Objectives: Diffusion tensor imaging (DTI) techniques are being studied as a possible diagnostic and predictive tool for the evaluation of cervical spinal cord disease. This systematic review aims to evaluate the previous DTI studies that specifically investigated the repeatability and reproducibility of DTI in the cervical spinal cord. Methods and materials: A search in the PubMed, Scopus, Web of Science and Ovid electronic databases was conducted for articles published between January 1990 and February 2022 that related to the repeatability and reproducibility of DTI in evaluating the cervical spinal cord using one of the following measurements: the intraclass correlation coefficient (ICC) and/or the coefficient of variation (CV), and/or Bland-Altman (BA) differences analysis methods. DTI studies that presented full statistical analysis of repeatability and/or reproducibility tests of the cervical spinal cord in peer-reviewed full-text publications published in journals were included. Articles that included at least one of the keywords within the titles or abstracts were identified. Additional full-text papers were found by searching the citations and reference lists of related articles. This review has followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Risk of bias was evaluated with 13 criteria weighted toward methodological quality of reported studies using the QuADS assessment criteria. This assessment only included full-text articles written in English. Results: A total of 11 studies were included and assessed for different characteristics, including sample size,(3–34) re-test time interval (3 months), test-retest reproducibility scores and acquisition method. Six studies used ICC which ranged from poor (ICC<0.37) to excellent reproducibility (ICC 0.91–0.99). Four studies reported an overall CV lower than 40% for all DTI metrics. Three studies reported the Bland-Altman (BA) differences and reported a minimum percentage showing no strong differences between repeated measurements. Quantitative analysis was not undertaken due to heterogeneity of methods. Repeatability and reproducibility measures were generally found to be good. Conclusion: This study revealed that the application of DTI and its related measures in a clinical setting in the assessment of cervical spinal cord changes is feasible and reproducible. However, cervical spinal cord DTI suffers from some existing limitations that prevent it from being routinely used in research and clinical settings. Advances in knowledge: DTI with its parametric maps provide broad evaluation of the tissue structure of axonal white matter and are being studied as a possible diagnostic and predictive tool for the assessment of cervical spinal cord (CSC) disease.

Diffusion tensor imaging (DTI) is a promising technique for the visualization of the cervical spinal cord (CSC) in vivo. It provides information about the tissue structure of axonal white matter, and it is thought to be more sensitive than other MR imaging techniques for the evaluation of damage to tracts in the spinal cord. The purpose of this study was to determine the within-participants reliability and error magnitude of measurements of DTI metrics in healthy human CSC. A total of twenty healthy controls (10 male, mean age: 33.9 ± 3.5 years, 10 females, mean age: 47.5 ± 14.4 years), with no family history of any neurological disorders or a contraindication to MRI scanning were recruited over a period of two months. Each participant was scanned twice with an MRI 3 T scanner using standard DTI sequences. Spinal Cord Toolbox (SCT) software was used for image post-processing. Data were first corrected for motion artefact, then segmented, registered to a template, and then the DTI metrics were computed. The within-participants coefficients of variation (CV%), the single and average within-participants intraclass correlation coefficients (ICC) and Bland-Altman plots for WM, VC, DC and LC fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were determined for the cervical spinal cord (between the 2nd and 5th cervical vertebrae). DTI metrics showed poor to excellent within-participants reliability for both single and average ICC and moderate to high reproducibility for CV%, all variation dependent on the location of the ROI. The BA plots showed good within-participants agreement between the scan-rescan values. Results from this reliability study demonstrate that clinical trials using the DTI technique are feasible and that DTI, in particular regions of the cord is suitable for use for the monitoring of degenerative WM changes.

