The impact of post-processing on spinal cord diffusion tensor imaging.

Diffusion tensor imaging (DTI) provides information about the microstructure in the brain and spinal cord. While new neuroimaging techniques have significantly advanced the accuracy and sensitivity of DTI of the brain, the quality of spinal cord DTI data has improved less. This is in part due to the small size of the spinal cord (ca. 1cm diameter) and more severe instrumental (e.g. eddy current) and physiological (e.g. cardiac pulsation) artefacts present in spinal cord DTI. So far, the improvements in image quality and resolution have resulted from cardiac gating and new acquisition approaches (e.g. reduced field-of-view techniques). The use of retrospective correction methods is not well established for spinal cord DTI. The aim of this paper is to develop an improved post-processing pipeline tailored for DTI data of the spinal cord with increased quality. For this purpose, we compared two eddy current and motion correction approaches using three-dimensional affine (3D-affine) and slice-wise registrations. We also introduced a new robust-tensor-fitting method that controls for whole-volume outliers. Although in general 3D-affine registration improves data quality, occasionally it can lead to misregistrations and biassed tensor estimates. The proposed robust tensor fitting reduced misregistration-related bias and yielded more reliable tensor estimates. Overall, the combination of slice-wise motion correction, eddy current correction, and robust tensor fitting yielded the best results. It increased the contrast-to-noise ratio (CNR) in FA maps by about 30% and reduced intra-subject variation in fractional anisotropy (FA) maps by 18%. The higher quality of FA maps allows for a better distinction between grey and white matter without increasing scan time and is compatible with any multi-directional DTI acquisition scheme.