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Updated: Jan 14, 2026
Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
Evolution of MRI Parameters from the Subacute to Chronic Phase After Human Traumatic Cervical Spinal Cord Injury:
Andreas Grillhösl1, Iris Leister2, Florian Högel3
1Department of Radiology, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany.
Purpose:
Imaging modalities, particularly magnetic resonance imaging (MRI), have become the gold standard for assessing lesion characteristics of traumatic spinal cord injuries (SCI). Diffusion tensor imaging (DTI), an advanced MRI technique, offers insights into microstructural changes in white matter tracts. While previous studies focused on either acute or chronic SCI, few have examined longitudinal changes during the transition from acute to chronic stages of injury. This study addresses this gap by analyzing the evolution of DTI metrics over the first year following cervical SCI.
Methods:
This prospective longitudinal study involved 52 patients with traumatic cervical SCI. MRI and neurological examinations using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) were performed 1 month, 3 months, and 1 year post-injury. Linear mixed model analyses assessed DTI measures over time.
Results:
Fractional anisotropy (FA) values gradually decreased in the reference area at the cranio-cervical junction (C0-C4; p < 0.001), indicating ongoing tissue degeneration up to one year after injury, independent of initial clinical severity. FA values at the lesion site correlated moderately with the total motor score 1 month post-SCI (R = 0.37, p = 0.033). Mean diffusivity (MD) increased significantly over time (p < 0.001), suggesting progressive microstructural changes. Axial diffusivity (AD) decreased until 3 months after injury (p < 0.001), then returned to its initial values by 1 year, reflecting dynamic pathophysiological events.
Conclusion:
This study highlights the potential of DTI for monitoring microstructural changes after SCI. Longitudinal imaging offers insights into evolving pathology, supports prognostic modeling, and may aid treatment monitoring and outcome prediction.
Insights
Diffusion tensor imaging (DTI) reveals ongoing spinal cord degeneration up to one year after injury. These longitudinal DTI metrics track microstructural changes, aiding in prognosis and treatment monitoring for spinal cord injury (SCI).
Area of Science:
- Neuroimaging
- Spinal Cord Injury Research
- Diffusion Tensor Imaging
Background:
- Magnetic resonance imaging (MRI) is standard for assessing spinal cord injury (SCI) lesions.
- Diffusion tensor imaging (DTI) provides microstructural insights into white matter changes.
- Few studies have longitudinally tracked SCI changes from acute to chronic stages.
Purpose of the Study:
- To analyze the evolution of DTI metrics over the first year following cervical SCI.
- To investigate longitudinal microstructural changes during the acute-to-chronic transition in SCI.
- To assess DTI's potential for monitoring SCI pathology over time.
Main Methods:
- Prospective longitudinal study of 52 traumatic cervical SCI patients.
- MRI and neurological assessments (ISNCSCI) at 1 month, 3 months, and 1 year post-injury.
- Linear mixed model analyses to evaluate DTI metrics (FA, MD, AD) over time.
Main Results:
- Fractional anisotropy (FA) decreased longitudinally, indicating ongoing degeneration.
- Mean diffusivity (MD) increased significantly over the year, suggesting progressive microstructural changes.
- Axial diffusivity (AD) showed dynamic changes, decreasing then returning to baseline values.
Conclusions:
- DTI is valuable for monitoring microstructural changes post-SCI.
- Longitudinal imaging provides insights into SCI pathology evolution.
- DTI aids in prognostic modeling, treatment monitoring, and outcome prediction for SCI.
