Full cervical cord tractography: A new method for clinical use

Area of Science:

• Neuroimaging
• Neurosurgery
• Medical Technology

Background:

• Spinal cord tractography is crucial for neurosurgical planning but faces challenges in clinical application due to complex reconstruction and lengthy processing times.
• Existing methods often require extensive manual filtering and multiple seed regions, hindering routine clinical adoption.

Purpose of the Study:

• To develop and validate a novel, simplified full tractography approach for the cervical spinal cord.
• To provide neurosurgeons with a reliable 3D-rendering for improved surgical strategy in spinal cord disorders.

Main Methods:

• Acquired diffusion-weighted images of the cervical spinal cord in healthy volunteers and patients using a Philips 3 Tesla MRI scanner.
• Applied distortion correction using FSL software and performed full cervical spinal cord tracking with DSI Studio's quantitative anisotropy-based deterministic algorithm.
• Utilized a unique region of avoidance and specific fiber tracking parameters (adaptive FA, fiber length, angular threshold) for efficient tractogram generation.

Main Results:

• Successfully performed full cervical cord tractography from the medulla to the C7 level in all participants.
• Demonstrated clear visualization of key anatomical landmarks, including the medulla-spinal cord junction, cerebellar peduncles, and dorsal sulcus tracts.
• Observed displacement of spinal tracts in patients with intramedullary tumors or spinal cord injuries, aiding in surgical strategy adjustment.

Conclusions:

• The proposed full tractography approach simplifies the pipeline for cervical spinal cord imaging.
• This method offers reliable 3D rendering, potentially enhancing neurosurgical management of spinal cord pathologies.
• The technique facilitates better pre-operative planning and intra-operative guidance for neurosurgeons.