Diffusion tensor tractography demonstration of partially injured spinal cord tracts in a patient with posttraumatic brown sequard syndrome

Abstract

The authors report the utility of diffusion tensor tractography in demonstrating the partially severed spinal cord tracts on one side with normal, intact, distally traceable tracts on the opposite side in a patient with posttraumatic Brown Sequard syndrome. A 30-year-old man presented with typical clinical features of a hemisection injury of the thoracic spinal cord, 2 months after he had sustained a back stab injury. Routine MRI showed T2 hyperintense zones in the thoracic spinal cord at the level of T5. We did axial single shot echo planar diffusion tensor imaging with a 1.5 Tesla MR machine. Tractography effectively depicted the injured spinal cord tracts on the left side with normal intact tracts on the right side, which could be traced distally. The fractional anisotropy and apparent diffusion coefficient values showed significant changes at the level of injury. Tractographic demonstration of human spinal cord injury is reported for the first time.

Diffusion Tensor Imaging as a Predictor of Locomotor Function after Experimental Spinal Cord Injury and Recovery

“…Several small clinical studies have explored DTI and FA in evaluating post-traumatic SCI neurologic function and recovery [59][60][61][62] and have tried to correlate imaging and clinical findings 8,9,63,64 with some success. DTI has also been explored in other spinal neurologic conditions such as cervical spondolytic myelopathy, 61,62,65 neuromyelitis optica, 66 transverse myelitis, 67 multiple sclerosis, 68 Brown-Sequard syndrome, 6 and spinal neoplasms. 69,70 Our findings suggest that FA is able to differentiate between mild and moderate/severe experimental traumatic SCI within parenchyma outside of the contusion site itself, and that these findings correlate with locomotor activity, especially within caudal segments.…”

“…2,3 While efforts to understand and overcome these barriers are active areas of research, clinical assessments of locomotor function using motor/sensory testing and spinal white matter integrity via imaging remain critical aspects of comprehensive post-SCI analyses and are used to track (potential) recovery after trauma. [3][4][5][6][7][8][9][10][11][12][13][14][15] Current imaging modalities such as conventional magnetic resonance (MR) illustrate SCI pathology at the level of the whole cord; however, evaluation of individual cord components such as white matter tracts remains more complex. Diffusion tensor imaging (DTI), an MR imaging technique, allows for the examination of white matter directionality and relative health by measuring the anisotropic diffusion of water in the white matter.…”

Diffusion tensor imaging and tractography in brown-sequard syndrome

“…3 To the best of our knowledge, only one previous study has documented the role of DTI and DTT in patients with penetrating SCI. 6 In that study, DTI was performed in a single patient with BSS 2 months after a thoracic stab injury. Similar to their results, we found lower FA values and higher MD values at the injury zone.…”

Conditions for quantitative evaluation of injured spinal cord by in vivo diffusion tensor imaging and tractography: Preclinical longitudinal study in common marmosets

“…Previous studies demonstrated that DTT is effective for depicting spinal cord disorders, including inflammatory and degenerative disorders (Cruz et al, 2009;Renoux et al, 2006), tumors Setzer et al, 2010), arteriovenous malformations (Ozanne et al, 2007), and trauma (Rajasekaran et al, 2010). However, major concerns about DTT analyses still remain.…”