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E1220. Spinal Cord Diffusion Weighted Imaging: A Necessary Adjunct to Spinal MR Imaging
Authors
  1. Nicole Sakla; Newark Beth Israel Medical Center
  2. Gagandeep Singh; Newark Beth Israel Medical Center
  3. Rishabh Gattu; Newark Beth Israel Medical Center
  4. Waqas Bari; Newark Beth Israel Medical Center
  5. German Kilimnik; Newark Beth Israel Medical Center
  6. John Matthews; Newark Beth Israel Medical Center
  7. Anatoliy Vaysberg; Newark Beth Israel Medical Center
Background
Diffusion weighted imaging (DWI) is presently the most sensitive MR technique utilized for the identification of acute ischemia in the brain due to its rapid detection of shifting intracellular water. Despite this vital sensitivity for ischemia within the brain, its application within the spinal cord is currently underutilized because of inherent difficulties associated with the spinal cord’s smaller size and cerebrospinal fluid flow. Modifications in the echo-planar imaging techniques being employed for diffusion spinal imaging are now enabling radiologists to overcome the aforementioned limitations. DWI offers the diagnostician the ability to further characterize spinal cord lesions and to therefore improve patient treatment planning via targeted therapy. In this educational exhibit, the vital application of DWI with regards to differentiating and identifying a variety of spinal cord pathologies will be examined.

Educational Goals / Teaching Points
1. Understand the applications of DWI in the spinal cord 2. Recognize the MRI appearances of various spinal cord lesions with DWI 3. Understand the techniques developed to improve DWI of the spinal cord 4. Recognize the clinical implications of improved diagnosis of spinal cord pathology

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
DWI has been primarily used for the identification of intracranial ischemia and lesion characterization since its development in 1985. The expansion of its utility to other organ systems is currently under investigation with DWI now being utilized to image the breast, pancreas, thyroid, kidneys, and spinal cord. The application of DWI to the spinal cord is of particular importance since the present imaging paradigm does not adequately differentiate various intradural, extramedullary, epidural, or osseous marrow diseases from one another. The underutilization of DWI in spinal cord imaging has historically been attributed to difficulties involving image quality and acquisition. The smaller size of the spinal cord and motion-induced artifact are radiologic barriers that are currently being addressed with novel echo-planar techniques and specific diffusion attenuation values (b-values). This exhibit provides a practical approach to spinal cord lesion characterization through the use of DWI and underscores the necessity of diffusion techniques for improved spinal cord evaluation.

Conclusion
Through the use of spinal cord DWI, the identification and characterization of spinal cord lesions can be thoroughly delineated with improved diagnostic accuracy. The implementation of diffusion techniques will enable targeted, lesion specific, therapy and thereby has the potential to improve patient care.