Cross-sectional descriptive study.
To compare the diffusion tensor imaging (DTI) changes of the sacral cord in people with complete cervical spinal cord injury (SCI) and neurogenic bladder versus people without SCI, and to explore the relationship between sacral cord DTI changes and bladder contractility.
First Affiliated Hospital of Soochow University, Jiangsu Province, China.
Forty participants were included: 25 participants with complete cervical SCI and 15 without SCI. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated by DTI for ventral horn and intermediate column of sacral cord at S2–S4 level. All participants underwent urodynamic examination. The urodynamic parameters (voiding efficiency (VE), and bladder contractility index (BCI)) and DTI parameters were compared between people with and without SCI. The correlations between DTI values (FA and ADC) and urodynamic parameters were analyzed.
The FA values were significantly lower and the ADC values were significantly higher in the intermediate column and ventral horn at S2–S4 level of the participants with SCI compared with their able-bodied counterparts (p < 0.05). VE and BCI were significantly different between the two groups (p < 0.05). The FA values of intermediate column positively correlated with BCI (r = 0.749, p < 0.05) and the ADC values negatively correlated with BCI (r = −0.471, p < 0.05) in participants with SCI. The DTI values of sacral cord were not correlated with each urodynamic parameter in participants without SCI (p > 0.05).
Complete cervical SCI might lead to microstructural changes of the sacral cord, which might further affect bladder contraction.
Subscribe to Journal
Get full journal access for 1 year
only $30.08 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
The datasets analyzed during the current study are available from corresponding author on reasonable request.
Cadotte DW, Fehlings MG. Spinal cord injury: visualizing plasticity and repair in the injured CNS. Nat Rev Neurol. 2013;9:546–7.
Kim BG, Dai HN, McAtee M, Vicini S, Bregman BS. Remodeling of synaptic structures in the motor cortex following spinal cord injury. Exp Neurol. 2006;198:401–15.
Kanamoto H, Norimoto M, Eguchi Y, Oikawa Y, Orita S, Inage K, et al. Evaluating spinal canal lesions using apparent diffusion coefficient maps with diffusion-weighted imaging. Asian Spine J. 2020. https://doi.org/10.31616/asj.2019.0266.
de Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol. 2015;5:327–96.
Guleria S, Gupta RK, Saksena S, Chandra A, Srivastava RN, Husain M, et al. Retrograde Wallerian degeneration of cranial corticospinal tracts in cervical spinal cord injury patients using diffusion tensor imaging. J Neurosci Res. 2008;86:2271–80.
Shanmuganathan K, Zhuo J, Chen HH, Aarabi B, Adams J, Miller C, et al. Diffusion tensor imaging parameter obtained during acute blunt cervical spinal cord injury in predicting long-term outcome. J Neurotrauma. 2017;34:2964–71.
Freund P, Weiskopf N, Ward NS, Hutton C, Gall A, Ciccarelli O, et al. Disability, atrophy and cortical reorganization following spinal cord injury. Brain. 2011;134:1610–22.
Wrigley PJ, Gustin SM, Macey PM, Nash PG, Gandevia SC, Macefield VG, et al. Anatomical changes in human motor cortex and motor pathways following complete thoracic spinal cord injury. Cereb Cortex. 2009;19:224–32.
Sun P, Murphy RK, Gamble P, George A, Song SK, Ray WZ. Diffusion assessment of cortical changes, induced by traumatic spinal cord injury. Brain Sci. 2017;7:21–33.
Koskinen E, Brander A, Hakulinen U, Luoto T, Helminen M, Ylinen A, et al. Assessing the state of chronic spinal cord injury using diffusion tensor imaging. J Neurotrauma. 2013;30:1587–95.
Cheran S, Shanmuganathan K, Zhuo J, Mirvis SE, Aarabi B, Alexander MT, et al. Correlation of MR diffusion tensor imaging parameters with ASIA motor scores in hemorrhagic and nonhemorrhagic acute spinal cord injury. J Neurotrauma. 2011;28:1881–92.
Facon D, Ozanne A, Fillard P, Lepeintre JF, Tournoux-Facon C, Ducreux D. MR diffusion tensor imaging and fiber tracking in spinal cord compression. Am J Neuroradiol. 2005;26:1587–94.
Mulcahey MJ, Samdani AF, Gaughan JP, Barakat N, Faro S, Shah P, et al. Diagnostic accuracy of diffusion tensor imaging for pediatric cervical spinal cord injury. Spinal Cord. 2013;51:532–7.
Min KJ, Jeong HK, Kim B, Hwang DH, Shin HY, Nguyen AT, et al. Spatial and temporal correlation in progressive degeneration of neurons and astrocytes in contusion-induced spinal cord injury. J Neuroinflammation. 2012;9:100.
Yokota K, Kubota K, Kobayakawa K, Saito T, Hara M, Kijima K, et al. Pathological changes of distal motor neurons after complete spinal cord injury. Mol Brain. 2019;12:4.
Ellingson BM, Salamon N, Grinstead JW, Holly LT. Diffusion tensor imaging predicts functional impairment in mild-to-moderate cervical spondylotic myelopathy. Spine J. 2014;14:2589–97.
Kitzman P. Alterations in axial motoneuron morphology in the spinal cord injured spastic cat. Exp Neurol. 2005;192:100–8.
Fleming JC, Norenberg MD, Ramsay DA, Dekaban GA, Marcillo AE, Saenz AD, et al. The cellular inflammatory response in human spinal cords after injury. Brain. 2006;129:3249–69.
Aldamanhori R, Chapple CR. Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors. Curr Opin Urol. 2017;27:293–9.
Tai C, Roppolo JR, de Groat WC. Spinal reflex control of micturition after spinal cord injury. Restor Neurol Neurosci. 2006;24:69–78.
Ahmed A, Farhan B, Vernez S, Ghoniem GM. The challenges in the diagnosis of detrusor underactivity in clinical practice: a mini-review. Arab J Urol. 2016;14:223–7.
Lombardi G, Musco S, Celso M, Ierardi A, Nelli F, Del Corso F, et al. Intravesical electrostimulation versus sacral neuromodulation for incomplete spinal cord patients suffering from neurogenic non-obstructive urinary retention. Spinal Cord. 2013;51:571–8.
Chen SF, Lee CL, Kuo HC. Change of detrusor contractility in patients with and without bladder outlet obstruction at ten or more years of follow-up. Sci Rep. 2019;9:18887.
Smith PP, Valentini F, Mytilekas KV, Apostolidis A, Rademakers K, Cardozo L, et al. Can we improve our diagnosis of impaired detrusor contractility in women? An ICI-RS 2019 proposal. Neurourol Urodyn. 2019. https://doi.org/10.1002/nau.24260.
Vírseda M1, Salinas J, López A, Esteban M. Usefulness of Dynamic Urethral Resistance Relation (DURR) measurement for differential diagnosis between static and dynamic urinary obstruction in male spinal cord injury patients. Neurourol Urodyn. 2012;31:549–55.
Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013;64:118–40.
Weld KJ, Dmochowski RR. Association of level of injury and bladder behavior in patients with post-traumatic spinal cord injury. Urology. 2000;55:490–4.
Berić A, Dimitrijević MR, Light JK. A clinical syndrome of rostral and caudal spinal injury: neurological, neurophysiological and urodynamic evidence for occult sacral lesion. J Neurol Neurosurg Psychiatry. 1987;50:600–6.
Tosi L, Righetti C, Terrini G, Zanette G. Atypical syndromes caudal to the injury site in patients following spinal cord injury. A clinical, neurophysiological and MRI study. Paraplegia. 1993;31:751–6.
We would specially like to thank Dr Weixin Yang, Dr Li Li, Dr Shaofeng Zhao, Dr Qingmei Chen, Dr Kai Liu, Dr Haibo Wang, Dr Boye Ni, Dr Hongbing Zhang for their precious help and support.
The present study was supported by the National Natural Science Foundation of China (Grant no. 81971573) and the Project of Invigorating Health Care through Science, Technology and Education, Jiangsu Provincial Medical Youth Talent (grant no. QNRC2016709).
Conflict of interest
The authors declare that they have no conflict of interest.
We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Dai, H., Zhu, H., Zhang, D. et al. The correlation between diffusion tensor imaging of the sacral cord and bladder contractility in people with tetraplegia. Spinal Cord (2020). https://doi.org/10.1038/s41393-020-0484-9