title: Clinical evaluation of reduced field-of-view diffusion-weighted imaging of the cervical and thoracic spine and spinal cord.
abstract: OBJECTIVE
  DWI has the potential to improve the detection and evaluation of spine and spinal cord pathologies. This study assessed whether a recently described method (rFOV DWI) adds diagnostic value in clinical patients.
  
  
  METHODS
  Consecutive patients undergoing clinically indicated cervical and/or thoracic spine imaging received standard anatomic sequences supplemented with sagittal rFOV DWI by using a b-value of 500 s/mm(2). Two neuroradiologists blinded to clinical history evaluated the standard anatomic sequences only for pathology and provided their level of confidence in their diagnosis. These readers then rescored the examinations after reviewing the rFOV DWI study and indicated whether this sequence altered findings or confidence levels.
  
  
  RESULTS
  Two hundred twenty-three patients were included in this study. One hundred eighty patient scans (80.7%) demonstrated at least 1 pathologic finding. Interobserver agreement for identifying pathology (κ = 0.77) and in assessing the added value of the rFOV DWI sequence (κ = 0.77) was high. In pathologic cases, the rFOV DWI sequence added clinical utility in 33% of cases (P < .00001, Fisher exact test). The rFOV DWI sequence was found to be helpful in the evaluation of acute infarction, demyelination, infection, neoplasm, and intradural and epidural collections (P < .001, χ(2) test) and provided a significant increase in clinical confidence in the evaluation of 11 of the 15 pathologic subtypes assessed (P < .05, 1-sided paired Wilcoxon test).
  
  
  CONCLUSIONS
  rFOV diffusion-weighted imaging of the cervical and thoracic spine is feasible in a clinical population and increases clinical confidence in the diagnosis of numerous common spinal pathologies.
authors.affiliation: Departments of Radiology, Stanford University, Stanford, California, USA. drjalal@uw.edu
authors.forename: J B
authors.initials: JB
authors.lastname: Andre
authors.forename: G
authors.initials: G
authors.lastname: Zaharchuk
authors.forename: E
authors.initials: E
authors.lastname: Saritas
authors.forename: S
authors.initials: S
authors.lastname: Komakula
authors.forename: A
authors.initials: A
authors.lastname: Shankaranarayan
authors.forename: S
authors.initials: S
authors.lastname: Banerjee
authors.forename: J
authors.initials: J
authors.lastname: Rosenberg
authors.forename: D G
authors.initials: DG
authors.lastname: Nishimura
authors.forename: N J
authors.initials: NJ
authors.lastname: Fischbein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002574:Cervical Vertebrae; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000473:pathology*; D013118:Spinal Cord Diseases / Q000175:diagnosis*; D013122:Spinal Diseases / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000473:pathology*; D055815:Young Adult