Bammer Roland, Fazekas Franz
Lucas MRS/I Center, Stanford University, Stanford, CA 94305-5488, USA.
Top Magn Reson Imaging. 2003 Dec;14(6):461-76. doi: 10.1097/00002142-200312000-00004.
During the last decade, diffusion-weighted imaging (DWI) has matured from an experimental tool to a clinically useful modality that has not only significantly impacted the diagnosis of (acute) cerebral stroke but has also shown utility in other abnormalities of the brain. Although DWI should be equally sensitive to changes in the spine, it has been used far less frequently in this region of the body. This is mainly because of the inhomogeneous magnetic environment, the small size of the spinal cord, and increased motion in and around the spine. However, once these limitations are overcome, a whole range of applications can be envisioned. Already now, DWI promises to be able to differentiate between benign and malignant vertebral compression fractures. As in the brain, the immediate reduction of diffusivity following ischemic damage in the spinal cord may provide an early identification of patients with infarction. The study of diffusion anisotropy may open new avenues for the detection and better understanding of damage to the long fiber tracts with important clinical implications for disorders like multiple sclerosis and amyotrophic lateral sclerosis. It may also be possible to address, in a more refined manner, mechanisms of damage such as occur with spondylotic myelopathy. To lay the basis for future research in these areas, we will discuss the most appropriate DWI methods for the spine. Following an overview of the basic principles of DWI and associated pitfalls, the most commonly used imaging methods are addressed. Finally, experimental and clinical applications in the spinal cord and the vertebral column and their clinical relevance thus far are reviewed.
在过去十年中，扩散加权成像（DWI）已从一种实验工具发展成为一种临床实用的检查方式，它不仅对（急性）脑卒的诊断产生了重大影响，还在其他脑部异常情况中显示出应用价值。尽管DWI对脊柱变化的敏感性应该是相同的，但它在身体的这个部位的使用频率却低得多。这主要是由于磁环境不均匀、脊髓体积小以及脊柱及其周围运动增加。然而，一旦克服这些限制，就可以设想一系列的应用。现在，DWI有望能够区分良性和恶性椎体压缩骨折。与脑部情况一样，脊髓缺血损伤后扩散率的立即降低可能有助于早期识别梗死患者。扩散各向异性的研究可能为检测和更好地理解长纤维束损伤开辟新途径，这对多发性硬化症和肌萎缩侧索硬化症等疾病具有重要的临床意义。还可能以更精细的方式研究诸如脊髓型颈椎病所发生的损伤机制。为这些领域的未来研究奠定基础，我们将讨论用于脊柱的最合适的DWI方法。在概述DWI的基本原理和相关陷阱之后，将介绍最常用的成像方法。最后，回顾了迄今为止在脊髓和脊柱中的实验和临床应用及其临床相关性。
