Magnetic Resonance Diffusion Tensor Imaging (MR-DTI) in Spinal Cord Lesions: a Feasibility Study

Abstract

Background/Aims: Magnetic Resonance Diffusion Tensor Imaging (MR-DTI) enables in vivo visualization of spinal cord white matter integrity and may provide complementary diagnostic information beyond conventional MRI. Despite its potential, clinical application in spinal cord pathology remains limited due to technical challenges. This study aimed to assess the feasibility and clinical value of MR-DTI for evaluating various spinal cord lesions. Methods: We retrospectively analyzed 55 consecutive patients with spinal cord lesions who underwent MR-DTI between September 2012 and January 2022. Imaging was performed on a Philips Achieva 3.0 T scanner using 16 non-collinear diffusion directions (b-value 500–800 s/mm2). Clinical severity was classified according to the American Spinal Injury Association Impairment Scale (AIS). Demographic, etiologic, and lesion-level data were evaluated descriptively. Results: The cohort comprised 38 men and 17 women (mean age 57.7 ± 15.9 years). Lesions were cervical in 55%, thoracic in 40%, and mixed in 5%. Etiologies included traumatic (n = 24), compressive (n = 24), ischemic (n = 20), and inflammatory (n = 7) causes, with overlaps across categories. AIS grades were A = 13, B = 7, C = 8, D = 14. Fiber-tracking revealed rarefaction or disconnection of tracts at the lesion level in 16 patients. Conclusion: MR-DTI of the spinal cord is feasible in a clinical setting and provides valuable structural information not visible on conventional MRI. Visualization of tract disruption supports its potential as a complementary diagnostic and prognostic tool. Standardized quantitative protocols and multicenter validation are warranted to establish MR-DTI as part of routine spinal cord imaging. Cell Physiol Biochem Press GmbH&Co. KG