Purpose: To assess the within -participant reliability and measurement error in the determination of MTR in the healthy human cervical spinal cord. Methods and materials: A total of twenty healthy controls (10 male, mean +/- sd age: 33.9 +/- 3.5 years, 10 females, mean +/- sd age: 47.5 +/- 14.4 years), with no family history of any neurological disorders or a contraindication to MRI scanning were recruited over a period of two months. Each participant was scanned twice with a 3T MRI scanner using standard MTI sequences. Spinal Cord Toolbox (v5.4) was used for image post -processing. Data were first segmented and then registered to a template and then MTR was computed. The within -participant coef ficients of variation (CV%), single and average withinparticipants intraclass correlation coef ficients (ICC) and Bland -Altman plots were determined for MT values over the volume between the 2nd and 5th cervical vertebrae for the total WM and for speci fic WM regions: dorsal column (DC), ventral column (VC) and lateral column (LC). Results: MTR showed poor to excellent within -participant reliability for the total WM, DC, VC and LC with single/average ICC values of 0.03/0.06, 0.10/0.18, 0.39/0.75, and 0.001/0.002, respectively, and the CV % reported an acceptable variation with values less than 10%. The Bland -Altman plots showed good within -participant agreement between the scan-rescan values. Conclusion: This study demonstrates that clinical trials using MTI technique are feasible and shows that quantitative MTI can monitor tissue changes in degenerative WM patients. Implications for practice: MTI with its MTR index provide broad assessment of the integrity of white matter tissue and are being studied widely in brain as a diagnostic tool for the assessment of different neurological diseases. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of The College of Radiographers. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Purpose: To determine whether magnetization transfer imaging (MTI) is able to detect microstructure alterations in the cervical spinal cord (CSC) in relapsing‐remitting multiple sclerosis (RRMS) patients and whether they correlate with clinical disability.Methods and Materials: Fifteen RRMS patients (5 males, 10 females, mean ± standard deviation (SD) age: 47.0 ± 12.9 years, age range: 18–70 years; median Expanded Disability Status Scale (EDSS) score = 2; (range: 0.5–6.5) and 20 healthy controls (10 male, 10 females, mean ± sd age: 40.7 ± 12.4 years) underwent 3T MRI scans using standard MTI sequences. Spinal Cord Toolbox (SCT) was used for image post‐processing. Data were first segmented and then registered to a template and then the magnetization transfer ratio (MTR) was computed over the volume between the 2nd and 5th cervical vertebrae for the total white matter (WM) and for specific WM regions: dorsal column (DC), ventral column (VC), and lateral column (LC). Independent sample t‐tests were used to conduct a comparative analysis of means between the healthy and RRMS groups. The association between MTR measures over different ROIs and EDSS was investigated by the univariate association using Pearson correlation coefficient (r) and a simple linear regression analysis.Results: MTR values were significantly decreased in all ROIs (p < 0.01) in RRMS versus Healthy participants. There was no significant correlation between MTR and EDSS in all ROIs.Conclusion: This study demonstrates that clinical trials using MTI techniques are feasible and show that quantitative MTI can monitor tissue changes in degenerative WM patients.

Background: The steady rise of prostate cancer in Saudi Arabia signals a critical public health shift that requires immediate investment in early detection and prevention to mitigate a future clinical crisis. Accurate diagnosis using multiparametric MRI and PI-RADS scoring remains challenging, as interpretations are highly experience-dependent and subspecialized radiologists are limited. Methods: To address this gap, this study introduces a novel Dual-Stream Attention Network designed to automate the classification of low-risk (PIRADS 2-3) versus high-risk (PIRADS 4-5) lesions from T2-weighted MRI. Leveraging a ResNet50 backbone, the architecture employs parallel streams for Local and Global Feature Processing, each enhanced by a Channel-Spatial Attention module to highlight diagnostically relevant regions. These features are integrated through a Cross-Stream Fusion mechanism and a gate-controlled Adaptive Feature Fusion module to optimize multi-scale information. The model was developed and validated on a regional dataset of 3850 images from Jazan Specialist Hospital and Prince Mohammed bin Naser Hospital. This research provides a standardized, high-precision diagnostic path tailored to the Saudi Arabian population, conducted under institutional review board approval (No. 25138). Results: The proposed dual-stream attention network achieved an accuracy of 97.8% on the validation set and 96.4% on the test set, demonstrating high performance and generalization capabilities in classifying prostate lesions from Saudi patient populations. Conclusions: The proposed dual-stream architecture with novel attention and fusion mechanisms demonstrates high effectiveness for prostate cancer classification from T2-weighted MRI in Saudi clinical settings. This represents the first deep learning model specifically trained and validated on Saudi Arabian prostate MRI data, with the potential to address the shortage of specialized expertise and improve diagnostic efficiency in the Kingdom.

Objectives: The objective of magnetisation transfer imaging (MTI) is to quantitatively assess myelin integrity in the cervical spinal cord (CSC) using MRI technology. The magnetisation transfer ratio (MTR) has been extensively studied as a prospective biomarker for identifying microstructural alterations in both healthy and diseased tissue. This systematic review aims to assess the repeatability and reproducibility of MTI-derived MTR studies in human CSC. Methods: A systematic search was performed in PubMed, Scopus, and Web of Science to identify studies evaluating the reliability of MTI, specifically MTR. Studies that met the criteria presented statistical metrics including intraclass correlation coefficient (ICC), coefficient of variation (CV%), or Bland–Altman (BA) analysis. Only peer-reviewed articles in English were included. The review adhered to PRISMA 2020 guidelines, and methodological quality was evaluated using the Quality Assessment with Diverse Studies (QuADS) tool. Results: Thirty studies were identified; following screening, six studies satisfied the inclusion requirements. These investigations assessed the reliability and reproducibility of MTR in both healthy individuals and patients with cervical myelopathy throughout spinal levels C1–C7. The ICC values exhibited considerable variability, spanning from poor agreement to about 0.90%, depending on the region of interest. The CV% values varied from 1.3% to 6.1% in non-healthy populations and from 0.5% to 12.7% in healthy groups. The BA analysis indicated no systematic bias, characterised by relatively minimal mean differences. A quantitative meta-analysis was not conducted due to methodological differences in each study. QuADS ratings demonstrated moderate to high methodological quality (77–96%). Conclusions: MTR exhibits generally low ICC values over different ROIs in most of the included studies and high to medium reproducibility for the evaluation of CSC. Nonetheless, diversity in acquisition procedures, statistical reporting and ROI selection continues to be a significant limitation of our study for not reporting the meta-analysis.