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Updated: May 12, 2026
Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
Diagnostic accuracy of diffusion tensor imaging for pediatric cervical spinal cord injury
M J Mulcahey1, A F Samdani, J P Gaughan
1Occupational Therapy, Thomas Jefferson University, Jefferson School of Health Professions, Philadelphia, PA, USA. maryjane.mulcahey@jefferson.edu
Insights
Diffusion tensor imaging (DTI) shows good to strong predictive accuracy for assessing pediatric spinal cord injury (SCI) outcomes, including sacral sparing, motor level, and MRI level.
Area of Science:
- Neuroimaging
- Orthopedics
- Pediatric Medicine
Background:
- Pediatric spinal cord injury (SCI) diagnosis and outcome prediction remain challenging.
- Diffusion tensor imaging (DTI) offers potential for non-invasive assessment of white matter integrity.
Purpose of the Study:
- To evaluate the diagnostic accuracy of DTI parameters in pediatric SCI.
- To correlate DTI findings with clinical outcomes such as sacral sparing and neurological level.
Main Methods:
- A cross-sectional study involving 35 pediatric subjects (10 SCI, 25 controls) using 3.0T MR scanner.
- Calculation of fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) values.
- Comparison of DTI values between SCI and control groups, and correlation with clinical assessments.
Main Results:
- DTI values significantly differed between SCI subgroups and controls (P<0.003).
- Combined DTI parameters demonstrated strong diagnostic accuracy (ROC AUC 0.88–0.93) for predicting sacral sparing, motor level, and MRI level.
- Resampling methods confirmed the reliability of DTI parameter estimates.
Conclusions:
- DTI is a valuable tool for predicting functional outcomes in pediatric SCI.
- The study highlights the potential of DTI in guiding clinical management and prognosis for pediatric SCI.
Study Design:
Cross-sectional non-experimental study.
Objectives:
To examine diagnostic accuracy of diffusion tensor imaging (DTI) for pediatric spinal cord injury (SCI).
Setting:
Pediatric Orthopedic Hospital.
Methods:
Thirty-five subjects, 10 SCI and 25 controls, mean age 13.38 years underwent two scans with 3.0 T MR scanner. Fractional anisotropy (FA), axial diffusivity (AD) and radial diffusivity (RD) values were calculated. Subjects with SCI underwent examination of muscle strength, sensation and sacral sparing. Mean and s.d. values for FA, AD and RD were compared by group (controls, SCI with sacral sparing, SCI without sacral sparing) using analysis of variance for repeated measures. Comparisons were also made of DTI values at the injury site to values from cervical regions outside of the injury site. Specificity, sensitivity, receiver operating characteristics area under the curve (ROC AUC) and corresponding 95% confidence intervals were calculated. Resampling methods were used to validate the estimates from the final models.
Results:
FA values differed among SCI subjects with intact sacral sparing, absent sacral sparing and controls, P<0.003 (adjusted). DTI values in combination showed the strongest diagnostic accuracy for predicting the presence of anal contraction (AD, RD; ROC AUC=0.90), deep anal pressure (FA; ROC AUC=0.88), S4-5 sensation (FA, RD; ROC AUC=0.93), motor level (FA, AD, RD; ROC AUC=0.92) and MRI level (FA, AD, RD; ROC AUC=0.92). Bootstrap and Jackknife median values indicated consistency of the parameter estimates.
Conclusion:
The predictive accuracy of DTI for sacral sparing end points and motor and MRI level of injury was good to strong.
