Diffusion Tensor Imaging in Syringomyelia Secondary to Chiari Malformation in Cavalier King Charles Spaniel-A Preliminary Study

Simple Summary In our research, we discussed the problem of Chiari-like malformation-syringomyelia syndrome (CM-SM syndrome). It is challenging to determine the harmfulness of the disease as the severity of clinical symptoms is often not commensurate with MRI results. For the same reason, another challenge is a preventive prediction of the disease. In this study, we used the modern technique magnetic resonance diffusion tensor imaging (MR-DTI) to assess the microstructural degree of spinal cord damage in the course of syringomyelia. We found a difference in two DTI parameters: fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between non-symptomatic and symptomatic Cavalier King Charles Spaniel dogs. The use of DTI imaging in the MRI evaluation of CM-SM patients carries potential value in the development of a clinically useful protocol for an objective assessment of the spinal cord and to understand what processes lie at the basis of many diseases, the diagnosis of which is currently difficult. Tests performed on animals may contribute to progress in the diagnosis of CM-SM in humans. Syringomyelia secondary to Chiari-like malformation (so-called CM-SM syndrome) is a common disorder in Cavalier King Charles Spaniels (CKCS) that is diagnosed using standard structural MRI, though imaging findings often do not correlate with the severity of clinical symptoms. Diffusion tensor imaging (DTI) is a technique that defines subtle microstructural changes in the course of many brain and spinal cord diseases, that are not visible on standard MRI. The aim of the study was to identify the correlation between the presence of clinical symptoms and DTI parameters, such as apparent diffusion coefficient (ADC) and fractional anisotropy (FA) within the spinal cord in the course of CM-SM. Study subjects included 18 dogs, CKCS with MRI-confirmed SM (SM group), and 12 CKCS dogs without SM (non-SM group). The SM group was divided into SM-symptomatic group (n = 8) and SM-asymptomatic group, n = 10). All dogs underwent same clinical and neurological assessment followed by MRI examination. All MRI studies were performed on a 1.5T MRI scanner. The MRI spine protocol included: transverse and sagittal T2-weighted images followed by DTI performed in the sagittal plane. The measurements of FA and ADC values were performed manually using the region of interest (ROI) method at the level of three intervertebral discs between C1 and C4. Notable differences in age and body weight were found. No significant differences in FA and ADC values between the SM and non-SM groups were found, but between non-SM, SM-asymptomatic and SM-symptomatic groups significant differences were found in ADC values in all three ROIs and in FA values in ROI-1 and ROI-3. SM-symptomatic dogs compared to non-SM, showed decreased FA value in ROI-1 and ROI-3 also increased ADC value in ROI-1, ROI-2 and ROI-3. SM-symptomatic dogs compared to SM-asymptomatic showed also decreased FA value in ROI-1 and ROI-3, and also increased ADC value in ROI-1, ROI-2 and ROI-3. The results suggest that the values of DTI parameters correlate with the severity of clinical symptoms in the course of CM-SM in animals. The use of DTI evaluation of CM-SM patients carries a potential value as a clinically relevant protocol for an objective assessment of the spinal cord.

Automated summary

In our research, we used DTI imaging to assess the microstructural degree of spinal cord damage in the course of CM-SM syndrome. We found differences in DTI parameters FA and ADC between non-symptomatic and symptomatic dogs. The study aims to identify the correlation between clinical symptoms and DTI parameters.