Diffusion Tensor Imaging: New Diagnostic Tool for Degenerated Lumbar Disease

Abstract

Introduction It is difficult to correctly diagnose lumbar degenerated disease with foraminal stenosis using conventional X-ray imaging, CT, and MRI. This difficulty can sometimes result in failed back syndrome. Diffusion Tensor Imaging (DTI) was reported as a potential tool for the diagnosis for foraminal stenosis. The purpose of this study is to evaluate the efficacy of DTI for diagnosis of degenerated lumbar disease. Materials and Methods Total 27 patients (20 men, mean age, 68.5 years) with degenerated lumbar disease who underwent 3.0 T MRI and surgical treatment were included. DTI (tractography), fractional anisotropy (FA), and improvement in Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) pain score were investigated. Results The diagnoses by conventional imaging were lumbar spinal stenosis without foraminal stenosis in 11 cases, with foraminal stenosis in 10 cases, lumbar disk herniation in 3 cases, spondylolisthesis in 2 cases, and discogenic low back pain in 1 case. We classified the patients into following four groups by the shape of the tractography; disruption, narrowing, tapering, and no abnormalities. The mean preoperative JOA and VAS score were 14 and 88, and postoperative score were 21 and 12, respectively. The JOA score was improved by 46%. Tractography of the ipsilateral side showed disruption, narrowing, and tapering, and a lower FA compared with the contralateral side. There was no significant correlation between FA and symptoms. Conclusion Although there is no significant correlation between DTI and postsurgical symptoms, DTI has the possibility of detecting lesions of nerve damage, and to be a new diagnostic tool for the degenerated lumbar disease. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared