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Diffusion Tensor Tractography of the Pediatric Cervical Spinal Cord Using 3.0 Tesla MRI 2014

Category General Spine Kathleen e. Carey, M.D. Chetan Shah, MD Purpose Diffusion tensor imaging and fiber tractography of the spinal cord allows for imaging of the white matter tracts of the spine in vivo. Specifically, alterations of the spinal white matter tracts due to spinal lesions can be detected. This has great clinical utility for biopsy and neurosurgical treatment planning as well as follow-up. Our aim is to review the application of diffusion tensor imaging of the spine in the pediatric population and provide example cases illustrating the impact of diffusion tensor imaging and fiber tractography on surgical planning. Materials & Methods We perform literature review about latest techniques used for diffusion tensor imaging and fiber tractography of pediatric spinal cord using 3.0 Tesla MRI. We compare various methodologies like reduced field of view, coronal acquisitions and axial acquisitions. Usefulness of spinal cord tractography to assess resectibility of intramedullary tumors will be discussed. We also address limitations of spinal cord tractography with current technique. We illustrate the utility of spinal cord tractography with example cases (attached graphic). Results Spinal cord tractography demonstrates displacement versus destruction of white matter fiber tracts. The location of fiber tracts with respect to the spinal cord lesion may help the neurosurgeon decide the approach for biopsy as well as surgical resection. Resectability of the spinal cord intramedullary masses can be assessed pre-operatively using this information. Conclusion Advanced MRI techniques like diffusion tensor imaging and fiber tractography of the pediatric spinal cord using 3.0 Tesla MRI provides excellent information for surgical planning. References Hodel J, Besson P, Outteryck O, et al. Pulse-triggered DTI sequence with reduced FOV and coronal acquisition at 3T for the assessment of the cervical spinal cord in patients with myelitis. AJNR Am J Neuroradiol. 2013;34(3):676-82. Setzer M, Murtagh RD, Murtagh FR, et al. Diffusion tensor imaging tractography in patients with intramedullary tumors: comparison with intraoperative findings and value for prediction of tumor resectability. J Neurosurg Spine. 2010;13(3):371-80.