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Advances in spinal cord diffusion tensor imaging and its clinical applications
ZHANG Beiqi  CHEN Nan 

Cite this article as ZHANG B Q, CHEN N. Advances in spinal cord diffusion tensor imaging and its clinical applications[J]. Chin J Magn Reson Imaging, 2026, 17(6): 198-204. DOI:10.12015/issn.1674-8034.2026.06.025.


[Abstract] Spinal cord diffusion imaging is currently the only technique that enables in vivo assessment of axonal and myelin integrity. As the cornerstone of this technique, diffusion tensor imaging (DTI) holds significant value in investigating the pathological mechanisms and enabling early diagnosis of spinal cord diseases. However, its clinical application has long been challenged by constraints such as the small size of the spinal cord and physiological motion. In recent years, a series of more advanced diffusion imaging techniques derived from DTI, including diffusion kurtosis imaging, high angular resolution diffusion imaging, diffusion spectrum imaging, and neurite orientation dispersion and density imaging, have been progressively applied in clinical research, driven by technological breakthroughs in image preprocessing and fiber tract reconstruction. These techniques demonstrate substantial value for early diagnosis, progression prediction, and therapeutic evaluation of spinal cord pathologies. This article reviews the technological advances and future trends of the aforementioned spinal cord diffusion imaging techniques, points out the limitations of current research and directions for future studies, aiming to provide a basis for their clinical application.
[Keywords] spinal cord；magnetic resonance imaging；diffusion tensor imaging；diffusion kurtosis imaging；neurite orientation dispersion and density imaging；tractography；clinical application

ZHANG Beiqi1, 2   CHEN Nan1, 2*  

1 Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing 100053, China

2 Beijing Key Lab of MRI and Brain Informatics, Beijing 100053, China

Corresponding author: CHEN N, E-mail: chenzen8057@sina.com

Conflicts of interest   None.

Received  2026-03-24
Accepted  2026-05-25
DOI: 10.12015/issn.1674-8034.2026.06.025
Cite this article as ZHANG B Q, CHEN N. Advances in spinal cord diffusion tensor imaging and its clinical applications[J]. Chin J Magn Reson Imaging, 2026, 17(6): 198-204. DOI:10.12015/issn.1674-8034.2026.06.025.

