Perera Molligoda Arachchige AS. Magnetic resonance tractography of the cervical spine: Toward routine clinical use. World J Radiol 2025; 17(11): 114451 [DOI: 10.4329/wjr.v17.i11.114451]
Corresponding Author of This Article
Arosh S Perera Molligoda Arachchige, MD, Faculty of Medicine, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele 20072, Lombardy, Italy. aroshperera@outlook.it
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Nov 28, 2025; 17(11): 114451 Published online Nov 28, 2025. doi: 10.4329/wjr.v17.i11.114451
Magnetic resonance tractography of the cervical spine: Toward routine clinical use
Arosh S Perera Molligoda Arachchige
Arosh S Perera Molligoda Arachchige, Faculty of Medicine, Humanitas University, Pieve Emanuele 20072, Lombardy, Italy
Author contributions: Perera Molligoda Arachchige AS read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The author has no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arosh S Perera Molligoda Arachchige, MD, Faculty of Medicine, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele 20072, Lombardy, Italy. aroshperera@outlook.it
Received: September 19, 2025 Revised: October 21, 2025 Accepted: October 29, 2025 Published online: November 28, 2025 Processing time: 69 Days and 3.9 Hours
Abstract
Spinal cord injury and non-traumatic myelopathies are major causes of lifelong disability, yet conventional magnetic resonance imaging (MRI) can underestimate microstructural damage. Diffusion tensor imaging (DTI) and tractography map white-matter integrity by measuring fractional anisotropy (FA) and mean diffusivity (MD), but their adoption in spine imaging has been limited by long scan times and complex post-processing. Supsupin et al report a two-minute cervical DTI sequence integrated into routine MRI and applied to four representative pathologies – spinal cord contusion, metastatic compression, degenerative myelopathy, and multiple sclerosis – compared with five controls. Each lesion showed distinctive tractographic and quantitative patterns: For example, reduced FA with preserved MD in contusion and combined FA decrease and MD elevation in metastatic compression. These findings highlight the potential of tractography to improve diagnosis, guide surgical planning, and monitor treatment, while maintaining clinical feasibility. Remaining challenges include limited angular resolution, motion artifacts, and the need for multicenter validation and advanced reconstruction methods. This manuscript places the study in the context of current spinal diffusion imaging and outlines future directions toward routine, precision care.
Core Tip: A rapid two-minute diffusion tensor imaging sequence enables cervical spinal cord tractography during routine magnetic resonance imaging (MRI). Supsupin et al demonstrate that distinct fractional anisotropy and mean diffusivity patterns reveal microstructural injury in contusion, metastasis, degenerative myelopathy, and multiple sclerosis – lesions that may appear less conspicuous on conventional MRI. Their work shows how tractography can support diagnosis, surgical planning, and longitudinal follow-up.
