ARRS 2022 Abstracts

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E1421. Beyond Infarcts: The Utility of Diffusion Weighted Imaging of the Spine
Authors
  1. Leen Alkukhun; SUNY Upstate Medical University
  2. Meghan Stanton; SUNY Upstate Medical University
  3. Alyssa Ionno; SUNY Upstate Medical University
  4. Benjamin Kaminski; SUNY Upstate Medical University
  5. Abdelmohsen Hussien; UT Southwestern Medical Center
  6. Rajiv Mangla; SUNY Upstate Medical University
Background
Diffusion weighted imaging (DWI) is an MR technique that relies on the assessment of the Brownian motion of intra- and extracellular water molecules and their diffusion characteristics across the cellular membrane. DWI was initially used in imaging of the brain, but its application has since expanded to cover abdominal, breast, and musculoskeletal pathologies. This technique was also used in spinal imaging, but its application was more challenging due to the spine’s complex anatomy and heterogenous magnetic environment. With improving MRI techniques, including the development of the MS EPI (“Resolve” technique) DWI technique in the spine, many of these challenges have been overcome, allowing for a broader application of DWI and increasing the MR sensitivity in detecting certain pathologies such as acute epidural/subdural hemorrhages. It has since been used in the detection of spinal pathologies involving the osseous structures, epidural and intradural spaces including the spinal cord. In this exhibit we present a pictorial case-based review of diffusion restricting lesions in the spine using original images from our institution utilizing the Resolve technique.

Educational Goals / Teaching Points
The goals of this exhibit are to review the DWI technique in the spine regarding its limitations, newer sequences, and potential applications; review normal marrow imaging characteristics of the spine on DWI; and provide a case-based review of diffusion restriction or facilitation in the lesions of the spine including osseous, dural spaces, and spinal cord pathologies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Spinal pathologies that may demonstrate diffusion restriction/facilitation may affect the osseous structures, the surrounding soft tissues, the spinal cord, and the dural spaces. This exhibit will discuss diffusion imaging in various spinal lesions including but not limited to infarcts, abscesses, discitis/osteomyelitis, neoplasms such as multiple myeloma, lymphoma, drop metastases, and leptomeningeal metastatic disease. Diffusion restriction is demonstrated as hyperintense signal on the DWI sequences with a corresponding hypointense signal on the ADC map, whereas diffusion facilitation is DWI hyperintense signal without a corresponding hypointense signal on ADC.

Conclusion
In conclusion, DWI is a great imaging tool in MRI that aids in detection and characterization of different spinal pathologies. Despite its limitations in the spine due to the spinal anatomy and the heterogeneity of the magnetic field, DWI offers valuable information for comprehensive characterization of spinal pathologies.