[1]
YACUBIAN FERNANDES A, FERNANDES DA SILVA F E, HAMAMOTO FILHO P T, et al. MR diffusion tensor imaging applied to the spinal cord of patients with neuropathic pain secondary to herpes zoster infection[J/OL]. J Clin Neurosci, 2024, 130: 110912 [2026-03-24]. https://doi.org/10.1016/j.jocn.2024.110912. DOI: 10.1016/j.jocn.2024.110912.
[2]
BASSER P J, MATTIELLO J, LEBIHAN D. MR diffusion tensor spectroscopy and imaging[J]. Biophys J, 1994, 66(1): 259-267. DOI: 10.1016/S0006-3495(94)80775-1.
[3]
GONZÁLEZ-SALAZAR C, PIMENTEL-SILVA L R, REZENDE T J R, et al. Spinal cord structural changes in SPG4: insights from a large cohort using advanced neuroimaging[J/OL]. J Neurol, 2025, 272(9): 557 [2026-03-24]. https://doi.org/10.1007/s00415-025-13251-5. DOI: 10.1007/s00415-025-13251-5.
[4]
MIDDLETON D M, SHAHRAMPOUR S, KRISA L, et al. Correlations of diffusion tensor imaging and clinical measures with spinal cord cross-sectional area measurements in pediatric spinal cord injury patients[J]. J Spinal Cord Med, 2023, 46(6): 950-957. DOI: 10.1080/10790268.2021.1997027.
[5]
JENSEN J H, HELPERN J A, RAMANI A, et al. Diffusional kurtosis imaging: the quantification of non-gaussian water diffusion by means of magnetic resonance imaging[J]. Magn Reson Med, 2005, 53(6): 1432-1440. DOI: 10.1002/mrm.20508.
[6]
TUCH D S, REESE T G, WIEGELL M R, et al. High angular resolution diffusion imaging reveals intravoxel white matter fiber heterogeneity[J]. Magn Reson Med, 2002, 48(4): 577-582. DOI: 10.1002/mrm.10268.
[7]
WEDEEN V J, HAGMANN P, TSENG W I, et al. Mapping complex tissue architecture with diffusion spectrum magnetic resonance imaging[J]. Magn Reson Med, 2005, 54(6): 1377-1386. DOI: 10.1002/mrm.20642.
[8]
ZHANG H, SCHNEIDER T, WHEELER-KINGSHOTT C A, et al. NODDI: practical in vivo neurite orientation dispersion and density imaging of the human brain[J]. Neuroimage, 2012, 61(4): 1000-1016. DOI: 10.1016/j.neuroimage.2012.03.072.
[9]
CUI Y N, MIAO Y W. Advances in quantitative DTI research of healthy and diseased spinal cord[J/OL]. Chin J Magn Reson Imaging, 2021, 12(7): 102-105. DOI: 10.12015/issn.1674-8034.2021.07.024.
[10]
HORI M, MAEKAWA T, KAMIYA K, et al. Advanced diffusion MR imaging for multiple sclerosis in the brain and spinal cord[J]. Magn Reson Med Sci, 2022, 21(1): 58-70. DOI: 10.2463/mrms.rev.2021-0091.
[11]
WANG J, HUANG J, CUI B, et al. Diffusion tensor imaging identifies cervical spondylosis, myelitis, and spinal cord tumors[J/OL]. Diagnostics (Basel), 2024, 14(12): 1225 [2026-03-24]. https://doi.org/10.3390/diagnostics14121225. DOI: 10.3390/diagnostics14121225.
[12]
THYGESEN M M, LUND T E, MIKKELSEN I K, et al. Diffusional kurtosis imaging as a possible prognostic marker of cervical incomplete spinal cord injury outcome: a prospective pilot study[J]. Acta Neurochir, 2022, 164(1): 25-32. DOI: 10.1007/s00701-021-05018-4.
[13]
TRÒ R, ROASCIO M, TORTORA D, et al. Diffusion kurtosis imaging of neonatal spinal cord in clinical routine[J/OL]. Front Radiol, 2022, 2: 794981 [2026-03-24]. https://doi.org/10.3389/fradi.2022.794981. DOI: 10.3389/fradi.2022.794981.
[14]
SINGHAL S, SARAN S, SAXENA S, et al. Role of diffusion kurtosis imaging in evaluating microstructural changes in spinal cord of patients with cervical spondylosis[J]. Eur Spine J, 2023, 32(3): 986-993. DOI: 10.1007/s00586-023-07559-x.
[15]
AL-SHAARI H, FULFORD J, HEALES C J. Diffusion tensor imaging within the healthy cervical spinal cord: within-participants reliability and measurement error[J]. Magn Reson Imaging, 2024, 109: 56-66. DOI: 10.1016/j.mri.2024.03.005.
[16]
WANG C, ELLINGSON B M, SALAMON N, et al. Recovery of supraspinal microstructural integrity and connectivity in patients undergoing surgery for degenerative cervical myelopathy[J]. Neurosurgery, 2022, 90(4): 447-456. DOI: 10.1227/NEU.0000000000001839.
