The aim of this study was to quantify the association between diffusion tensor imaging (DTI) parameters of the cervical spinal cord and neurological disability in patients with chronic traumatic spinal cord injury (SCI). A cervical spinal cord 3T magnetic resonance imaging (MRI) with DTI sequences was performed on 28 patients with chronic traumatic SCI and 40 healthy control subjects. DTI metrics, including fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD), were calculated within the normal-appearing spinal cord area at levels C2 or C3. Clinical assessment of the patients was performed according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the motor subscale of the Functional Independence Measure (FIM). The FA values of the patients with SCI were significantly lower than those of healthy control subjects (p<0.000001). In contrast, the ADC and RD values of these patients were significantly higher than those of control subjects (ADC p<0.0001, RD p<0.00001). In patients with SCI, the FA values were positively correlated with the motor (pr=0.56, p<0.01) and sensory (pr=0.66, p<0.001) scores of ISNCSCI and with the motor subscale of FIM (pr=0.51, p<0.01). DTI revealed spinal cord pathology, which was undetectable using conventional MRI. DTI changes in regions that were remote from the site of primary injury were most likely the result of secondary degeneration of white matter tracts. Decreased FA values were correlated with poorer motor and sensory function, as well as a lack of independence in daily living. DTI is a promising quantitative and objective tool that may be used in the clinical assessment of patients with SCI.

Study design: Population-based prospective study. Objectives: To determine the incidence and evaluate the characteristics of newly injured patients with traumatic spinal cord injury (TSCI) admitted to two of the three national spinal cord injury (SCI) centers during the first year after the centralization of SCI care in Finland. Setting: Oulu and Tampere University Hospital SCI centers, Finland. Methods: The designated rehabilitation teams evaluated all of the patients with a new SCI and persisting neurological symptoms. The data were recorded according to the International Spinal Cord Injury Core Data Set. Results In a 1-year period, 77 new patients with TSCI were admitted to the study centers serving a population of 3 065 946. In the whole catchment area, the mean annual incidence of TSCI was 25.1 per million, and in the hospital districts of the SCI centers, the incidence was even higher, at 38.1 per million. The mean age of the patients was 58.7 years. Falls were the leading cause of injury (64.9%), and the injury resulted in tetraplegia in 70.1% of the cases. Alcohol use was a contributing factor in 39% of the cases in the entire sample and in 58.6% of cases among patients aged younger than 60 years. Conclusion The incidence rates of TSCI were markedly higher than expected, demonstrating the previously hidden morbidity. The epidemiological features of TSCI appeared to follow the trends in developed countries, highlighting the increasing incidence of cervical lesions due to falling among the elderly. The results need to be confirmed in an extended follow-up.

Both ROI- and FT-based measurements are applicable methods yielding reproducible results for cervical spinal cord DTI metrics. Normative values for both measurement methods are presented.

Study design: Prospective clinical case-control study. Objectives: The aim of this study was to use diffusion tensor imaging (DTI) to assess the state of cerebral white matter tracts after spinal cord injury (SCI). The DTI metrics were evaluated in relation to neurological deficits and to the size and level of the spinal cord lesions. Setting: Tampere University Hospital, Tampere, Finland. Methods: Thirty-four patients (n ¼ 34) with clinically complete and incomplete SCI were evaluated using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). DTI metrics (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) were calculated for multiple levels along the course of the corticospinal tract. The state of the spinal cord after injury was assessed using conventional magnetic resonance imaging (MRI). DTI parameters were compared with 40 orthopedically injured control subjects. Results: Statistically significant differences in the DTI values between patients and controls were detected in the posterior area of the centrum semiovale. In this area, the FA values were lower in the patients compared with controls (P ¼ 0.008). For patients with clinically complete injury, the difference was even more significant (P ¼ 0.0005). Motor and sensory scores of the ISNCSCI correlated positively with FA and negatively with ADC values of the centrum semiovale. A moderate association was observed between the macroscopic changes in the spinal cord and the DTI abnormalities in the centrum semiovale. Conclusion: In patients with chronic SCI, DTI changes can be observed in the cerebral white matter. These alterations are associated with the clinical state of the patients.

LAY ABSTRACTThe Finnish Spinal Cord Injury Study (FinSCI) collects information from people with spinal cord injury about their own health, ability to function, and their challenges in terms of accessibility. The study includes a questionnaire and interviews. The questionnaire is based on international guidelines. Participants are recruited from the registers of Oulu, Tampere and Helsinki university hospitals. Almost 1,800 people met the criteria and it is hoped that at least half of them will answer the questionnaire. Interviews will be performed with 45 persons. Interviews have several different themes, such as returning home, housing and living arrangements, employment situation and pathways to employment. The aim of this study is to help to develop the care and rehabilitation policies for the spinal cord injury population, to plan training models, and to provide information for different parties and gain understanding of the lived experience of people with spinal cord injury. Background and purpose: The purpose of the Finnish Spinal Cord Injury Study (FinSCI) is to identify fac tors related to the health and functioning of people with spinal cord injury, their challenges with acces sibility, and how such factors are interconnected. The International Classification of Functioning, Disa bility and Health (ICF) is used as a structured frame work in the study. Design: Protocol of mixed methods study. Results: Study participants were recruited from all 3 spinal cord injury outpatient clinics in Finland. The final target group consists of 1,789 subjects with spinal cord injury. The final questionnaire was for med from 5 different patientreported instruments. The spinal cord injury-specified instruments are the Spinal Cord Injury Secondary Condition Scale, the Spinal Cord Independence Measure, and the Nottwil Environmental Factors Inventory Short Form. In ad dition, questions from the following generic instru ments were chosen after a selection process: the PatientReported Outcomes Measurement Informa tion System, PROMIS®, and the National Study of Health, Wellbeing and Service, FinSote. Altogether, the final questionnaire covers 64 ICF categories and consists of 151 ICF-linked questions. Conclusion: The formulated questionnaire covers widely different aspects of health, functioning and accessibility. The questionnaire results and subse quent interviews will help in developing care and rehabilitation policies and services for people with spinal cord injury.