title: A better characterization of spinal cord damage in multiple sclerosis: a diffusional kurtosis imaging study.
abstract: OBJECTIVE
  The spinal cord is a site of predilection for MS lesions. While diffusion tensor imaging is useful for the study of anisotropic systems such as WM tracts, it is of more limited utility in tissues with more isotropic microstructures (on the length scales studied with diffusion MR imaging) such as gray matter. In contrast, diffusional kurtosis imaging, which measures both Gaussian and non-Gaussian properties of water diffusion, provides more biomarkers of both anisotropic and isotropic structural changes. The aim of this study was to investigate the cervical spinal cord of patients with MS and to characterize lesional and normal-appearing gray matter and WM damage by using diffusional kurtosis imaging.
  
  
  METHODS
  Nineteen patients (13 women, mean age = 41.1 ± 10.7 years) and 16 controls (7 women, mean age = 35.6 ± 11.2-years) underwent MR imaging of the cervical spinal cord on a 3T scanner (T2 TSE, T1 magnetization-prepared rapid acquisition of gradient echo, diffusional kurtosis imaging, T2 fast low-angle shot). Fractional anisotropy, mean diffusivity, and mean kurtosis were measured on the whole cord and in normal-appearing gray matter and WM.
  
  
  RESULTS
  Spinal cord T2-hyperintense lesions were identified in 18 patients. Whole spinal cord fractional anisotropy and mean kurtosis (P = .0009, P = .003), WM fractional anisotropy (P = .01), and gray matter mean kurtosis (P = .006) were significantly decreased, and whole spinal cord mean diffusivity (P = .009) was increased in patients compared with controls. Mean spinal cord area was significantly lower in patients (P = .04).
  
  
  CONCLUSIONS
  Diffusional kurtosis imaging of the spinal cord can provide a more comprehensive characterization of lesions and normal-appearing WM and gray matter damage in patients with MS. Diffusional kurtosis imaging can provide additional and complementary information to DTI on spinal cord pathology.
authors.affiliation: Department of Radiology, New York University School of Medicine, New York, New York.
authors.forename: E
authors.initials: E
authors.lastname: Raz
authors.forename: M
authors.initials: M
authors.lastname: Bester
authors.forename: E E
authors.initials: EE
authors.lastname: Sigmund
authors.forename: A
authors.initials: A
authors.lastname: Tabesh
authors.forename: J S
authors.initials: JS
authors.lastname: Babb
authors.forename: H
authors.initials: H
authors.lastname: Jaggi
authors.forename: J
authors.initials: J
authors.lastname: Helpern
authors.forename: R J
authors.initials: RJ
authors.lastname: Mitnick
authors.forename: M
authors.initials: M
authors.lastname: Inglese
mesh_terms: D000328:Adult; D000465:Algorithms; D003627:Data Interpretation, Statistical; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications* / Q000473:pathology*; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000209:etiology* / Q000473:pathology*