Department of Clinical Medicine

TY - JOUR

T1 - Diffusional kurtosis imaging as a possible prognostic marker of cervical incomplete spinal cord injury outcome

T2 - a prospective pilot study

AU - Thygesen, Mathias

AU - Lund, Torben Ellegaard

AU - Mikkelsen, Irene Klærke

AU - Kasch, Helge

AU - Dalby, Rikke Beese

AU - Dyrskog, Stig Eric

AU - Pedersen, Michael

AU - Rasmussen, Mikkel Mylius

PY - 2022/1

Y1 - 2022/1

N2 - Background: Spinal cord injury (SCI) is associated with substantial chronic morbidity and mortality. Routine imaging techniques such as T1- and T2-weighted magnetic resonance imaging (MRI) are not effective in predicting neurological deficiency grade or outcome. Diffusional kurtosis imaging (DKI) is an MR imaging technique that provides microstructural information about biological tissue. There are no longitudinal prospective studies assessing DKI metrics in acute traumatic SCI. Therefore, the purpose of this study was to establish a DKI protocol for acute SCI and correlate the DKI metrics to the functional neurological outcome of the patients.Methods: Eight consecutive SCI patients referred to our institution with cervical SCI were included in the study. An acute diagnostic MRI scan was supplemented with a novel fast, mean kurtosis DKI protocol, which describes the average deviation from Gaussian diffusional along nine different directions. Mean kurtosis values were measured at the injury site and normalized to the mean kurtosis values of a non-injured site. At discharge form specialized rehabilitation, patients were evaluated using the Spinal Cord Independence Measure-III (SCIM-III). The DKI metrics and SCIM-III were analysed using Spearman's rank correlation.Results: This pilot study found a significant correlation between decreasing mean kurtosis values at the injury site of the spinal cord and higher grade of disability measured by the SCIM-III (p = 0.002).Conclusion: This pilot study found that DKI may be a valuable tool as a prognostic marker in the acute phase of SCI.

AB - Background: Spinal cord injury (SCI) is associated with substantial chronic morbidity and mortality. Routine imaging techniques such as T1- and T2-weighted magnetic resonance imaging (MRI) are not effective in predicting neurological deficiency grade or outcome. Diffusional kurtosis imaging (DKI) is an MR imaging technique that provides microstructural information about biological tissue. There are no longitudinal prospective studies assessing DKI metrics in acute traumatic SCI. Therefore, the purpose of this study was to establish a DKI protocol for acute SCI and correlate the DKI metrics to the functional neurological outcome of the patients.Methods: Eight consecutive SCI patients referred to our institution with cervical SCI were included in the study. An acute diagnostic MRI scan was supplemented with a novel fast, mean kurtosis DKI protocol, which describes the average deviation from Gaussian diffusional along nine different directions. Mean kurtosis values were measured at the injury site and normalized to the mean kurtosis values of a non-injured site. At discharge form specialized rehabilitation, patients were evaluated using the Spinal Cord Independence Measure-III (SCIM-III). The DKI metrics and SCIM-III were analysed using Spearman's rank correlation.Results: This pilot study found a significant correlation between decreasing mean kurtosis values at the injury site of the spinal cord and higher grade of disability measured by the SCIM-III (p = 0.002).Conclusion: This pilot study found that DKI may be a valuable tool as a prognostic marker in the acute phase of SCI.

KW - Spinal Cord Injury

KW - Diffusional kurtosis imaging

KW - Magnetic resonance imaging

KW - Predictive

KW - SCIM-III

KW - Spinal cord injury

KW - Prognostic

KW - MICROSTRUCTURAL CHANGES

KW - TRAUMATIC BRAIN-INJURY

KW - DTI

KW - SEVERITY

KW - Prognosis

KW - Prospective Studies

KW - Spinal Cord Injuries/diagnostic imaging

KW - Humans

KW - Diffusion Tensor Imaging

KW - Pilot Projects

KW - Diffusion Magnetic Resonance Imaging

U2 - 10.1007/s00701-021-05018-4

DO - 10.1007/s00701-021-05018-4

M3 - Journal article

C2 - 34671848

VL - 164

SP - 25

EP - 32

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

SN - 0001-6268

IS - 1

ER -