[17]
DAULEAC C, BOUKHARI A, JACQUESSON T, et al. Microstructural characteristics of cervical spinal cord using high angular resolution diffusion imaging (HARDI) and tractography in healthy subjects[J]. Clin Neuroradiol, 2025, 35(2): 315-324. DOI: 10.1007/s00062-024-01481-5.
[18]
HAN X, MA X, LI D, et al. Application of neurite orientation dispersion and density imaging to evaluate and predict the surgical outcome for degenerative cervical myelopathy[J]. Orthop Surg, 2022, 14(7): 1482-1488. DOI: 10.1111/os.13326.
[19]
ZHANG M, OU-YANG H, LIU J, et al. Utility of advanced DWI in the detection of spinal cord microstructural alterations and assessment of neurologic function in cervical spondylotic myelopathy patients[J]. J Magn Reson Imaging, 2022, 55(3): 930-940. DOI: 10.1002/jmri.27894.
[20]
CRONIN A E, COMBES A, NARISETTI L, et al. Comparing single-shot EPI and 2D-navigated, multi-shot EPI diffusion tensor imaging acquisitions in the lumbar spinal cord at 3T[J/OL]. Magn Reson Imaging, 2025, 122: 110445 [2026-03-24]. https://doi.org/10.1016/j.mri.2025.110445. DOI: 10.1016/j.mri.2025.110445.
[21]
DONG Z, REESE T G, LEE H H, et al. Romer-EPTI: rotating-view motion-robust super-resolution EPTI for SNR-efficient distortion-free in-vivo mesoscale diffusion MRI and microstructure imaging[J]. Magn Reson Med, 2025, 93(4): 1535-1555. DOI: 10.1002/mrm.30365.
[22]
DONG Z, WALD L L, POLIMENI J R, et al. Single-shot echo planar time-resolved imaging for multi-echo functional MRI and distortion-free diffusion imaging[J]. Magn Reson Med, 2025, 93(3): 993-1013. DOI: 10.1002/mrm.30327.
[23]
SCHILLING K G, COMBES A J E, RAMADASS K, et al. Influence of preprocessing, distortion correction and cardiac triggering on the quality of diffusion MR images of spinal cord[J]. Magn Reson Imaging, 2024, 108: 11-21. DOI: 10.1016/j.mri.2024.01.008.
[24]
YOUNG F, AQUILINA K, SEUNARINE K K, et al. Fibre orientation atlas guided rapid segmentation of white matter tracts[J/OL]. Hum Brain Mapp, 2024, 45(2): e26578 [2026-03-24]. https://doi.org/10.1002/hbm.26578. DOI: 10.1002/hbm.26578.
[25]
YUAN C, CHEN S, LIANG L, et al. High-resolution and high-fidelity diffusion tensor imaging of cervical spinal cord using 3D reduced-FOV multiplexed sensitivity encoding (3D-rFOV-MUSE)[J]. Magn Reson Med, 2025, 94(1): 166-182. DOI: 10.1002/mrm.30455.
[26]
SCHILLING K G, FADNAVIS S, BATSON J, et al. Denoising of diffusion MRI in the cervical spinal cord-effects of denoising strategy and acquisition on intra-cord contrast, signal modeling, and feature conspicuity[J/OL]. Neuroimage, 2023, 266: 119826 [2026-03-24]. https://doi.org/10.1016/j.neuroimage.2022.119826. DOI: 10.1016/j.neuroimage.2022.119826.
[27]
SHAO H, LIU Q, SAEED A, et al. Feasibility of diffusion tensor imaging in cervical spondylotic myelopathy using MUSE sequence[J]. Spine J, 2024, 24(8): 1352-1360. DOI: 10.1016/j.spinee.2024.03.015.
[28]
VALOŠEK J, COHEN-ADAD J. Reproducible spinal cord quantitative MRI analysis with the spinal cord toolbox[J]. Magn Reson Med Sci, 2024, 23(3): 307-315. DOI: 10.2463/mrms.rev.2023-0159.
[29]
LIU W, LU Q, ZHUO Z, et al. Volumetric segmentation of white matter tracts with label embedding[J/OL]. Neuroimage, 2022, 250: 118934 [2026-03-24]. https://doi.org/10.1016/j.neuroimage.2022.118934. DOI: 10.1016/j.neuroimage.2022.118934.
[30]
FANG Y, LI S, WANG J, et al. Diagnostic efficacy of tract-specific diffusion tensor imaging in cervical spondylotic myelopathy with electrophysiological examination validation[J]. Eur Spine J, 2024, 33(3): 1230-1244. DOI: 10.1007/s00586-023-08111-7.
[31]
DAULEAC C, MERTENS P, FRINDEL C, et al. Atlas-guided brain projection tracts: from regions of interest to tractography 3D rendering[J]. J Anat, 2025, 246(5): 732-744. DOI: 10.1111/joa.14120.
