{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:36:43Z","timestamp":1760060203784,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T00:00:00Z","timestamp":1755302400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Spinal diffusion tensor imaging (sDTI) remains a challenging method for the selective evaluation of key anatomical structures, like pyramidal tracts (PTs) and dorsal columns (DCs), and for reliably quantifying diffusion metrics such as fractional anisotropy (FA), radial diffusivity (RD), mean diffusivity (MD), and axial diffusivity (AD). This prospective, single-center study aimed to assess the reproducibility, robustness, and reliability of an optimized axial sDTI protocol, specifically intended for long fiber tracts. Methods: We developed an optimized Stejskal\u2013Tanner sequence for high-resolution, axial sDTI of the cervical spinal cord at 3.0 T. Using advanced standardized evaluation and post-processing methods, we estimated DTI values for PTs, DCs, and AHs at the level of the second cervical vertebra. Reliability was evaluated through repeated measurements in 16 healthy volunteers and by comparing results from two 3.0 T scanners (Magnetom Skyra and Magnetom Prisma, Siemens Healthineers, Erlangen, Germany). Reproducibility was assessed using paired t-tests, intraclass correlation coefficients (ICCs), Bland\u2013Altman analysis, and coefficients of variation (CVs). Results: The optimized sDTI protocol demonstrated high consistency for FA between test\u2013retest sessions and across scanners. For the Skyra, the DC region showed the highest reliability (average ICC = 0.858) followed by the PT region (average ICC = 0.789). On the Prisma, the PT region reached an average ICC of 0.854, with the DC region at 0.758. Pooled inter-scanner data indicated good-to-excellent agreement, particularly in the PT region (average ICC = 0.860). FA CVs remained low (&lt;10%) across all regions and scanners. RD showed good-to-excellent ICC values for PTs and DCs (average ICC for Skyra 0.642 and 0.769 and 0.926 and 0.830 for Prisma, respectively) but showed a higher CV between 14.6 and 19.4% for these two scanners. Conclusions: Improved sDTI offers highly reproducible FA measurements for all metrics with scanner independence, supporting its potential as a robust tool for detecting and monitoring spinal cord pathologies.<\/jats:p>","DOI":"10.3390\/diagnostics15162057","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T07:53:12Z","timestamp":1755503592000},"page":"2057","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Test\u2013Retest Reliability and Inter-Scanner Reproducibility of Improved Spinal Diffusion Tensor Imaging"],"prefix":"10.3390","volume":"15","author":[{"given":"Christer","family":"Ruff","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls-University Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"K\u00f6nig","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls-University Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim W.","family":"Rattay","sequence":"additional","affiliation":[{"name":"Center for Neurology, University Hospital Kiel, Arnold-Heller-Str 3, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7596-5139","authenticated-orcid":false,"given":"Georg","family":"Gohla","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls-University Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrike","family":"Ernemann","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls-University Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3205-4631","authenticated-orcid":false,"given":"Benjamin","family":"Bender","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls-University Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5236-3450","authenticated-orcid":false,"given":"Uwe","family":"Klose","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls-University Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Lindig","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls-University Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.neuroimage.2012.11.014","article-title":"Improved in vivo diffusion tensor imaging of human cervical spinal cord","volume":"67","author":"Xu","year":"2013","journal-title":"Neuroimage"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2991","DOI":"10.1007\/s00586-015-4144-2","article-title":"Normal values of cervical spinal cord diffusion tensor in young and middle-aged healthy Chinese","volume":"24","author":"Chan","year":"2015","journal-title":"Eur. Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1590\/0004-282X20130099","article-title":"Diffusion tensor magnetic resonance imaging may show abnormalities in the normal-appearing cervical spinal cord from patients with multiple sclerosis","volume":"71","author":"Miraldi","year":"2013","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2697","DOI":"10.1016\/j.ejrad.2011.11.026","article-title":"The cervical spinal cord in neuromyelitis optica patients: A comparative study with multiple sclerosis using diffusion tensor imaging","volume":"81","author":"Pessoa","year":"2012","journal-title":"Eur. J. Radiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/s00234-010-0782-6","article-title":"Diffusion tensor MR imaging (DTI) metrics in the cervical spinal cord in asymptomatic HIV-positive patients","volume":"53","author":"Law","year":"2011","journal-title":"Neuroradiology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1007\/s00330-010-1927-z","article-title":"Diffusion tensor imaging and fibre tracking in cervical spondylotic myelopathy","volume":"21","author":"Budzik","year":"2011","journal-title":"Eur. Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1002\/nbm.788","article-title":"Diffusion tensor imaging in spinal cord: Methods and applications\u2014A review","volume":"15","author":"Clark","year":"2002","journal-title":"NMR Biomed."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S45","DOI":"10.1016\/S0022-510X(01)00490-7","article-title":"Diffusion-weighted imaging of the spinal cord and optic nerve","volume":"186","author":"Barker","year":"2001","journal-title":"J. Neurol. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.nurt.2007.05.003","article-title":"Examination of spinal cord tissue architecture with magnetic resonance diffusion tensor imaging","volume":"4","author":"Maier","year":"2007","journal-title":"Neurotherapeutics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1002\/jmri.20357","article-title":"Apparent diffusion coefficient and fractional anisotropy in spinal cord: Age and cervical spondylosis-related changes","volume":"22","author":"Mamata","year":"2005","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_11","first-page":"128","article-title":"Schmit, B.D. Optimal diffusion tensor indices for imaging the human spinal cord","volume":"43","author":"Ellingson","year":"2007","journal-title":"Biomed. Sci. Instrum."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1055\/s-2007-962832","article-title":"Diffusion tensor imaging of the spinal cord at 1.5 and 3.0 Tesla","volume":"179","author":"Rossi","year":"2007","journal-title":"Rofo"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103213","DOI":"10.1016\/j.nicl.2022.103213","article-title":"Detection of spinal long fiber tract degeneration in HSP: Improved diffusion tensor imaging","volume":"36","author":"Lindig","year":"2022","journal-title":"Neuroimage Clin."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1063\/1.1695690","article-title":"Spin Diffusion Measurements: Spin Echoes in the Presence of a Time-Dependent Field Gradient","volume":"42","author":"Stejskal","year":"1965","journal-title":"J. Chem. Phys."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1080\/01688639408402625","article-title":"Multiple Comparison Methods\u2014Establishing Guidelines for Their Valid Application in Neuropsychological Research","volume":"16","author":"Cicchetti","year":"1994","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1037\/0033-2909.86.2.420","article-title":"Intraclass Correlations\u2014Uses in Assessing Rater Reliability","volume":"86","author":"Shrout","year":"1979","journal-title":"Psychol. Bull."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.pscychresns.2006.01.008","article-title":"Regional distribution of measurement error in diffusion tensor imaging","volume":"147","author":"Marenco","year":"2006","journal-title":"Psychiatry Res.-Neuroimaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.yebeh.2014.06.020","article-title":"Reliability and variability of diffusion tensor imaging (DTI) tractography in pediatric epilepsy","volume":"37","author":"Carlson","year":"2014","journal-title":"Epilepsy Behav."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1002\/nbm.1447","article-title":"Reproducibility of tract-specific magnetization transfer and diffusion tensor imaging in the cervical spinal cord at 3 tesla","volume":"23","author":"Smith","year":"2010","journal-title":"NMR Biomed."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"339","DOI":"10.3174\/ajnr.A2334","article-title":"Diffusion tensor imaging of the pediatric spinal cord at 1.5T: Preliminary results","volume":"32","author":"Mohamed","year":"2011","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.3174\/ajnr.A2924","article-title":"Diffusion tensor imaging of the normal pediatric spinal cord using an inner field of view echo-planar imaging sequence","volume":"33","author":"Barakat","year":"2012","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E797","DOI":"10.1097\/BRS.0b013e3182470a08","article-title":"Diffusion tensor imaging in pediatric spinal cord injury: Preliminary examination of reliability and clinical correlation","volume":"37","author":"Mulcahey","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"279","DOI":"10.4329\/wjr.v7.i9.279","article-title":"Inter- and intra-rater reliability of diffusion tensor imaging parameters in the normal pediatric spinal cord","volume":"7","author":"Barakat","year":"2015","journal-title":"World J. