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The paramagnetic nature of metallic implants has hampered the application of diffusion tensor imaging (DTI) in postsurgical SCI monitoring. We describe here a successful implementation of spinal DTI in postsurgical SCI patients. Data were acquired using a single\u2010shot turbo\u2010spin\u2010echo sequence, where an extra gradient is applied before the refocusing pulse train to eliminate contributions from the non\u2010Carr\u2010Purcell\u2010Meiboom\u2010Gill components following a diffusion preparation block where a single\u2010spin echo scheme is deployed. The DTI images were acquired in axial orientation with a 2 x 2 x 4 mm<jats:sup>3<\/jats:sup> resolution and a total of 18 slices. Diffusion gradients were applied in six directions with b values of 0 and 600 seconds\/mm<jats:sup>2<\/jats:sup>. The whole scan took ~10 minutes. The sequence was compared with SENSE\u2010DW\u2010EPI and ZOOM\u2010DW\u2010EPI on a phantom, eight patients with either anterior or posterior titanium alloy implants, and a pork loin with a similar implant. The protocol resulted in dramatically reduced geometric distortions compared with routine imaging sequences, however, the SNR efficiency was compromised. The spinal cord signal displacement was 0.68<jats:styled-content>\u00b1<\/jats:styled-content>1.00 mm (mean<jats:styled-content>\u00b1<\/jats:styled-content>SD, <jats:italic>n<\/jats:italic> = 8) for the proposed protocol, and 5.14<jats:styled-content>\u00b1<\/jats:styled-content>3.07 and 2.82<jats:styled-content>\u00b1<\/jats:styled-content>1.60 mm for the SENSE\u2010DW\u2010EPI and ZOOM\u2010DW\u2010EPI sequences, respectively. Fiber tracking was achieved in the presence of implants, which in one case was accompanied by central spinal cord caviation. Mathematical analysis concluded that the proposed protocol would be generally applicable in the spinal cord when the titanium alloy implant is ~15 mm away (&lt;0.5 kHz B<jats:sub>0<\/jats:sub> field drift). The protocol described is capable of DTI in postsurgery SCI patients with metallic implants at sufficient resolution and SNR.<\/jats:p>","DOI":"10.1002\/nbm.4321","type":"journal-article","created":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T09:30:55Z","timestamp":1588152655000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Diffusion tensor magnetic resonance imaging of the postoperative spine with metallic implants"],"prefix":"10.1002","volume":"33","author":[{"given":"Lian","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Radiology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan 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