[32]
LI G S, WANG X X, TAN R B, et al. Ultrastructural destruction of neurovascular unit in experimental cervical spondylotic myelopathy[J/OL]. Front Neurosci, 2022, 16: 1031180 [2026-03-24]. https://doi.org/10.3389/fnins.2022.1031180. DOI: 10.3389/fnins.2022.1031180.
[33]
SONG X F, GAO F, CHEN D, et al. Quantitative DTI analysis of spinal cord injury severity and evaluation of cervical paravertebral muscle degenerative changes in patients with cervical spondylotic myelopathy[J]. Chin J Bone Joint Injury, 2025, 40(7): 733-737. DOI: 10.7531/j.issn.1672-9935.2025.07.013.
[34]
LIANG S, YANG F, ZHANG Y, et al. Changes and clinical correlation of diffusion tensor imaging parameters of compressed spinal cord and nerve root in patients with cervical spondylosis[J]. BMC Med Imaging, 2022, 22(1): 107-117. DOI: 10.1186/s12880-022-00835-0.
[35]
XU S J, ZHAO P, CHEN X M, et al. Diffusion tensor imaging of the lumbosacral enlargement helps to estimate the neurologic recovery after decompression surgery in patients with cervical spondylotic myelopathy[J]. Chin J Magn Reson Imaging, 2022, 13(6): 98-102. DOI: 10.12015/issn.1674-8034.2022.06.019.
[36]
NI M, LI S, WEN X, et al. A matched case-control study of early cervical spondylotic myelopathy based on diffusion magnetic resonance imaging[J]. Insights Imaging, 2024, 15(1): 25-35. DOI: 10.1186/s13244-023-01579-3.
[37]
WANG C, HAN X, MA X, et al. Spinal cord perfusion is associated with microstructural damage in cervical spondylotic myelopathy patients who underwent cervical laminoplasty[J]. Eur Radiol, 2023, 34(2): 1349-1357. DOI: 10.1007/s00330-023-10011-9.
[38]
WANG X, TIAN X, ZHANG Y, et al. Predictive value of dynamic diffusion tensor imaging for surgical outcomes in patients with cervical spondylotic myelopathy[J]. BMC Med Imaging, 2024, 24(1): 260-271. DOI: 10.1186/s12880-024-01428-9.
[39]
KORKMAZER B, KEMERDERE R, BAS G, et al. The efficacy of preoperative diffusion tensor tractography on surgical planning and outcomes in patients with intramedullary spinal tumor[J]. Eur Spine J, 2023, 32(12): 4321-4327. DOI: 10.1007/s00586-023-07872-5.
[40]
CHEN T, WANG P, GAO E, et al. Utilizing multiple diffusion metrics in evaluation of corticospinal tract injury in patients with glioblastoma[J/OL]. Front Neurosci, 2025, 19: 1605786 [2026-03-24]. https://doi.org/10.3389/fnins.2025.1605786. DOI: 10.3389/fnins.2025.1605786.
[41]
HOHENHAUS M, MERZ Y, KLINGLER J H, et al. Diffusion tensor imaging in unclear intramedullary tumor-suspected lesions allows separating tumors from inflammation[J]. Spinal Cord, 2022, 60(7): 655-663. DOI: 10.1038/s41393-021-00741-2.
[42]
SUPSUPIN E P, SERRANO A, LOUVIERE C, et al. Magnetic resonance tractography of the cervical spine: a rapid diffusion tensor imaging protocol to serve as a clinical evaluation tool[J/OL]. World J Radiol, 2025, 17(9): 110267 [2026-03-24]. https://doi.org/10.4329/wjr.v17.i9.110267. DOI: 10.4329/wjr.v17.i9.110267.
[43]
HAN D, SUN Y, LIU C J, et al. Value of dynamic contrast-enhanced MRI combined with DWI quantitative parameters in the diagnosis of spinal cord lesions[J]. Hebei Med, 2025, 31(8): 1376-1381. DOI: 10.3969/j.issn.1006-6233.2025.08.026.
[44]
DAULEAC C, JACQUESSON T, FRINDEL C, et al. Value of spinal cord diffusion imaging and tractography in providing predictive factors for tumor resection in patients with intramedullary tumors: a pilot study[J/OL]. Cancers, 2024, 16(16): 2834 [2026-03-24]. https://doi.org/10.3390/cancers16162834. DOI: 10.3390/cancers16162834.
[45]
WITT A A, FLEISHMAN S, HOUSTON D, et al. Tract-specific analysis of diffusion MRI at 3T detects cervical spinal cord aberrations in multiple sclerosis[J/OL]. Imaging Neurosci, 2025, 3: IMAG.a.72[2026-03-24]. https://doi.org/10.1162/IMAG.a.72. DOI: 10.1162/IMAG.a.72.
