Reproducible evaluation of spinal cord DTI using an optimized inner volume sequence in combination with probabilistic...

The purpose of this work was to reliably acquire and evaluate diffusion tensor data of the cervical spine. Thereto, we describe an optimized, time-efficient inner-volume echo planar imaging sequence. Multislice capability is achieved by restoring the magnetization in neighbouring slices early during the twice refocused diffusion preparation. The acquired diffusion images showed compelling image quality. To reduce the arbitrariness of conventional region of interest (ROI) analysis, a tissue classification algorithm was applied. The classification was independent of the ROI shape and hence, a reliable and stable evaluation of the diffusion tensor could be achieved. The mean fractional anisotropy (FA) of five healthy subjects decreased from C1 (FA = 0.81 +/- 0.03) to C7 (FA = 0.60 +/- 0.03), while the mean apparent diffusion coefficient (ADC) increased from C1 (ADC= 0.78 +/- 0.08 microm2/ms) to C7 (ADC = 1.08 +/- 0.08 microm2/ms). In subsequent measurements of the individual healthy subjects, the standard deviation of the FA was 0.024 +/- 0.011 and the standard deviation of the ADC was 0.045 +/- 0.017 microm2/ms. The FA values of a patient with acute ischemic spinal trauma were significantly lower and changed more drastically than ADC values. Here, absolute FA ranged from 0.23 to 0.42, showing that DTI of the spine may serve as surrogate marker for tissue integrity and therapy monitoring.