Original articleDiffusion tensor imaging of the maturing paediatric cervical spinal cord: From the neonate to the young adultImagerie du tenseur de diffusion de la maturation de la moelle cervicale chez l’enfant : de la période néonatale à l’âge adulte
Introduction
Multiple techniques have been developed to study brain maturation both qualitatively and quantitatively. While conventional T1- and T2-weighted magnetic resonance imaging (MRI) plays a central role in the qualitative evaluation of normal [1] and abnormal brain development, functional sequences such as diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and 1H-MR spectroscopy (MRS) allow a quantitative analysis of brain maturation [2], [3], [4], [5], [6], [7], [8].
DTI is a recently developed non-invasive functional MRI technique that exploits the three-dimensional diffusion characteristics of water within the central nervous system (CNS). Various DTI scalars including the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) can be calculated to quantify the integrity and architecture of the maturing brain in vivo [9], [10], [11]. ADC values are markers of overall diffusion within the brain while FA-measurements quantify the degree of anisotropic diffusion [12]. Previous studies have shown, that with ongoing brain maturation, ADC values progressively decrease while FA values increase [2], [3], [4], [5], [6], [7], [8]. Comparison of measured ADC/FA data with normative, age-related data allows for the quantification of brain injury and abnormal or delayed brain maturation non-invasively [2], [3], [4], [5], [6], [7], [8].
Several recent studies have demonstrated the clinical utility of DTI in the characterization of spinal cord pathologies [12], [13], [14], [15], [16], [17], [18], [19], [20], [21].
Currently no studies have summarized or evaluated the age-related evolution of the ADC/FA metrics of the maturing paediatric spinal cord. Similar to the brain, collection of age-correlated normative spinal cord DTI metrics may be helpful in the early identification and quantification of spinal cord pathology.
Consequently, the goal of our study was to evaluate the age-dependent evolution of the ADC/FA-values of the “healthy” cervical spinal cord (CSC) from the neonate through young adults.
Section snippets
Patients
All patients who had received a MRI study of the brain and cervical spinal cord between June 2009 and March 2010 were retrospectively evaluated. Inclusion criteria for enrolment in this study were: age less than 18 years, and; receiving a simultaneous MRI and DTI study of the brain and spinal cord. Exclusion criteria were:
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clinically confirmed CNS/CSC disease/pathology;
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focal or systemic CNS/CSC pathology identified on the MRI/DTI examination;
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non-diagnostic image quality;
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incomplete MRI/DTI data
Results
One hundred and five children between 0 and 18 years received a clinically indicated MRI of the cervical spine during the 10-month study period. Forty-one children who met the enrolment criteria were included for further analyses. There were 20 males and 21 females in this study group, ranging in age from 0.3 to 16 years, with a mean age of 6.2 (SD = 4.67) years. The demographic characteristics of our patient population as well as the mean and standard deviation of the measured FA and ADC scalars
Discussion
Our study demonstrates that DTI of the CSC is feasible at any age and can be used to quantitatively characterize the progressive maturation and development of the CSC in vivo. As expected, our data analysis showed that with increasing age (from the neonatal period to adolescence), the ADC values decrease while the FA values increase within the CSC. Age-related evolution of DTI scalars has previously been reported for the normal development of the brain [1], [2], [3], [4], [5], [6], [7], [8].
Conclusion
Our study demonstrates that DTI of the paediatric cervical spinal cord is feasible and can be used to quantitatively study the progressive maturation of the normal paediatric cervical spinal cord. The simultaneous age-related decrease in ADC and increase in FA metrics likely reflect progressive maturation, myelination and fibre packing within the spinal cord similar to that observed in the brain. The normative dataset derived from our study describes the normal maturation of the paediatric
Disclosure of interest
Wesley D. Gilson, is employed by Siemens Inc, Erlangen, Germany. All other authors have no conflict of interest.
References (28)
- et al.
Diffusion tensor imaging and tractography of human brain development
Neuroimaging Clin N Am
(2006) - et al.
Pediatric diffusion tensor imaging: normal database and observation of the white matter maturation in early childhood
Neuroimage
(2006) - et al.
MR Diffusion tensor spectroscopy and imaging
Biophys J
(1994) - et al.
Diffusion-weighted magnetic resonance imaging of the spine and spinal cord
Semin Roentgenol
(2006) - et al.
Investigating cervical spinal cord structure using axial diffusion tensor imaging
Neuroimage
(2002) - et al.
Microstructural maturation of the human brain from childhood to adulthood
Neuroimage
(2008) - et al.
Normal maturation of the neonatal and infant brain: MR imaging at 1.5T
Radiology
(1988) - et al.
Diffusional anisotropy of the human brain assessed with diffusion-weighted MR: relation with normal brain development and aging
AJNR Am J Neuroradiol
(1994) - et al.
Normal brain in human newborns: apparent diffusion coefficient and diffusion anisotropy measured by using diffusion tensor MR imaging
Radiology
(1998) - et al.
Microstructural development of human newborn cerebral white matter assessed in vivo by diffusion tensor magnetic resonance imaging
Ped Res
(1998)
Normal brain maturation during childhood: developmental trends characterized with diffusion-tensor MR imaging
Radiology
Fast quantitative diffusion-tensor imaging of cerebral white matter from the neonatal period to adolescence
Neuroradiology
The basis of anisotropic water diffusion in the nervous system – a technical review
NMR Biomed
Applications of diffusion-weighted and diffusion tensor MRI to white matter diseases – a review
NMR Biomed
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