The correlation between diffusion tensor imaging of the sacral cord and bladder contractility in people with tetraplegia


Study design

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.

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Fig. 1: MR image of sacral cord.
Fig. 2: Correlations between DTI values in intermediate column of sacral cord and BCI.
Fig. 3: Correlations between DTI values in ventral horn of sacral cord and MUP.

Data availability

The datasets analyzed during the current study are available from corresponding author on reasonable request.


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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).

Author information




HZ was responsible for designing the study, collecting and analyzing data, revising the paper. HD was responsible for designing the study, MR examination, collecting and analyzing data, writing the paper. DZ and LZ were responsible for urodynamic assessment and collecting data. CL, YZ, and PC contributed to screening potential participants and collecting data.

Corresponding author

Correspondence to Hongjun Zhu.

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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).

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