Supsupin EP, Serrano A, Louviere C, Pearson L, Hernandez M, Sekar V, Amer A, Cikla U, Virarkar M, Gumus KZ. Magnetic resonance tractography of the cervical spine: A rapid diffusion tensor imaging protocol to serve as a clinical evaluation tool. World J Radiol 2025; 17(9): 110267 [PMID: 41025056 DOI: 10.4329/wjr.v17.i9.110267]
Corresponding Author of This Article
Alejandro Serrano, MD, Research Fellow, Department of Radiology, University of Florida College of Medicine, 655 8th St W, Jacksonville, FL 32209, United States. alejandro.serrano@jax.ufl.edu
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Retrospective Study
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. Sep 28, 2025; 17(9): 110267 Published online Sep 28, 2025. doi: 10.4329/wjr.v17.i9.110267
Magnetic resonance tractography of the cervical spine: A rapid diffusion tensor imaging protocol to serve as a clinical evaluation tool
Emilio P Supsupin, Alejandro Serrano, Christopher Louviere, Luke Pearson, Mauricio Hernandez, Vashisht Sekar, Aboubakr Amer, Ulas Cikla, Mayur Virarkar, Kazim Z Gumus
Emilio P Supsupin, Alejandro Serrano, Christopher Louviere, Luke Pearson, Mauricio Hernandez, Mayur Virarkar, Kazim Z Gumus, Department of Radiology, University of Florida College of Medicine, Jacksonville, FL 32209, United States
Vashisht Sekar, Aboubakr Amer, Ulas Cikla, Department of Neurological Surgery, University of Florida College of Medicine, Jacksonville, FL 32209, United States
Co-corresponding authors: Alejandro Serrano and Kazim Z Gumus.
Author contributions: Supsupin EP conception and design of the study, supervision; Serrano A manuscript writing; analyzed data; Louviere C manuscript writing; analyzed data; Pearson L data curation; literature review; Hernandez M data curation; statistical analysis, manuscript revision; Virarkar M analyzed data; manuscript revision; Gumus KZ project supervision; analyzed data, final approval of the manuscript; Sekar V conceptual input; manuscript revision; Amer A conceptual input; manuscript revision; Cikla U conceptual input; manuscript revision. All authors contributed to this paper with the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and approval of the final version. We would like to clarify that two co-corresponding authors are listed because one of the authors has since left the institution and will no longer have access to their institutional email. Including both authors ensures continuity in correspondence and availability for any future queries regarding the manuscript.
Institutional review board statement: This study involved retrospective analysis of anonymized human data. In accordance with institutional policy, it did not require approval from the Institutional Review Board.
Informed consent statement: Informed consent was not required for this study, as it involved retrospective analysis of de-identified data in accordance with institutional policies and applicable regulations.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest relevant to the content of this manuscript.
Data sharing statement:
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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: Alejandro Serrano, MD, Research Fellow, Department of Radiology, University of Florida College of Medicine, 655 8th St W, Jacksonville, FL 32209, United States. alejandro.serrano@jax.ufl.edu
Received: June 3, 2025 Revised: June 21, 2025 Accepted: September 9, 2025 Published online: September 28, 2025 Processing time: 115 Days and 16.7 Hours
Abstract
BACKGROUND
Spinal cord injury can lead to long-term disability, but current imaging methods are limited in predicting outcomes. Rapid diffusion tensor imaging (DTI) has shown promise, yet its clinical utility remains underexplored.
AIM
To evaluate the potential applications of a short DTI sequence, incorporated into a cervical spine magnetic resonance imaging (MRI) protocol, for characterizing a range of symptomatic spinal cord pathologies. We propose that cervical spine tractography can provide essential diagnostic information beyond what is currently available from conventional MRI.
METHODS
We utilized a quick DTI sequence to create tractography models of the cervical spinal cord in four patients with distinct pathologies of various etiologies: Cord contusion, metastasis, myelopathy, and multiple sclerosis. We used DSI Studio software for post-processing of tractography cases. Fiber tract findings for each pathology case were compared to five control cases from the same scanner by looking for individual differences in white matter tract integrity based on the fractional anisotropy (FA) and mean diffusivity (MD) of the regions of interest from controls. These correlated with clinical presentations and conventional MRI findings.
RESULTS
Control cases showed consistent and intact tract patterns with stable FA and MD values. In pathological cases, abnormalities in fiber orientation and tract continuity correlated with clinical symptoms and lesion locations.
CONCLUSION
The tractography models can provide additional information on white matter disruption that was not discernible on standard MRI sequences. However, its clinical use remains limited due to the need for specialized imaging protocols and complex post-processing, restricting its use to mostly academic settings.
Core Tip: This study demonstrates the utility of cervical spinal cord MR tractography in characterizing various spinal cord pathologies, including trauma, demyelination, and neoplasms. By analyzing fractional anisotropy and mean diffusivity across lesion sites and adjacent levels, tractography revealed microstructural changes not visible on conventional magnetic resonance imaging. The findings support tractography as a promising adjunct tool for diagnosis, surgical planning, and treatment follow-up, offering unique insights into fiber integrity in spinal cord disease.
