Reduced Field-of-View Diffusion Tensor Imaging of the Spinal Cord Shows Motor Dysfunction of the Lower Extremities in Patients With Cervical Compression Myelopathy

Maki, Satoshi; Koda, Masao; M, Ota; Oikawa, Yoshihiro; Kamiya, Koshiro; Inada, Taigo; Furuya, Takeo; Takahashi, Kazuhisa; Masuda, Yoshitada; Matsumoto, Koji; Kojima, Masatoshi; Obata, Takayuki; Yamazaki, Masashi

doi:10.1097/brs.0000000000001123

Cited by 29 publications

(16 citation statements)

References 34 publications

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“…Among these studies, the majority (38/67, 57%) only investigated correlations with a single coarse clinical measure, such as Expanded Disability Status Scale (EDSS), Japanese Orthopedic Association (JOA), modified JOA (mJOA), amyotrophic lateral sclerosis (ALS) Functional Rating Scale (ALSFRS), or ASIA Impairment Scale (AIS), rather than employing a battery of assessments or using more detailed measures of impairment such as ASIA motor/sensory scores. The majority of DTI studies reporting biomarker utility results focused on the metric FA, which was particularly successful in CSM with significant results in 5/5 studies correlating with JOA or mJOA (Spearman r = 0.48–0.88, Pearson R = 0.57–0.64) ( Ellingson et al, 2014 , Gao et al, 2013 , Jones et al, 2013 , Maki et al, 2015 , Wen et al, 2014b ) and in SCI in 4/4 studies correlating with ASIA motor/sensory scores (r = 0.59–0.74, R = 0.78–0.92) ( Cheran et al, 2011 , Cohen-Adad et al, 2011 , Koskinen et al, 2013 , Vedantam et al, 2015 ), but slightly less successful in MS with significant results in only 7/15 studies correlating with EDSS (r = − 0.37–0.51, R = − 0.60) ( Agosta et al, 2007a , Benedetti et al, 2010 , Naismith et al, 2013 , Oh et al, 2013a , Oh et al, 2013b , Toosy et al, 2014 , Valsasina et al, 2005 ), with negative results in 8 studies ( Agosta et al, 2005 , Ciccarelli et al, 2007 , Hodel et al, 2013 , Miraldi et al, 2013 , Oh et al, 2015 , Raz et al, 2013 , Rocca et al, 2012 , Ukmar et al, 2012 ). Other metrics had limited success in MS correlating with EDSS, with significant results for MD in 3/13 studies ( Oh et al, 2013a , Oh et al, 2013b , Valsasina et al, 2005 ), RD in 4/8 studies ( Naismith et al, 2013 , Oh et al, 2013a , Oh et al, 2013b , Toosy et al, 2014 ), MTR in 6/15 studies ( Agosta et al, 2007b , Bozzali et al, 1999 , Kearney et al, 2014 , Lycklama et al, 2000 , Oh et al, 2013a , Oh et al, 2013b ), MTCSF in 2/2 studies ( Fatemi et al, 2005 , Zackowski et al, 2009 ), and the ...…”

Section: Resultsmentioning

confidence: 99%

Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI

Martín

Aleksanderek

Cohen‐Adad

et al. 2016

NeuroImage: Clinical

189

169

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BackgroundA recent meeting of international imaging experts sponsored by the International Spinal Research Trust (ISRT) and the Wings for Life Foundation identified 5 state-of-the-art MRI techniques with potential to transform the field of spinal cord imaging by elucidating elements of the microstructure and function: diffusion tensor imaging (DTI), magnetization transfer (MT), myelin water fraction (MWF), MR spectroscopy (MRS), and functional MRI (fMRI). However, the progress toward clinical translation of these techniques has not been established.MethodsA systematic review of the English literature was conducted using MEDLINE, MEDLINE-in-Progress, Embase, and Cochrane databases to identify all human studies that investigated utility, in terms of diagnosis, correlation with disability, and prediction of outcomes, of these promising techniques in pathologies affecting the spinal cord. Data regarding study design, subject characteristics, MRI methods, clinical measures of impairment, and analysis techniques were extracted and tabulated to identify trends and commonalities. The studies were assessed for risk of bias, and the overall quality of evidence was assessed for each specific finding using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.ResultsA total of 6597 unique citations were identified in the database search, and after full-text review of 274 articles, a total of 104 relevant studies were identified for final inclusion (97% from the initial database search). Among these, 69 studies utilized DTI and 25 used MT, with both techniques showing an increased number of publications in recent years. The review also identified 1 MWF study, 11 MRS studies, and 8 fMRI studies. Most of the studies were exploratory in nature, lacking a priori hypotheses and showing a high (72%) or moderately high (20%) risk of bias, due to issues with study design, acquisition techniques, and analysis methods. The acquisitions for each technique varied widely across studies, rendering direct comparisons of metrics invalid. The DTI metric fractional anisotropy (FA) had the strongest evidence of utility, with moderate quality evidence for its use as a biomarker showing correlation with disability in several clinical pathologies, and a low level of evidence that it identifies tissue injury (in terms of group differences) compared with healthy controls. However, insufficient evidence exists to determine its utility as a sensitive and specific diagnostic test or as a tool to predict clinical outcomes. Very low quality evidence suggests that other metrics also show group differences compared with controls, including DTI metrics mean diffusivity (MD) and radial diffusivity (RD), the diffusional kurtosis imaging (DKI) metric mean kurtosis (MK), MT metrics MT ratio (MTR) and MT cerebrospinal fluid ratio (MTCSF), and the MRS metric of N-acetylaspartate (NAA) concentration, although these results were somewhat inconsistent.ConclusionsState-of-the-art spinal cord MRI techniques are emerging with great pot...

