Role of conventional MRI and MR diffusion tensor imaging in cervical spine trauma: A comprehensive evaluation of the cervical cord

Background: Cervical spine trauma was a critical clinical condition requiring accurate assessment for optimal management. This study aims to evaluate the role of Diffusion Tensor Imaging (DTI) and fiber tractography, alongside conventional MRI, in assessing cervical spinal cord injury (SCI). The objective was to analyse in vivo microstructural parameters—Fractional Anisotropy (FA) and Apparent Diffusion Coefficient (ADC)—using region of interest (ROI) analysis and to compare these parameters with conventional MRI findings for early detection of axonal injury. Method: This hospital-based prospective observational study included 50 patients referred to the Department of Radio-Diagnosis for cervical spine MRI with clinical suspicion or confirmation of cervical spine trauma during 2022. Imaging was performed using a 1.5T Siemens Amira MR unit. Results: The mean length of cord involvement was 3.39 cm on conventional MRI and 5.28 cm on DTI/MR tractography, a statistically significant difference. Patients with some or good clinical improvement had normal or increased ADC values, while those with decreased ADC showed no improvement. ADC was significantly reduced in cases of acute traumatic spinal cord injury (TSCI) and spinal cord haemorrhage. Although no strong correlation was found between FA values and clinical recovery, mean FA values were consistently lower in all cord pathologies, including swelling, contusion, haemorrhage, and transection. Conclusion: DTI, with its quantitative indices, enhances the assessment of traumatic cervical spinal cord injury. Compared to conventional MRI, it provides additional valuable information. Incorporating DTI into routine imaging protocols