MRI Directional Diffusivity Values of Cervical Cord White Matter: Multiple Sclerosis Patients Vs. Healthy Controls

Sigal Tal Hillel S

doi:10.4172/2165-7939.1000246

Abstract

Background: Early diagnosis of multiple sclerosis (MS) can lead to preventive treatment and a favorable prognosis. Cervical spinal cord matter that appears normal on conventional MR images may be detected as abnormal using advanced MRI techniques. Objective: To pinpoint values and cervical spine locations in Diffusion Tensor Imaging (DTI) which best differentiate relapsing-remitting MS from healthy cases. Methods: 10 relapsing-remitting MS and 8 healthy control patients underwent DTI of the cervical spine. DTI values were measured in anterior, lateral and posterior cord locations. Results: Differences in values per location show statistical significance among all areas of the cord in both Normal Appearing White Matter (NAWM) and control groups. We derived an ADC cut-off value of 0.8 mm2/sec and λ2 value of 0.8 mm2/sec for optimal differentiation between NAWM and control. Using these cut-off metrics, values above 0.8 for Receiver Operating Characteristics (ROC) (area under curve) may be considered ‘good’ tests for pathology. ROC analysis showed that the optimal differentiation between NAWM of MS patients versus healthy controls was seen in the anterior area of the cervical cord. Sensitivity and specificity for λ2 and ADC are 85.7 & 75.0 and 85.7 & 75.0 respectively. Conclusion: DTI can detect early changes in relapsing-remitting MS with the anterior area of the cervical spine being the most representative of disease processes. Diagnostic cut-off values should be considered.

Highlights

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system characterized by neurodegenerative and inflammatory processes that cause chronic disability
Higher values than the cut-off are suspicious of Normal Appearing White Matter (NAWM) pathology
Previous studies have failed to find a correlation between the clinical disability of multiple sclerosis (MS) patients and the number and extent of spinal cord lesions detected by MR [4]

Summary

Introduction

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system characterized by neurodegenerative and inflammatory processes that cause chronic disability. Asymptomatic spinal cord lesions are common in MS and uncommon in other white matter (WM) diseases [3]. The spinal cord lesion burden as obtained by a conventional MR examination (T1, T2, FLAIR) does not always correlate well with clinical disability or histological study [4]. Histopathological examination of the spinal cord reveals lesions that could not be detected on conventional MRI [3]. Diagnosis of multiple sclerosis (MS) can lead to preventive treatment and a favorable prognosis. Cervical spinal cord matter that appears normal on conventional MR images may be detected as abnormal using advanced MRI techniques

Methods

Results

Discussion

Conclusion