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Section: Resultsmentioning

confidence: 99%

Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI

Martín

Aleksanderek

Cohen‐Adad

et al. 2016

NeuroImage: Clinical

189

169

View full text Add to dashboard Cite

show abstract

“…A recent systematic review of the literature 59 identified a total of 25 studies that used these techniques to study DCM; 22 used DTI, 3 used MRS, and 1 used MT (in combination with DTI). 10,17,21,22,24,25,30,35,36,39,46,52,53,55,56,58,73,93,104,112,116,124,125,129,136 No clinical studies that used MWF or fMRI were identified. Among the identified DCM studies, the DTI metric fractional anisotropy (FA), a number that ranges from 0 for isotropic diffusion (same in all directions) to 1 for anisotropic (all in 1 direction), seemed to have the strongest results.…”

Section: Studies Using Advanced Mri In Dcmmentioning

confidence: 99%

Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques

Nouri

Martín

Mikulis

et al. 2016

FOC

158

124

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Degenerative cervical myelopathy encompasses a spectrum of age-related structural changes of the cervical spine that result in static and dynamic injury to the spinal cord and collectively represent the most common cause of myelopathy in adults. Although cervical myelopathy is determined clinically, the diagnosis requires confirmation via imaging, and MRI is the preferred modality. Because of the heterogeneity of the condition and evolution of MRI technology, multiple techniques have been developed over the years in an attempt to quantify the degree of baseline severity and potential for neurological recovery. In this review, these techniques are categorized anatomically into those that focus on bone, ligaments, discs, and the spinal cord. In addition, measurements for the cervical spine canal size and sagittal alignment are also described briefly. These tools have resulted collectively in the identification of numerous useful parameters. However, the development of multiple techniques for assessing the same feature, such as cord compression, has also resulted in a number of challenges, including introducing ambiguity in terms of which methods to use and hindering effective comparisons of analysis in the literature. In addition, newer techniques that use advanced MRI are emerging and providing exciting new tools for assessing the spinal cord in patients with degenerative cervical myelopathy.

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“…rFOV DTI of the spinal cord allows for acquisition of high-resolution images for assessment of specific spinal cord tracts and discrimination of white matter from gray matter. Maki et al 72) showed correlations between the FA of specific white matter in spinal cord tracts and myelopathy severity in …”

Section: Future Directions; High-resolution Dtimentioning

confidence: 99%

Recent advances in magnetic resonance neuroimaging of lumbar nerve to clinical applications: A review of clinical studies utilizing Dffusion Tensor Imaging and Diffusion-weighted magnetic resonance neurography

Eguchi

Kanamoto

Oikawa³

et al. 2017

Spine Surg Relat Res

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Abstract:Much progress has been made in neuroimaging with Magnetic Resonance neurography and Diffusion Tensor Imaging (DTI) owing to higher magnetic fields and improvements in pulse sequence technology. Reports on lumbar nerve DTI have also increased considerably.Many studies have shown that the use of DTI in lumbar nerve lesions, such as lumbar foraminal stenosis and lumbar disc herniation, makes it possible to capture images of interruptions of tractography at stenotic sties, enabling the diagnosis of stenosis. DTI can also reveal significant decreases in fractional anisotropy (FA) with significant increases in apparent diffusion coefficient (ADC) values in compression lesions.FA values have higher accuracy than ADC values. Furthermore, strong correlations exist between FA values and indications of neurological severity, including the Japanese Orthopedic Association (JOA) score, the Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RDQ) in patients with lumbar disc herniation-induced radiculopathy.Most lumbar DTI has become 3T; 3T MRI has made it possible to take high-resolution DTI measurements in a short period of time. However, increased motion artifacts in the magnetic susceptibility effect lead to signal irregularities and image distortion. In the future, high-resolution DTI with reduced field-of-view may become useful in clinical applications, since visualization of nerve lesions and quantification of DTI parameters could allow more accurate diagnoses of lumbar nerve dysfunctions. Future translational studies will be necessary to successfully bring MR neuroimaging of lumbar nerve into clinical use.

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Reduced Field-of-View Diffusion Tensor Imaging of the Spinal Cord Shows Motor Dysfunction of the Lower Extremities in Patients With Cervical Compression Myelopathy

Abstract: 4.

Cited by 29 publications

References 34 publications

Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI

Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI

Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques

Recent advances in magnetic resonance neuroimaging of lumbar nerve to clinical applications: A review of clinical studies utilizing Dffusion Tensor Imaging and Diffusion-weighted magnetic resonance neurography

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