Diffusion Tensor Imaging (DTI) for Nerve and Musculoskeletal Disorders-An Updated Review

Abstract

Background: Diffusion Tensor Imaging (DTI) has become a significant imaging modality for evaluating muscle and nerve disorders, providing enhanced insights into muscle fiber structure and abnormalities. Traditional MRI methods primarily assess muscle edema and tissue changes indirectly, limiting their ability to assess fiber repair accurately. DTI offers a more detailed evaluation of muscle fiber integrity by measuring parameters like fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). This imaging technique has shown promise in monitoring muscle injuries, rehabilitation, and muscle adaptations to training.

Aim: The review aims to explore the utility of DTI in diagnosing and monitoring musculoskeletal disorders, particularly muscle injuries, neuromuscular diseases, and adaptations from training or rehabilitation. It also examines the challenges and potential of DTI in clinical applications, focusing on its advantages over traditional MRI techniques.

Methods: This updated review synthesizes current research on DTI applications in musculoskeletal and nerve disorders. Key studies on muscle injury, training, rehabilitation, myopathies, and neuromuscular diseases are discussed. It also covers the role of DTI in differentiating muscle fiber types and monitoring recovery, alongside the use of intravoxel incoherent motion (IVIM) to correct biases introduced by tissue perfusion.

Results: DTI successfully distinguishes between healthy and injured muscle tissues by detecting variations in fiber alignment and diffusivity parameters. Studies reveal that DTI parameters such as FA, MD, AD, and RD correlate well with muscle injury severity, training adaptations, and disease progression. The combination of DTI with IVIM models improves diagnostic accuracy, especially in cases affected by muscle perfusion and edema. DTI has shown potential in assessing myopathies like Duchenne muscular dystrophy and monitoring recovery from athletic injuries.

Conclusion: DTI proves to be a valuable tool for evaluating muscle injuries, training adaptations, and neuromuscular disorders. Its ability to provide detailed fiber orientation data and assess muscle integrity surpasses traditional MRI methods. However, further research is needed to refine protocols and standardize DTI applications, especially in clinical settings.