title: Diffusion Tensor Imaging Parameter Obtained during Acute Blunt Cervical Spinal Cord Injury in Predicting Long-Term Outcome.
abstract: There are no reliable neuroimaging biomarkers to predict long-term outcome after spinal cord injury. This prospective longitudinal study evaluates diffusion tensor imaging (DTI) in predicting long-term outcome after cervical spinal cord injury (CSCI). We investigate the admission DTI parameters measured in 30 patients with CSCI, with 16 of them followed up to one year, and 15 volunteers serving as controls. All magnetic resonance imaging examinations were performed within 24 h of injury. The DTI parameters were measured in patients and controls, avoiding areas of hemorrhage in patients and at corresponding upper/middle/lower regions of the spinal cord in controls. Stepwise regression analysis was performed to find relevant parameters (normalized DTI values, age, sex, hemorrhagic contusion [HC or non-HC]) that correlated with two primary outcome measures: patient International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and Spinal Cord Independence Measure (SCIM III) scores at one year. Among all DTI measures, axial diffusivity (AD) most strongly correlated with both motor (r2= 0.76, p < 0.01) and SCIM III scores (r2= 0.77, p < 0.01) at one year. Further stepwise regression indicated that including AD (p = 0.0001) and presence of HC (p < 0.0001) in the regression model provided the best model fit for one year ISNCSCI (r2= 0.93). The AD is a more specific parameter for axonal injury than radial diffusivity; this may indicate that axonal injury in the cord is the main factor affecting patient recovery. Our study demonstrates DTI measurement at the CSCI is a potential neuroimaging biomarker in predicting long-term neurological and functional outcome in blunt CSCI.
authors.affiliation: 1 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine , Baltimore, Maryland.
authors.forename: Kathirkamanathan
authors.initials: K
authors.lastname: Shanmuganathan
authors.affiliation: 1 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine , Baltimore, Maryland.
authors.forename: Jaichen
authors.initials: J
authors.lastname: Zhuo
authors.affiliation: 2 Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, Maryland.
authors.forename: Hegang H
authors.initials: HH
authors.lastname: Chen
authors.affiliation: 3 Department of Neurosurgery, University of Maryland School of Medicine , Baltimore, Maryland.
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.affiliation: 4 Department of Rehabilitation Services, University of Maryland School of Medicine , Baltimore, Maryland.
authors.forename: Jason
authors.initials: J
authors.lastname: Adams
authors.affiliation: 5 Department of Aeromedical Research, U.S. Air Force School of Aerospace Medicine, Research Initiatives, US Air Force c-STARS Baltimore, Baltimore, Maryland.
authors.forename: Catriona
authors.initials: C
authors.lastname: Miller
authors.affiliation: 6 R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine , Baltimore, Maryland.
authors.forename: Jay
authors.initials: J
authors.lastname: Menakar
authors.affiliation: 1 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine , Baltimore, Maryland.
authors.forename: Rao P
authors.initials: RP
authors.lastname: Gullapalli
authors.affiliation: 1 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine , Baltimore, Maryland.
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Mirvis
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000473:pathology; D013997:Time Factors; D055815:Young Adult
keywords: cervical spine; diffusion tensor imaging; magnetic resonance; traumatic spinal cord injury