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Guan, L., Chen, X., Hai, Y., Ma, X., He, L., Wang, G., Yuan, C., and Guo, H. (2017). High-resolution diffusion tensor imaging in cervical spondylotic myelopathy: A preliminary follow-up study. NMR Biomed., 30.","DOI":"10.1002\/nbm.3769"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lee, E., Lee, J.W., Bae, Y.J., Kim, H.J., Kang, Y., and Ahn, J.M. (2020). Reliability of pre-operative diffusion tensor imaging parameter measurements of the cervical spine in patients with cervical spondylotic myelopathy. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-74624-6"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.3174\/ajnr.A5334","article-title":"Test-Retest and Interreader Reproducibility of Semiautomated Atlas-Based Analysis of Diffusion Tensor Imaging Data in Acute Cervical Spine Trauma in Adult Patients","volume":"38","author":"Peterson","year":"2017","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1002\/jmri.25308","article-title":"Quantifying the impact of underlying measurement error on cervical spinal cord diffusion tensor imaging at 3T","volume":"44","author":"By","year":"2016","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.3174\/ajnr.A5163","article-title":"Clinically Feasible Microstructural MRI to Quantify Cervical Spinal Cord Tissue Injury Using DTI, MT, and T2*-Weighted Imaging: Assessment of Normative Data and Reliability","volume":"38","author":"Martin","year":"2017","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1002\/nbm.3530","article-title":"Tract-specific and age-related variations of the spinal cord microstructure: A multi-parametric MRI study using diffusion tensor imaging (DTI) and inhomogeneous magnetization transfer (ihMT)","volume":"29","author":"Taso","year":"2016","journal-title":"Nmr Biomed."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1177\/0284185113499752","article-title":"Diffusion tensor imaging of the cervical spinal cord in healthy adult population: Normative values and measurement reproducibility at 3T MRI","volume":"55","author":"Brander","year":"2014","journal-title":"Acta Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2196","DOI":"10.1016\/j.ejrad.2014.09.010","article-title":"Age-related changes of the diffusion tensor imaging parameters of the normal cervical spinal cord","volume":"83","author":"Wang","year":"2014","journal-title":"Eur. J. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.3174\/ajnr.A4850","article-title":"Cervical Spinal Cord DTI Is Improved by Reduced FOV with Specific Balance between the Number of Diffusion Gradient Directions and Averages","volume":"37","author":"Crombe","year":"2016","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1177\/1352458512436593","article-title":"Increased radial diffusivity in spinal cord lesions in neuromyelitis optica compared with multiple sclerosis","volume":"18","author":"Klawiter","year":"2012","journal-title":"Mult. Scler."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/S1474-4422(08)70163-7","article-title":"Diffusion-based tractography in neurological disorders: Concepts, applications, and future developments","volume":"7","author":"Ciccarelli","year":"2008","journal-title":"Lancet Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.acra.2007.04.006","article-title":"Gray and white matter delineation in the human spinal cord using diffusion tensor imaging and fuzzy logic","volume":"14","author":"Ellingson","year":"2007","journal-title":"Acad. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Samson, R.S., Levy, S., Schneider, T., Smith, A.K., Smith, S.A., Cohen-Adad, J., and Wheeler-Kingshott, C.A.G. (2016). ZOOM or Non-ZOOM? Assessing Spinal Cord Diffusion Tensor Imaging Protocols for Multi-Centre Studies. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0155557"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1002\/mrm.23254","article-title":"Six is enough? Comparison of diffusion parameters measured using six or more diffusion-encoding gradient directions with deterministic tractography","volume":"68","author":"Lebel","year":"2012","journal-title":"Magn. Reson. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1002\/mrm.25290","article-title":"Parallel imaging and compressed sensing combined framework for accelerating high-resolution diffusion tensor imaging using inter-image correlation","volume":"73","author":"Shi","year":"2015","journal-title":"Magn. Reson. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1002\/mrm.24721.","article-title":"Accelerated MR diffusion tensor imaging using distributed compressed sensing","volume":"71","author":"Wu","year":"2014","journal-title":"Magn. Reson. Med."},{"key":"ref_41","first-page":"281","article-title":"Diffusion tensor imaging in pediatric transverse myelitis: A case study","volume":"5","author":"Barakat","year":"2012","journal-title":"J. Pediatr. Rehabil. Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/16\/2057\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:28:59Z","timestamp":1760034539000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/16\/2057"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,16]]},"references-count":41,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["diagnostics15162057"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15162057","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,8,16]]}}}