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      <h1 class="highwire-cite-title" id="page-title">Comparison Between Diffusion Tensor Imaging and Conventional MR Imaging Sequences in the Detection of Spinal Cord Abnormalities</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Alexis Lacout</span>, <span class="highwire-citation-author" data-delta="1">Stephen Binsse</span> and <span class="highwire-citation-author" data-delta="2">El-Hajjam Mostafa</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2007,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">28 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">806-807; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-6966--61329592270" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Alexis Lacout </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Alexis%2BLacout%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lacout%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAlexis%2BLacout%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Stephen Binsse </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Stephen%2BBinsse%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Binsse%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AStephen%2BBinsse%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">El-Hajjam Mostafa </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=El-Hajjam%2BMostafa%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mostafa%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AEl-Hajjam%2BMostafa%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view"><span class="highwire-journal-article-marker-start"></span><p id="p-1">We read with interest the articles by Renoux et al<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> and Facon et al,<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> respectively, in the October 2006 and in the June–July 2005 issues of the <em>AJNR</em>.</p><p id="p-2">The authors evaluated the diagnostic accuracy of diffusion tensor imaging (by using the apparent diffusion coefficient and fractional anisotropy) in inflammatory diseases of the spinal cord<sup><a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a></sup> and in spinal cord compression.<sup><a id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2</a></sup> In these 2 articles, diffusion tensor imaging was compared with T2-fast spin-echo (FSE)–weighted sequences. The authors found a higher sensitivity in the detection of spinal cord abnormalities with diffusion tensor imaging than with T2-FSE–weighted sequences in both articles.<sup><a id="xref-ref-1-3" class="xref-bibr" href="#ref-1">1</a>,<a id="xref-ref-2-3" class="xref-bibr" href="#ref-2">2</a></sup></p><p id="p-3">We draw the authors’ attention to the previously published reports about the diagnostic accuracy of spinal cord abnormalities with conventional MR imaging sequences. We cite only 2 of them because of the restriction on the number of references. These reports showed that short τ inversion recovery FSE (STIR-FSE) sequences may have a higher sensitivity than T2-FSE–weighted sequences in the detection of spinal cord lesions.<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a>,<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> Campi et al<sup><a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">3</a></sup> and Rocca et al<sup><a id="xref-ref-4-2" class="xref-bibr" href="#ref-4">4</a></sup> concluded that STIR-FSE sequences had a higher sensitivity in the detection of demyelinating lesions. Furthermore, Campi et al showed a better demarcation and maybe a better sensitivity in the detection of spinal cord abnormalities in a group of patients with myelopathy of unknown etiology with STIR-FSE sequences.</p><p id="p-4">We hypothesize that the best conventional sequence, with the highest sensitivity in the detection of spinal cord abnormalities, may be the STIR-FSE sequence. We think that future studies evaluating the diagnostic accuracy of diffusion tensor imaging in the detection of spinal cord abnormalities should include STIR-FSE sequences.</p><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-28.5.806.1"><div class="cit-metadata"><cite>Renoux J, Facon D, Fillard P, et al. <strong>MR diffusion tensor imaging and fiber tracking in inflammatory diseases of the spinal cord.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2006</span>;<span class="cit-vol">27</span>:<span class="cit-fpage">1947</span>–51</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIyNy85LzE5NDciO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMjgvNS84MDYuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-other" id="cit-28.5.806.2"><div class="cit-metadata"><cite>Facon D, Ozanne A, Fillard P, et al. <strong>MR diffusion tensor imaging and fiber tracking in spinal cord compression.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2005</span>;<span class="cit-vol">26</span>:<span class="cit-fpage">1587</span>–94</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIyNi82LzE1ODciO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMjgvNS84MDYuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3 in text" id="ref-3">↵</a><div class="cit ref-cit ref-other" id="cit-28.5.806.3" data-doi="10.1007/s002340000368"><div class="cit-metadata"><cite>Campi A, Pontesilli S, Gerevini S, et al. <strong>Comparison of MRI pulse sequences for investigation of lesions of the cervical spinal cord.</strong> <span class="cit-source">Neuroradiology</span> <span class="cit-pub-date">2000</span>;<span class="cit-vol">42</span>:<span class="cit-fpage">669</span>–75</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s002340000368&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=11071441&amp;link_type=MED&amp;atom=%2Fajnr%2F28%2F5%2F806.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4 in text" id="ref-4">↵</a><div class="cit ref-cit ref-other" id="cit-28.5.806.4"><div class="cit-metadata"><cite>Rocca MA, Mastronardo G, Horsfield MA, et al. <strong>Comparison of three MR sequences for the detection of cervical cord lesions in patients with multiple sclerosis.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">1999</span>;<span class="cit-vol">20</span>:<span class="cit-fpage">1710</span>–16</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIyMC85LzE3MTAiO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMjgvNS84MDYuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li></ol></div><div class="response fulltext-view" id="R1"><h1 id="article-title-2">Reply:</h1><p id="p-5">Short τ inversion recovery (STIR) MR imaging has a better sensitivity to detect spinal cord lesions compared with regular spin-echo (SE) T2-weighted imaging as stated in this letter. The purpose of our work in the 2 cited articles<sup><a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">1</a>,<a id="xref-ref-6-1" class="xref-bibr" href="#ref-6">2</a></sup> was mostly based on how diffusion tensor imaging (DTI) and fractional anisotropy (FA) could help locate lesions within the spinal cord and, at the same, how to better understand the pathophysiology of inflammatory myelitis as well as spinal cord compressions. Sensitivity of MR SE T2-weighted imaging sequences was only assessed to hypothesize pathophysiologic patterns of these diseases. Indeed, our observations led us to draw a scheme of FA value changes that may correlate with patient outcome. If conventional MR imaging sequence sensitivity plays an important role in detecting spinal cord lesions, this sensitivity could not be used to assess understanding of the neuronal cluster regeneration that occurs in such diseases, contrary to the use of DTI and FA values. We used SE T2-weighted imaging instead of STIR because we focused more on pathophysiology than on MR imaging accuracy.</p><p id="p-6">The authors of the letter are right: STIR is better than SE T2. However, only DTI, FA, and fiber tracking may help to understand these diseases at the water molecule level.</p><div class="section ref-list" id="ref-list-2"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 1 in text" id="ref-5">↵</a><div class="cit ref-cit ref-other" id="cit-28.5.806.5"><div class="cit-metadata"><cite>Renoux J, Facon D, Fillard P, et al. <strong>MR diffusion tensor imaging and fiber tracking in inflammatory diseases of the spinal cord.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2006</span>;<span class="cit-vol">27</span>:<span class="cit-fpage">1947</span>–51</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIyNy85LzE5NDciO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMjgvNS84MDYuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-6-1" title="View reference 2 in text" id="ref-6">↵</a><div class="cit ref-cit ref-other" id="cit-28.5.806.6"><div class="cit-metadata"><cite>Facon D, Ozanne A, Fillard P, et al. <strong>MR diffusion tensor imaging and fiber tracking in spinal cord compression.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2005</span>;<span class="cit-vol">26</span>:<span class="cit-fpage">1587</span>–94</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIyNi82LzE1ODciO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMjgvNS84MDYuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li></ol></div></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 28</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">May 2007 </div></div>
      
      
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