July-August 2017

Diffusion Tensor Imaging of the Normal Cervical and Thoracic Pediatric Spinal Cord

Mohamed picture

Feroze B. Mohamed

My interest in the use of diffusion tensor imaging to diagnose spinal cord injury was spurred by a casual conversation over dinner with Dr. M.J. Mulcahey (who went on to become my collaborator) regarding her work on children with spinal cord injury. During this conversation, I was moved to learn about the heartbreaking challenges faced by children with spinal cord injury and their caregivers. I learned how difficult it is to qualitatively and quantitatively assess clinical damage to the spinal cord in the pediatric population. From a biomedical imaging standpoint, the challenge essentially lies in the difficulty of obtaining reliable, functional information from a structure as small as the spinal cord. This gap in science served as the impetus for me to spend the last 9 years attempting to improve functional imaging of the spinal cord.

In short, current clinical methods to evaluate and classify neurologic impairment in the spinal cord are unreliable, are too invasive, and fail to provide a direct assessment of damage to white matter tracts within the injured spinal cord. If diffusion tensor imaging can be used to accurately and consistently quantify viable neural tissue within the spinal cord in young children, it could be established as a critical noninvasive neurodiagnostic tool and a useful addition to the current International Standards for Neurological Classification of Spinal Cord Injury. Creating such a new bioimaging marker could help neuroradiologists, neurosurgeons, physical and occupational therapists, and physical medicine and rehabilitation physicians diagnose pediatric spinal cord injury, improve rehabilitation outcomes, and facilitate emerging therapies, such as those using stem cells.

Thanks to the talented scientists, engineers, and neuroscientists whom I currently work with, there is a realistic chance of expanding our biomarker repertoire to include more advanced diffusion methods, such as neurite orientation dispersion and density imaging (NODDI), to evaluate white matter tissue microstructure in the spinal cord, as well as to quantify structural information of the pediatric spinal cord. The goal is to obtain quantitative, reliable, and reproducible functional and structural information from the spinal cord in a noninvasive manner to aid in improving the quality of life for patients with spinal cord injury. I would like to personally thank everyone at the Jefferson Integrated MR Imaging Center, Thomas Jefferson Radiology Department, and funding agencies, including the National Institutes of Health–National Institutes of Neurological Disorders and Stroke,

Shriners Foundation, and Craig Neilsen Foundation, for making this possible.

Read this article at AJNR.org …