Demonstration of Spinal Cord and Nerve Root Abnormalities by Diffusion Neurography

Abstract

Diffusion-weighted magnetic resonance imaging postprocessed by maximum-intensity projection reportedly demonstrates the nerve roots. We modified this technique using a fluid-attenuated inversion-recovery-based diffusion-tensor scan using parallel imaging and evaluated its feasibility in demonstrating spinal cord and nerve root abnormalities. We applied this technique to 18 patients with miscellaneous pathological conditions that included multiple sclerosis, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), neurofibromatosis (NF), schwannoma, cord injury, and tethered cord. The neurographic images were visually assessed regarding the lesion depiction. In each subject, not only the cord but also the nerve roots were visualized. This technique demonstrated cord plaques of multiple sclerosis (5/6 cases), enlarged nerve roots in CIDP (3/3 cases), multiple neurogenic tumors in NF (3/3 cases), and schwannoma (1/1 case). It better demonstrated nerve root abnormalities of CIDP (3/3 cases) and NF (2/3 cases) than conventional magnetic resonance images. This technique can effectively demonstrate most of the cord and nerve root pathology.