Keywords:
Cross-sectional study, Prospective, Neoplasia, Diagnostic procedure, MR-Functional imaging, MR-Diffusion/Perfusion, MR, Oncology, Neuroradiology spine, CNS, Neuro, Performed at one institution
Authors:
D. K. M. Khedr, M. tantawy, M. Settein, G. el hawary; Mansoura/EG
DOI:
10.26044/ecr2020/C-04084
Results
Conventional MRI evaluation:
The inflammatory cases included: 13 cases of multiple sclerosis, 12 cases of transverse myelitis and one case of neuromyelitis optica. The involved tumor cases included: 8 cases of astrocytomas, 5cases of ependymomas, 2 cases of metastasis and one case of hemangioblastoma.
In the post-contrast study: the demyelinating group patients showed faint enhancement in 11 cases and no enhancement in 7 cases. While the intramedullary tumors all cases showed enhancement. 12 cases showed marked enhancement and 4 cases with mild enhancement
Qualitative DTI assessment:
Black-white and color-coded FA maps analysis:
On color-coded and FA maps; the inflammatory group: 15 cases showed abnormal color hue, 10 cases showed normal appearance and 1 case with loss of color corresponding to interruption of fibers (Fig.1). The intramedullary tumors group: 10 cases showed abnormal color hue and 6 cases showed loss or disorganized color (Fig.2).
Tractography appearance and classification system:
Based on tractography, most of the inflammatory groups showed normal thickness and appearance of fibers (12 out of 26 cases). While the intramedullary tumors group: Variable degree of fibers affection, 6 cases showed displaced cord, 6 cases showed cord invasion and 4 cases with interrupted cord fibers.
example of 3D inflammatory course with thinning of fibers (Fig.3) and normal fibers (Fig.4)
case of an intramedullary tumor with displaced fibers (Fig.5).
Quantitative DTI assessment:
MD and FA values:
There was a statistically significant difference in mean values of FA and MD between tumors and inflammatory lesions with p-value 0.02 and 0.001 respectively. The receiver operating characteristic (ROC) curve analysis showed MD is better in evaluation with a sensitivity of 87.5% and specificity of 53.8 % using a cutoff value of 1.6 ×10-3 mm²/s to differentiate between tumors and tumor-like lesions (Fig.3) and (Table 1).