Test-Retest and Interreader Reproducibility of Semiautomated Atlas-Based Analysis of Diffusion Tensor Imaging Data in Acute Cervical Spine Trauma in Adult Patients

AJNR Am J Neuroradiol, 2017 · DOI: http://dx.doi.org/10.3174/ajnr.A5334 · Published: October 1, 2017

Spinal Cord Injury Medical Imaging Research Methodology & Design

Simple Explanation

This study evaluates how reliable a new method is for looking at spinal cord injuries using a special type of MRI called DTI. DTI helps see tiny changes in the spinal cord that regular MRI might miss. The new method uses a computer program to automatically divide the spinal cord into different areas, and then measures how water moves in those areas. This can show how damaged the spinal cord is. The study found that the new method is quite reliable, meaning it gives similar results when used multiple times or by different people. This is important because it means the method can be used to accurately track spinal cord injuries over time.

Study Duration

Not specified

Participants

42 consecutive patients undergoing acute trauma cervical spine MR imaging

Evidence Level

Original Research

Key Findings

1
Test-retest reproducibility of fractional anisotropy was high for white matter as a whole (coefﬁcient of variation, 3.8%; intraclass correlation coefﬁcient, 0.93).
2
DTI spinal cord segmentation is reproducible in the setting of acute spine trauma, speciﬁcally for larger white matter tracts and total white or gray matter.
3
Cervical spinal cord tract-specific diffusion metrics are especially reproducible within the larger, major white matter tracts, with a lower degree of reproducibility in smaller white matter tracts.

Research Summary

This study evaluated the test-retest and interreader reproducibility of semiautomated atlas-based segmentation of DTI of the cervical spinal cord in patients with acute trauma. Atlas-based parcellation of spinal cord DTI data shows good to excellent test-retest reproducibility for volume of gray matter, white matter (total), and individual tracts. The manual step of identifying the vertebral levels and repeated cord segmentation introduces only limited variability in the extracted metrics of moderately sized and larger parcels, as shown by overall good to excellent interreader agreement.

Practical Implications

Clinical Feasibility

Spine DTI is feasible and reproducible in clinical patients with acute cervical spine trauma.

Sample Size Planning

Estimates of test-retest variability can be used for sample size planning in future longitudinal studies that use spinal cord DTI to measure outcomes.

Diagnostic and Therapeutic Interventions

The established test-retest and interreader reproducibility of these measures may inform the development of future studies focused on DTI as an imaging biomarker in diagnostic and therapeutic interventions in this patient population.

Study Limitations

1
12 of 42 patients had to be excluded for unusable image sets.
2
Patients were not removed from the table or room between DTI scans.
3
The DTI sequences were not cardiac-gated for control of spinal cord motion because of the time cost and lack of clinical feasibility in this population.

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