(Philadelphia, PA) - Most of the 11,000 new cases of spinal cord injury that are diagnosed each year in the United States occur in people under age 30, and often the sufferer is a child. But smaller spinal cords in children and a lack of adequate imaging technology has created major problems in precisely locating the site of injury. New technological developments in imaging could help clinical specialists design more effective treatment and rehabilitation strategies for pediatric patients.
Feroze B. Mohamed, PhD, Associate Professor of Radiology at the Temple University School of Medicine (TUSM), is now poised to overcome the challenge of pediatric spinal cord imaging. In June, Mohamed and co-investigator Mary Jane Mulcahey, Professor of Occupational Therapy at the Thomas Jefferson University School of Health Professions, received a five-year, $1.7-million grant from the National Institute of Neurological Disorders and Stroke (NINDS) to continue their development and refinement of a technology known as diffusion tensor imaging (DTI) for pediatric spinal cord injury diagnosis.
DTI is a relatively new type of noninvasive functional magnetic resonance imaging (fMRI) that measures the diffusive transport of water in tissues, which allows for the visualization of microscopic tissue structure. Mohamed is one of the first to apply it to pediatric spinal cord injury.
In earlier work, Mohamed found that DTI can effectively distinguish between white matter and gray matter in the spinal cord, as well as identify normal and pathological features in the cord, potentially facilitating assessments of spinal cord damage. In 2012, working with Mulcahey, he found that DTI was better correlated than conventional MRI to clinical examination scores of spinal cord damage in children.
With their new grant Mohamed and Mulcahey will examine how the DTI approach could be used alongside existing clinical tests of muscle strength and sensory function. One of the central goals of their research is to develop DTI as an imaging biomarker by establishing neuroimaging criteria in normal and pediatric subjects with spinal injury that correlate to the International Standards for Neurological Classification of Spinal Cord Injury, which are set by the American Spinal Injury Association (ASIA).
The ASIA Impairment Scale currently is the primary means for classifying spinal cord injury, and it is relied upon to identify patient needs. It distinguishes patients by severity of neurological damage, which requires knowledge of the level of damage within the vertebral column. Complete neurological impairment, for example, is defined as the loss of motor or sensory function at the lowest level of the sacrum (level S4-S5). However, the subjective nature of sensory function tests, which include tests based on the ability to feel light touch, are notoriously unreliable in children and can hinder the precise identification of injury level.
Over the five years of their study, Mohamed and Mulcahey plan to enroll 100 children, 75 with spinal cord injury and 25 who are healthy. They have already begun to recruit patients through the spinal cord injury program at Shriners Hospitals for Children in Philadelphia, where children come from around the country to receive treatment for their injuries.
In carrying out the study at Shriners Hospital in Philadelphia, Mohamed and Mulcahey are adding to that institution's strong history in spinal injury research. Mohamed's work also continues the outstanding tradition of clinical study by researchers in TUSM's Department of Radiology.
About Temple Health
Temple Health refers to the health, education and research activities carried out by the affiliates of Temple University Health System and by Temple University School of Medicine.
Temple University Health System (TUHS) is a $1.4 billion academic health system dedicated to providing access to quality patient care and supporting excellence in medical education and research. The Health System consists of Temple University Hospital (TUH), ranked among the "Best Hospitals" in the region by U.S. News & World Report; TUH-Episcopal Campus; TUH-Northeastern Campus; Fox Chase Cancer Center, an NCI-designated comprehensive cancer center; Jeanes Hospital, a community-based hospital offering medical, surgical and emergency services; Temple Transport Team, a ground and air-ambulance company; and Temple Physicians, Inc., a network of community-based specialty and primary-care physician practices. TUHS is affiliated with Temple University School of Medicine.
Temple University School of Medicine (TUSM), established in 1901, is one of the nation's leading medical schools. Each year, the School of Medicine educates approximately 840 medical students and 140 graduate students. Based on its level of funding from the National Institutes of Health, Temple University School of Medicine is the second-highest ranked medical school in Philadelphia and the third-highest in the Commonwealth of Pennsylvania. According to U.S. News & World Report, TUSM is among the top 10 most applied-to medical schools in the nation.
About Shriners Hospitals for Children
Shriners Hospitals for Children is changing lives every day through innovative pediatric specialty care, world-class research and outstanding medical education. Our 22 facilities, located in the United States, Canada and Mexico, provide advanced care for children with orthopaedic conditions, burns, spinal cord injuries, and cleft lip and palate.
Shriners Hospitals for Children is a 501(c)(3) nonprofit organization and relies on the generosity of donors. All donations are tax deductible to the fullest extent permitted by law.
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