Background Diffusion tensor imaging (DTI) is widely used; however, most of the prior studies have resulted in presurgical decreased fractional anisotropy (FA) values in patients with cervical spondylotic myelopathy (CSM). We used ZOOM DTI and could acquire highly accurate FA values during perioperative periods, which indicated different insights than preceding studies. The objective of this study was to assess the perioperative FA change in patients with CSM and determine the prognostic factor. Methods Twenty-eight patients with CSM and healthy control subjects were enrolled in this study. Twenty patients (71%) had intracordal high intensity before surgery. All patients underwent decompressive surgery. ZOOM DTI and the Japanese Orthopaedic Association (JOA) assessment were performed before and after surgery. The region of interest was manually contoured to omit the surrounding cerebrospinal fluid. The axial plane of the most stenotic cervical level was assessed. Results FA values before surgery and at 1 week after surgery, and FA values at 1 week after surgery and at 6 months after surgery differed significantly as determined. The FA values of patients with intracordal high intensity significantly decreased after surgery and significantly increased from 1 week to 6 months, whereas those of patients without intracordal high intensity did not significantly change. JOA scores at 6 months after surgery (13.1) improved significantly compared with JOA scores before surgery (10.8). Only FA values at 1 week after surgery had a significant positive relationship with JOA scores presurgery and at 6 months after surgery. Conclusions The presurgical FA value in patients with CSM did not differ from that of normal control subjects, but significantly decreased after surgery, and significantly increased 6 months after surgery. We concluded that the postsurgical FA value approximates the proper state of the damaged cord and the presurgical FA value includes a masked effect as an aligned fiber effect because of compression by degenerative construction. Only the FA value at 1 week had a significant positive relationship with the JOA score presugery and at 6 months, which established that the postsurgical FA value may be a more accurate prognostic factor than the presurgical FA value.

MAJOR PAPERhematoma. 5 Recently, DTI was used for the quantitative evaluation of the spinal cord region.6 Diffusion tensor imaging is generally acquired using single-shot echo-planar imaging (SS-EPI) 7 on a spin-echo (SE) sequence. The advantage of this technique is reduction of the ghost artifacts 8 caused by physiological motion of subjects. The K-space is filled with the combination of one excitation pulse and the inversion of a read-out gradient magnetic field on SS-EPI without the 180-degree refocus pulse used for conventional SE. 9 In general, magnetic artifacts occurring during DTI sequences are often observed on the cervical spinal cord owing to the surrounding unstable magnetic susceptibility region. Moreover, the cervical spinal cord is smaller than the whole brain. High-resolution images of cervical spinal cord DTI prolong the scan time, which is not preferable in a clinical setting. However, the lower resolution scan reduces the accuracy of the FA value. Considering such circumstances, a current technique such as zonally oblique multislice (ZOOM) DTI 10 was proposed. Zonally oblique multislice DTI is based on a reduced FOV (rFOV) 11 with SS-EPI, which indicates that it is useful for IntroductionDiffusion-weighted imaging (DWI) 1 reflects the Brownian motion of water molecules, and it is widely used to diagnose brain infarction. Results:The average FA value decreased in both ZOOM and conventional DTI in lower spinal cord levels; in contrast, the ADC value increased in lower spinal cord levels. Zonally oblique multislice DTI was superior to conventional DTI with regard to inter-rater and intra-rater reliability; further, visibility was better and the standard deviation was smaller in ZOOM DTI. On both the long and short axis, the geometric distortion ratio was lower in ZOOM DTI at all cervical spinal cord levels compared with the conventional DTI. There was a significant difference in the distortion ratios of the long and short axis between ZOOM and conventional DTI. Conclusion:Conventional DTI is unreliable owing to its susceptibility to the surrounding magnetic field. ZOOM DTI is reliable for performing highly accurate evaluations.

Gadolinium ethoxybenzyl diethylenetriamine pantaacetic acid (Gd-EOB-DTPA) is incorporated into liver cells, and liver parenchyma show hyperintensity due to the T1 shortening effect. The T1 value of liver parenchyma in the hepatocyte phase changes from the pre-contrast phase. However, in patients with liver dysfunction, the difference of T1 value is generally small. In examination of hepatic disease, the optimal flip angle should be selected according to the patient's state. The definition of hepatic dysfunction based on biochemical data is diverse. Therefore, if the image findings can estimate liver dysfunction, the operator will select the optimal flip angle. Hence, we defined the criteria of liver dysfunction based on the image data; one or more of the following abnormalities-irregular liver surface, splenomegaly, and expansion of portal trunk. In classification by imaging data, we compared the T1 value of liver parenchyma in the hepatocyte phase, and found that the T1 value was significantly different between normal and cirrhotic liver. Then, in a phantom study simulating normal and cirrhotic liver, we set the optimal flip angle (FA)-21 degrees for the normal liver state, and 18 degrees for the LC state. In Gd-EOB-DTPA-enhanced study, the operator can select the optimal FA for each patient according to the image findings.

Background Recent studies have indicated that injuries such as muscle tears modify the microstructural integrity of muscle, leading to substantial alterations in measured diffusion parameters. Therefore, the fractional anisotropy (FA) value decreases. However, we hypothesized that soft tissue, such as muscle tissue, undergoes reversible changes under conditions of compression without fiber injury. Purpose To evaluate the FA change due to compression in muscle tissue without fiber injury. Material and Methods Diffusion tensor imaging (DTI) was performed on both feet of 10 healthy volunteers (mean age = 35.0 ± 10.39 years; age range = 23–52 years) using a 3.0-T magnetic resonance imaging (MRI) scanner with an eight-channel phased array knee coil. An MRI-compatible sphygmomanometer was applied to the individuals’ lower legs and individuals were placed in a compressed state. Then, rest intervals of 5 min were set in re-rest state after compression. The FA value, apparent diffusion coefficient (ADC), and eigenvalues (λ1, λ2, λ3) of the gastrocnemius and soleus muscle were measured at each state. Results The mean FA values increased in all muscles in a compressed state, while the mean λ3 decreased. In all muscles, significant differences were found between the rest and compressed states in terms of mean FA and λ3 ( P < 0.0001). Conclusion We confirmed the reversibility of the DTI metrics, which suggests that there was no muscle injury during this study. In cases of compression without fiber injury, the FA value increases, because fibers are strongly aligned in the longitudinal direction.