AUTHOR=Ailes Isaiah , Syed Mashaal , Matias Caio M. , Krisa Laura , Miao Jingya , Sathe Anish , Fayed Islam , Alhussein Abdulaziz , Natale Peter , Mohamed Feroze B. , Talekar Kiran , Alizadeh Mahdi 

TITLE=Case report: Utilizing diffusion-weighted MRI on a patient with chronic low back pain treated with spinal cord stimulation

JOURNAL=Frontiers in Neuroimaging

VOLUME=Volume 2 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neuroimaging/articles/10.3389/fnimg.2023.1137848

DOI=10.3389/fnimg.2023.1137848

ISSN=2813-1193

ABSTRACT=Diffusion weighted magnetic resonance imaging (dwMRI) has increasingly demonstrated greater utility in analyzing neuronal microstructure. In patients with chronic low back pain (cLBP), using dwMRI to observe neuronal microstructure can lead to non-invasive biomarkers which could provide clinicians with an objective quantitative prognostic tool. In this case report, we investigated dwMRI for the development of non-invasive biomarkers by conducting regional based analysis of a 55-year-old male patient with failed back surgery syndrome (FBSS) treated with spinal cord stimulation (SCS). We hypothesized that dwMRI could safely generate quantitative data reflecting cerebral microstructural alterations driven by neuromodulation. Neuroimaging was performed at 6 and 12 months post-spinal cord stimulator implantation. Quantitative maps generated included diffusion tensor imaging (DTI) parameters; fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD), in addition to tract density index (TDI), computed from whole brain tractography. To examine specific areas of the brain, 44 regions-of-interest (ROIs) from a customized automated anatomical labeling (AAL) atlas were extracted and registered to the patient’s diffusion space using Medical Image Registration ToolKit (MIRTK) registration technique. These 44 regions comprise structures essential to pain sensation and discrimination, collectively representing the pain NeuroMatrix. Average diffusion indices were calculated from the ROIs at both 6 and 12 months. Regions with greater than a 10% relative change in at least 3 of the 5 maps were reported. Using this selection criteria, 8 ROIs had demonstrated over 10% relative changes. These ROIs were mainly located in the insular gyri. In addition to the quantitative data, a series of questionnaires were administered during the 6 and 12 month visits to assess pain intensity, functional disability, and quality of life. Overall improvements were observed in these components, with the Pain Catastrophizing Scale (PCS), from the quality-of-life category, improving by 17 points. Lastly, we demonstrated the safety of dwMRI for a patient with a spinal cord stimulator. In summary, the results from the case report prompt further investigation in applying dwMRI in a larger cohort to better correlate the influence of SCS with brain microstructural alterations, supporting the utility of dwMRI to generate non-invasive biomarkers for prognostication.