Researcher receives NINDS grant to develop DTI for pediatric spinal cord injury diagnosis

Most of the 11,000 new cases of spinal cord injury that are diagnosed each year in the United States occur in people under age 30, and often the sufferer is a child. But smaller spinal cords in children and a lack of adequate imaging technology has created major problems in precisely locating the site of injury. New technological developments in imaging could help clinical specialists design more effective treatment and rehabilitation strategies for pediatric patients.

Feroze B. Mohamed, PhD, Associate Professor of Radiology at the Temple University School of Medicine (TUSM), is now poised to overcome the challenge of pediatric spinal cord imaging. In June, Mohamed and co-investigator Mary Jane Mulcahey, Professor of Occupational Therapy at the Thomas Jefferson University School of Health Professions, received a five-year, $1.7-million grant from the National Institute of Neurological Disorders and Stroke (NINDS) to continue their development and refinement of a technology known as diffusion tensor imaging (DTI) for pediatric spinal cord injury diagnosis.

DTI is a relatively new type of noninvasive functional magnetic resonance imaging (fMRI) that measures the diffusive transport of water in tissues, which allows for the visualization of microscopic tissue structure. Mohamed is one of the first to apply it to pediatric spinal cord injury.

In earlier work, Mohamed found that DTI can effectively distinguish between white matter and gray matter in the spinal cord, as well as identify normal and pathological features in the cord, potentially facilitating assessments of spinal cord damage. In 2012, working with Mulcahey, he found that DTI was better correlated than conventional MRI to clinical examination scores of spinal cord damage in children.

With their new grant Mohamed and Mulcahey will examine how the DTI approach could be used alongside existing clinical tests of muscle strength and sensory function. One of the central goals of their research is to develop DTI as an imaging biomarker by establishing neuroimaging criteria in normal and pediatric subjects with spinal injury that correlate to the International Standards for Neurological Classification of Spinal Cord Injury, which are set by the American Spinal Injury Association (ASIA).

The ASIA Impairment Scale currently is the primary means for classifying spinal cord injury, and it is relied upon to identify patient needs. It distinguishes patients by severity of neurological damage, which requires knowledge of the level of damage within the vertebral column. Complete neurological impairment, for example, is defined as the loss of motor or sensory function at the lowest level of the sacrum (level S4-S5). However, the subjective nature of sensory function tests, which include tests based on the ability to feel light touch, are notoriously unreliable in children and can hinder the precise identification of injury level.

Over the five years of their study, Mohamed and Mulcahey plan to enroll 100 children, 75 with spinal cord injury and 25 who are healthy. They have already begun to recruit patients through the spinal cord injury program at Shriners Hospitals for Children in Philadelphia, where children come from around the country to receive treatment for their injuries.

In carrying out the study at Shriners Hospital in Philadelphia, Mohamed and Mulcahey are adding to that institution's strong history in spinal injury research. Mohamed's work also continues the outstanding tradition of clinical study by researchers in TUSM's Department of Radiology.