Magnetic resonance diffusion tensor imaging and tractography of the lower spinal cord: Application to diastematomyelia and tethered cord

Objectives: To investigate the feasibility of routine clinical DTI of the lower spinal cord using high-fieldstrength MRI and parallel imaging, and to evaluate the utility of diffusion tensor imaging and tractography as tools for study of lower cord pathology. Methods: Three patients with diastematomyelia, one patient with tethered cord, and six normal volunteers underwent MR imaging of the lower spine at 3T. A 15-channel spine coil and parallel imaging were used with a six-direction single-shot echo-planar gradient echo technique. Results: In normal volunteers, tractography delineated the conus and cauda equina. Tractography software permitted assessment of fractional anisotropy of the distal cord and nerve roots. In cases of tethered cord, tractography correlated with anatomical imaging. Tractography also correlated with the anatomical pathological findings in cases of diastematomyelia. Conclusions: The methods described enable routine DTI and tractography of the lower spinal cord at 3T. Compared with conventional imaging, tractography offers additional information that may prove useful in the characterization and surgical planning for congenital lesions involving the lower spinal cord.