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Multispectral diffusion-weighted MRI of the instrumented cervical spinal cord: a preliminary study of 5 cases. Eur Spine J 2020 05;29(5):1071-1077



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Scopus ID

2-s2.0-85076835282   1 Citation


PURPOSE: Diffusion-weighted imaging has undergone substantial investigation as a potential tool for advanced assessment of spinal cord health. Unfortunately, commonly encountered surgically implanted spinal hardware has historically disrupted these studies. This preliminary investigation applies the recently developed multispectral diffusion-weighted PROPELLER technique to quantitative assessment of the spinal cord immediately adjacent to metallic spinal fusion instrumentation.

METHODS: Morphological and diffusion-weighted MRI of the spinal cord was collected from 5 subjects with implanted cervical spinal fusion hardware. Conventional and multispectral diffusion-weighted images were also collected on a normative non-instrumented control cohort and utilized for methodological stability analysis. Variance of the ADC values derived from the normative control group was then analyzed on a subject-by-subject basis and qualitatively correlated with clinical morphological interpretations.

RESULTS: Normative control ADC values within the spinal cord were stable across DWI methods for a b value of 600A s/mm2, though this stability degraded at lower b value levels. Susceptibility artifacts precluded conventional DWI analysis of the cord in subjects with spinal fusion hardware in 4 of the 5 test cases. On the contrary, multispectral PROPELLER DWI produced viable ADC measurements within the cord of all 5 instrumented subjects. Instrumented cord regions without obvious pathology (NA =A 4) showed ADC values that were lower than expected, whereas one subject with diagnosed myelomalacia showed abnormally elevated ADC.

CONCLUSIONS: In the absence of instrumentation, multispectral DWI provides quantitative capabilities that match with those of conventional DWI approaches. In a preliminary instrumented subject analysis, cord ADC values showed both expected and unexpected variations from the normative cohort. These slides can be retrieved under Electronic Supplementary Material.

Author List

Koch KM, Bhave S, Kaushik SS, Nencka AS, Budde MD


Matthew Budde PhD Associate Professor in the Neurosurgery department at Medical College of Wisconsin
Kevin M. Koch PhD Center Director, Professor in the Radiology department at Medical College of Wisconsin
Andrew S. Nencka PhD Director, Associate Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cervical Cord
Diffusion Magnetic Resonance Imaging
Spinal Cord
Spinal Cord Diseases