The Role of DTI and DTT in the Evaluation of Cervical Extramedullary Tumors

To evaluate the efficacy of diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) in establishing the relationship between cervical extramedullary tumors and the spinal cord with reference to, especially treatment planning, clinical outcome prediction and diagnostic accuracy.

This was a retrospective study conducted on 15 patients diagnosed with cervical extramedullary tumors, wherein each patient underwent standard 3.0-T magnetic resonance imaging, DTI, and DTT to evaluate microstructural changes and neural tract displacement. Fractional anisotropy (FA) values were examined, and the relationship of tractography results with clinical presentation and outcomes was evaluated.

FA values revealed disturbances in the microstructure, which exhibited marked changes in lesion areas compared with that of normal tissue and displaced spinal cord (DSC). The DTT of each patient revealed neural tract anomalies or deformities related to the degree of their clinical symptoms. Receiver operating characteristic curve analysis demonstrated the excellent diagnostic accuracy of FA in separating lesions from normal tissue (AUC = 0.880) and DSC (AUC = 0.840).

FA values could help particularly in detecting early myelopathic changes due to cervical cord displacement, which might be a critical indication for surgical decisions. This study supports the usage of DTI and DTT in evaluating cervical extramedullary lesions, surgical planning, and outcome prediction by exposing microstructural changes and lesion-tract relationships.