Data_Sheet_1_Diffusion Kurtosis Imaging of Neonatal Spinal Cord in Clinical Routine.docx

Diffusion kurtosis imaging (DKI) has undisputed advantages over the more classical diffusion magnetic resonance imaging (dMRI) as witnessed by the fast-increasing number of clinical applications and software packages widely adopted in brain imaging. However, in the neonatal setting, DKI is still largely underutilized, in particular in spinal cord (SC) imaging, because of its inherently demanding technological requirements. Due to its extreme sensitivity to non-Gaussian diffusion, DKI proves particularly suitable for detecting complex, subtle, fast microstructural changes occurring in this area at this early and critical stage of development, which are not identifiable with only DTI. Given the multiplicity of congenital anomalies of the spinal canal, their crucial effect on later developmental outcome, and the close interconnection between the SC region and the brain above, managing to apply such a method to the neonatal cohort becomes of utmost importance. This study will (i) mention current methodological challenges associated with the application of advanced dMRI methods, like DKI, in early infancy, (ii) illustrate the first semi-automated pipeline built on Spinal Cord Toolbox for handling the DKI data of neonatal SC, from acquisition setting to estimation of diffusion measures, through accurate adjustment of processing algorithms customized for adult SC, and (iii) present results of its application in a pilot clinical case study. With the proposed pipeline, we preliminarily show that DKI is more sensitive than DTI-related measures to alterations caused by brain white matter injuries in the underlying cervical SC.

扩散峰度成像（Diffusion Kurtosis Imaging, DKI）相较于更为经典的扩散磁共振成像（diffusion magnetic resonance imaging, dMRI）拥有无可争议的优势，这一点从临床应用数量的快速增长以及其在脑成像领域被广泛采用的软件套件中便可得到印证。然而在新生儿成像场景中，DKI的应用仍未得到充分普及，尤其是在脊髓（spinal cord, SC）成像领域，这源于其本身对技术条件的严苛要求。由于对非高斯扩散具有极强的敏感性，DKI被证实尤其适用于检测发育早期关键阶段中该区域发生的复杂、细微且快速的微观结构变化——这类变化仅通过扩散张量成像（Diffusion Tensor Imaging, DTI）无法识别。鉴于先天性椎管异常种类繁多，其对后续发育结局具有关键影响，且脊髓区域与上方脑部存在紧密的相互联系，将这类方法应用于新生儿队列的研究便显得至关重要。本研究将（i）阐述婴幼儿时期先进dMRI方法（如DKI）应用相关的当前方法论挑战；（ii）展示首个基于脊髓工具箱（Spinal Cord Toolbox）构建的半自动化处理流程，该流程通过针对成人脊髓定制的处理算法进行精准调整，可实现新生儿脊髓DKI数据从采集设置到扩散指标估计的全流程处理；（iii）呈现其在一项试点临床案例研究中的应用结果。通过本次提出的处理流程，我们初步证实，相较于基于DTI的相关指标，DKI对颈段脊髓潜在脑白质损伤所引发的结构改变更为敏感。