Feasibility of diffusion kurtosis imaging in evaluating cervical spinal cord injury in multiple sclerosis

Abstract Background and purpose At present, it is a difficult problem to evaluate cervical spinal cord (CSC) injury in multiple sclerosis (MS). To assess gray matter (GM), white matter (WM), lesions of MS and the thrapeutic effect using diffusion kurtosis imaging (DKI). Material and Methods A total of 78 subjects (48 of MS and 30 of health ) perform routine MR scan and DKI of CSC. DKI-metrics were measured in the lesions, normal-appearing GM and WM. The MS patients were divided into two groups according to the presence or absence of T2 hyperintensity. The disability of the two groups was assessed by the extended disability status scale (EDSS) before and after treatment. Results 1) Significant differences were detected in DKI metrics between MS and healthy (P < 0.05) and between patients with CSC T2-hyperintense and without T2-hyperintense (P < 0.001); 2) Compared to healthy, GM-MK, GM-RK and WM-FA, WM-AD were statistically reduced in patients without T2-hyperintense (P < 0.05). 3) Significant differences were observed in DKI metrics between patients with T2-hyperintense after therapy (P < 0.05), as well as GM-MK and WM-FA, WM-AD in patients without T2-hyperintense (P < 0.05); 4) EDSS was correlated with MK values, as well as EDSS scores and MK values after therapy. Conclusions 1) DKI-metrics can detect and quantitatively evaluate the changes in cervical spinal cord micropathological structure; 2) MK and RK values are sensitive metrics to detect the damage of gray matter; 3) MK values quantitatively evaluate the clinical disability progression and the therapeutic effect in MS patients.