What can be achieved by using MR-DWI and ADC value in cases of intramedullary spinal cord lesions of non-traumatic causes

Early diagnosis and management of intra medullary spinal cord lesions is crucial for improving the outcome. This can be achieved by adding DW-MRI to spinal imaging protocol. Patients and methods: A prospective study included 42 patients proved to have intramedullary SOLs of non-traumatic causes based on cMRI, were subjected to DWI and ADC value measurement. Our findings were correlated to the clinical outcome in non-neoplastic lesions and ο the histopathological results in neoplastic lesions. Results: 20 cases of non-neoplastic lesions (group I) showed nonrestricted diffusion with variable increased ADC values (mean = 1.46 ± 0.35 multiplication sign 10³mm²/s), except in cord acute ischemia which had restricted diffusion and reduced ADC value (mean = 0.85 ± 0.07 multiplication sign 10³mm²/s). 22 cases of neoplastic lesions (group II) showed reduced ADC values (mean 1.05 ± 0.21 multiplication sign 10³mm²/s), the lowest was in metastatic lesions (mean 0.75 ± 0.15 multiplication sign 10³mm²/s) and medulloblastoma (mean 0.81 ± 0.09 multiplication sign 10³mm²/s) while a diagnostic overlap occurred between astrocytoma and ependymoma (mean 1.19± 0.07, 1.1 ± 0.07 multiplication sign 10³mm²/s respectively). A cut off value 1.25 multiplication sign 10³mm²/s was found to differentiate between the two groups. Conclusion: Optimum diagnosis for non-traumatic intramedullary spinal cord lesions can be achieved by using DWI and ADC value measurement