A diffusion tensor imaging group study of the spinal cord in multiple sclerosis patients with and without T2 spinal cord lesions

Purpose: To examine the T(2)-normal appearing spinal cord of patients with multiple sclerosis (MS) using diffusion tensor imaging.

Materials and methods: Diffusion tensor images of the spinal cord were acquired from 21 healthy subjects, 11 MS patients with spinal cord lesions, and 10 MS patients without spinal cord lesions on the T(2)-weighted MR images. Different diffusion measures were evaluated using both a region of interest (ROI) -based and a diffusion tensor tractography-based segmentation approach.

Results: It was observed that the FA, the transverse diffusivity lambda(perpendicular), and the ratio of the longitudinal and transverse diffusivities (lambda(parallel)/lambda (perpendicular)) were significantly lower in the spinal cord of MS patients with spinal cord lesions compared with the control subjects using both the ROI method (P = 0.014, P = 0.028, and P = 0.039, respectively) and the tractography-based approach (P = 0.006, P = 0.037, and P = 0.012, respectively). For both image analysis methods, the FA and the lambda (parallel)/lambda (perpendicular) values were significantly different between the control group and the MS patient group without T(2) spinal cord lesions (P = 0.013).

Conclusion: Our results suggest that the spinal cord may still be affected by MS, even when lesions are not detected on a conventional MR scan. In addition, we demonstrated that diffusion tensor tractography is a robust tool to analyze the spinal cord of MS patients.