Clinical applications of diffusion imaging in the spine

As in the brain, the sensitivity of diffusion-weighted imaging (DWI) to ischemic damage in the spinal cord may provide early identification of infarction. Diffusion anisotropy may enhance the detection and understanding of damage to the long fiber tracts with clinical implications for diseases such as multiple sclerosis and amyotrophic lateral sclerosis and may also yield insight into damage that occurs with spondylotic and traumatic myelopathy. This article reviews the basis for DWI for the evaluation of the spinal cord, osseous, and soft tissues of the spine and reviews the imaging appearance of a variety of disease states.