[46]
WITT A A, COMBES A J E, SWEENEY G, et al. Leveling up: along-level diffusion tensor imaging in the spinal cord of multiple sclerosis patients[J/OL]. Front Neuroimaging, 2025, 4: 1599966 [2026-03-24]. https://doi.org/10.3389/fnimg.2025.1599966. DOI: 10.3389/fnimg.2025.1599966.
[47]
COMBES A J E, O'GRADY K P, ROGERS B P, et al. Functional connectivity in the dorsal network of the cervical spinal cord is correlated with diffusion tensor imaging indices in relapsing-remitting multiple sclerosis[J/OL]. Neuroimage Clin, 2022, 35: 103127 [2026-03-24]. https://doi.org/10.1016/j.nicl.2022.103127. DOI: 10.1016/j.nicl.2022.103127.
[48]
BIAN B, ZHOU B, SHAO Z, et al. Feasibility of diffusion kurtosis imaging in evaluating cervical spinal cord injury in multiple sclerosis[J/OL]. Medicine, 2023, 102(29): e34205 [2026-03-24]. https://doi.org/10.1097/MD.0000000000034205. DOI: 10.1097/MD.0000000000034205.
[49]
BROAD R J, GABEL M C, DOWELL N G, et al. Neurite orientation and dispersion density imaging (NODDI) detects cortical and corticospinal tract degeneration in ALS[J]. J Neurol Neurosurg Psychiatry, 2019, 90(4): 404-411. DOI: 10.1136/jnnp-2018-318830.
[50]
QIN J, WANG X, FAN G, et al. Identifying amyotrophic lateral sclerosis using diffusion tensor imaging, and correlation with neurofilament markers[J/OL]. Sci Rep, 2024, 14(1): 28110 [2026-03-24]. https://doi.org/10.1038/s41598-024-79511-y. DOI: 10.1038/s41598-024-79511-y.
[51]
YANG C, XUE L, YING T, et al. Application of diffusion tensor imaging and tractography in predicting postoperative upper extremity motor recovery in acute cervical spinal cord injury[J/OL]. World Neurosurg, 2026, 205: 124650 [2026-03-24]. https://doi.org/10.1016/j.wneu.2025.124650. DOI: 10.1016/j.wneu.2025.124650.
[52]
ZHU F, WANG Y, KONG X, et al. Assessment of acute traumatic cervical spinal cord injury using conventional magnetic resonance imaging in combination with diffusion tensor imaging-tractography: a retrospective comparative study[J/OL]. Eur Spine J, 2022, 31(7): 1700-1709. DOI: 10.1007/s00586-022-07207-w.
[53]
SHAO C L, WANG Y Z, LIAO Z H. Value of DTI in evaluating clinical prognosis of elderly patients with traumatic cervical spinal cord injury[J]. Chin J CT MRI, 2022, 20(11): 160-162. DOI: 10.3969/j.issn.1672-5131.2022.11.058.
[54]
SUN H Y, GAO Y, WU J, et al. Application of diffusion tensor imaging of conus medullaris in lower urinary tract dysfunction[J]. Chin J Rehabil Theory Pract, 2024, 30(3): 333-338. DOI: 10.3969/j.issn.1006-9771.2024.03.011.
[55]
WANG J, HUANG J, SUN Z, et al. Structural changes in spinal cord following optic neuritis: insights from quantitative spinal MRI[J/OL]. Brain Res, 2024, 1831: 148830 [2026-03-24]. https://doi.org/10.1016/j.brainres.2024.148830. DOI: 10.1016/j.brainres.2024.148830.
[56]
FARO S H, SAKSENA S, KRISA L, et al. DTI of chronic spinal cord injury in children without MRI abnormalities (SCIWOMR) and with pathology on MRI and comparison to severity of motor impairment[J]. Spinal Cord, 2022, 60(5): 457-464. DOI: 10.1038/s41393-022-00770-5.
[57]
QUIZHPILEMA J C, LEGARDA A, HIDALGO J M, et al. Asymmetric white matter degeneration in amyotrophic lateral sclerosis: a diffusion kurtosis imaging study of motor and extra-motor pathways[J/OL]. Front Neurosci, 2025, 19: 1581719 [2026-03-24]. https://doi.org/10.3389/fnins.2025.1581719. DOI: 10.3389/fnins.2025.1581719.
[58]
FUKUI Y, HISHIKAWA N, SATO K, et al. Detecting spinal pyramidal tract of amyotrophic lateral sclerosis patients with diffusion tensor tractography[J/OL]. Neurosci Res, 2018, 133: 58-63 [2026-03-24]. https://doi.org/10.1016/j.neures.2017.11.005. DOI: 10.1016/j.neures.2017.11.005.

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