      has been difficult to achieve using most widely used DTI sequences. To date, DTI measurements
      reports have demonstrated a practical application of DTI on the cervical spinal cord with
      limited spatial resolutions from 8 mm3 to 16 mm3.

      To achieve high-resolution DTI of the spinal cord, two novel imaging techniques for
      high-resolution in-vivo DTI on a clinical 3T MRI system (Trio, Siemens Medical Solution,
      Erlangen Germany) have been developed: 2D singleshot Interleaved Multiple Inner Volume DWEPI
      (ss-IMIV-DWEPI) and 3D singleshot DW STimulated EPI (3D ss-DWSTEPI). These optimized DTI
      pulse sequences have typically achieved approximately 2.0 or 1.253 mm3 spatial resolution
      within clinically achievable imaging time (~5 min.). The sequences have been designed
      especially for high-resolution DTI of cervical spinal cord. They have been applied to spinal
      cord specimens ex vivo as well as to a small group of healthy volunteers and multiple
      sclerosis patients.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Study subjects will not be randomized, as treatment will follow the doctor's "standard of
        care." Patients will be selected and offered enrollment based upon the clinical diagnosis
        of spinal cord injury, either due to degenerative disease or trauma. Enrollment will be
        based on the chronology of patient presentation.
      
Keywords: spinal cord injury with traumatic event