Diffusion Tensor Imaging in Multiple Sclerosis: Assessment of Regional Differences in the Axial Plane within Normal-Appearing Cervical Spinal Cord
S.M. Hesseltinea,
M. Lawab,
J. Babba,
M. Rada,
S. Lopeza,
Y. Gea,
G. Johnsona and
R.I. Grossmana
a Departments of Radiology, New York University Medical Center, New York, NY
b Departments of Neurosurgery, New York University Medical Center, New York, NY
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Fig 1. Diagram of the cervical spinal cord in cross-section (A) showing regions of interest (ROIs) placed for the measurement of fractional anisotropy (FA) and mean diffusivity in the anterior, lateral, and posterior spinal cord, bilaterally.
B, Color FA map obtained in control patient at the C2-C3 level.
C, The corresponding black and white FA map is shown with ROIs placed, including a central region of interest. Values have been scaled by a factor of 1000.
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Fig 2. Receiver operating characteristic (ROC) curve for diagnostic model using fractional anisotropy (FA)mean, FAant,right, and FAcentral (model 1, solid line in 2A and 2B, area under ROC curve (AUC), 0.928; 95% confidence interval [CI], 0.813 to 0.982), showing a significantly higher AUC compared with a model using only FAmean (2A, thick dotted line, difference between AUCs = 0.180, P = .012) as well as a model using only FAcentral (2B, thick dotted line, difference between AUCs = 0.274, P = .001). In other words, the best performing test is one in which multiple ROIs provide spatial information.
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Fig 3. Diffusion tensor imaging (DTI) metrics of healthy patients within ROIs placed in the anterior, lateral, and posterior spinal cord (bilaterally, with 2 data points per location per patient) at the C2-C3 level. Fractional anisotropy (FA) versus age (A) and mean diffusivity (MD) versus age (B). None of the FA or MD measures exhibited a significant association with patient age (P > .15).
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