Diffusion Tensor Imaging Parameter Obtained during Acute Blunt Cervical Spinal Cord Injury in Predicting Long-Term Outcome

There are no reliable neuroimaging biomarkers to predict long-term outcome after spinal cord injury. This prospective longitudinal study evaluates diffusion tensor imaging (DTI) in predicting long-term outcome after cervical spinal cord injury (CSCI). We investigate the admission DTI parameters measured in 30 patients with CSCI, with 16 of them followed up to one year, and 15 volunteers serving as controls. All magnetic resonance imaging examinations were performed within 24 h of injury. The DTI parameters were measured in patients and controls, avoiding areas of hemorrhage in patients and at corresponding upper/middle/lower regions of the spinal cord in controls. Stepwise regression analysis was performed to find relevant parameters (normalized DTI values, age, sex, hemorrhagic contusion [HC or non-HC]) that correlated with two primary outcome measures: patient International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and Spinal Cord Independence Measure (SCIM III) scores at one year. Among all DTI measures, axial diffusivity (AD) most strongly correlated with both motor (r = 0.76, p