title: Spinal diffusion tensor tractography for differentiation of intramedullary tumor-suspected lesions.
abstract: OBJECTIVE
  Primary MRI diagnosis of spinal intramedullary tumor-suspected lesions can be challenging and often requires spinal biopsy or resection with a substantial risk of neurological deficits. We evaluated whether Diffusion Tensor Imaging (DTI) tractography can facilitate the differential diagnosis.
  
  
  METHODS
  Twenty-five consecutive patients with an intramedullary tumor-suspected lesion considered for spinal surgery were studied with a Diffusion-weighted multi-shot read out segmented EPI sequence (RESOLVE). White matter tracts ("streamlines") were calculated using the FACT algorithm and visually co-registered to a T2-weighted 3D sequence. The fused images were assessed concerning spinal streamline appearance as normal, displaced or terminated. Definite diagnosis was verified by histological analysis or further clinical work-up.
  
  
  RESULTS
  All patients with normal appearing streamlines (n=6) showed an acute inflammatory demyelinating pathology in the further clinical work-up. In 10 patients streamline displacing lesions were found from which 5 patients underwent a surgical treatment with histologically confirmed low-grade tumors like ependymomas and pilocytic astrocytomas. In nine patients streamlines were terminated, from which 6 patients received a histology proven diagnoses with a more heterogenous spectrum (3 cases of high grade tumor, 1 case of low grade tumor with intralesional hemorrhage and 2 cases with gliosis but no tumor cells).
  
  
  CONCLUSIONS
  Using multi-shot DTI spinal tractography acute inflammatory lesions can be differentiated from other tumorous intramedullary lesions. The entity diagnosis of spinal tumors seems to be more challenging, primarily due to the variety of factors like invasivity, expansion or intralesional hemorrhage.
authors.affiliation: Department of Neuroradiology, University Medical Center Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany. Electronic address: karl.egger@uniklinik-freiburg.de.
authors.forename: K
authors.initials: K
authors.lastname: Egger
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hohenhaus
authors.affiliation: Department of Neurosurgery, UZ Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: Van Velthoven
authors.affiliation: Department of Neuroradiology, University Medical Center Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Heil
authors.affiliation: Department of Neuroradiology, University Medical Center Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Urbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001254:Astrocytoma / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D056324:Diffusion Tensor Imaging / Q000379:methods*; D004806:Ependymoma / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005911:Gliosis / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D009187:Myelitis / Q000000981:diagnostic imaging / Q000473:pathology; D019635:Neurosurgical Procedures; D011446:Prospective Studies; D059629:Signal-To-Noise Ratio; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology; D013120:Spinal Cord Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D055815:Young Adult
keywords: DTI; Intramedullary; MRI; Spinal; Tractography