Quantification of DTI in the Pediatric Spinal Cord: Application to Clinical Evaluation in a Healthy Patient Population.

BACKGROUND AND PURPOSE: The purpose of the study is to characterize diffusion tensor imaging indices in the developing spinal cord, evaluating differences based on age and cord region. Describing the progression of DTI indices in the pediatric cord increases our understanding of spinal cord development. MATERIALS AND METHODS: A retrospective analysis was performed on DTI acquired in 121 pediatric patients (mean, 8.6 years; range, 0.3-18.0 years) at Monroe Carell Jr. Children's Hospital at Vanderbilt from 2017 to 2018. Diffusion-weighted images (15 directions; b = 750 s/mm2; slice thickness, 5 mm; in-plane resolution, 1.0 × 1.0 mm2) were acquired on a 3T scanner in the cervicothoracic and/or thoracolumbar cord. Manual whole-cord segmentation was performed. Images were masked and further segmented into cervical, upper thoracic, thoracolumbar, and conus regions. Analyses of covariance were performed for each DTI-derived index to investigate how age affects diffusion across cord regions, and 95% confidence intervals were calculated across age for each derived index and region. Post hoc testing was performed to analyze regional differences. RESULTS: Analyses of covariance revealed significant correlations of age with axial diffusivity, mean diffusivity, and fractional anisotropy (all, P < .001). There were also significant differences among cord regions for axial diffusivity, radial diffusivity, mean diffusivity, and fractional anisotropy (all, P < .001). CONCLUSIONS: This research demonstrates that diffusion evolves in the pediatric spinal cord during development, dependent on both cord region and the diffusion index of interest. Future research could investigate how diffusion may be affected by common pediatric spinal pathologies.

Case of the month

Each month, we will present a challenging Case of the Month for Green Journal readers, who must use their clinical acumen to arrive at the correct answer. We will also post the case each month on the Journal's web site (http://www.ajmselect.com). Several possible answers may be consistent with the case presentation; use your best judgment. Please send your answer (one per respondent) to The Green Journal at editors@amjmed.org or via FAX to (415) 447-2799. Indicate the case to which you are responding and include your complete address. The correct answer will appear in the next issue of the Journal. The first five persons who submit correct answers will receive a free one-year subscription to the Journal. Because of the volume of answers we receive, neither correct nor incorrect answers can be individually acknowledged. Colleagues of Drs. Ismail H and Bhat at Kasturba Medical College in Mangalore are not eligible for this month's case. If you would like to contribute a case, please submit a brief synopsis (<250 words) to the editorial office.

Case of the month

Each month, we will present a challenging Case of the Month for The Green Journal readers, who must use their clinical acumen to arrive at the correct answer. We will also post the case each month on the Journal's web site (http://www.elsevier.com/locate/ajmselect). Several possible answers may be consistent with the case presentation; use your best judgment. Please send your answer (one per respondent) and indicate the case to which you are responding to The Green Journal at editors@amjmed.org or via FAX to (415) 447-2799. Only those answers with a complete mailing address will be considered. The correct answer will appear in the August issue of the Journal. The first five persons who submit correct answers will receive a free one-year subscription to the Journal. Colleagues of Dr. Hirsch in Ann Arbor, Michigan, are not eligible for this month's case. If you would like to contribute a case, please submit a brief synopsis (<250 words) to the editorial office. An individual may win only once per calendar year.

Case of the month

Each month, we present a challenging Case of the Month for The Green Journal readers, who must use their clinical acumen to arrive at the correct answer. We will also post the case each month on the Journal's web site (http://www.elsevier.com/locate/ajmselect). Several possible answers may be consistent with the case presentation; use your best judgment. Please send your answer (one per respondent) and indicate the case to which you are responding to The Green Journal at editors@amjmed.org or via FAX to (415) 447-2799. Only those answers with a complete mailing address will be considered. The correct answer will appear in the June issue of the Journal. The first five persons who submit correct answers will receive a free one-year subscription to the Journal. Colleagues of Dr. Chittivelu at Texas Tech University Health Sciences Center are not eligible for this month's case. If you would like to contribute a case, please submit a brief synopsis (<250 words) to the editorial office. An individual may win only once per calendar year.