Accuracy of Diffusion Tensor Imaging for Diagnosing Cervical Spondylotic Myelopathy in Patients Showing Spinal Cord Compression

Abstract

ObjectiveTo assess the performance of diffusion tensor imaging (DTI) for the diagnosis of cervical spondylotic myelopathy (CSM) in patients with deformed spinal cord but otherwise unremarkable conventional magnetic resonance imaging (MRI) findings.Materials and MethodsA total of 33 patients who underwent MRI of the cervical spine including DTI using two-dimensional single-shot interleaved multi-section inner volume diffusion-weighted echo-planar imaging and whose spinal cords were deformed but showed no signal changes on conventional MRI were the subjects of this study. Mean diffusivity (MD), longitudinal diffusivity (LD), radial diffusivity (RD), and fractional anisotropy (FA) were measured at the most stenotic level. The calculated performance of MD, FA, MD∩FA (considered positive when both the MD and FA results were positive), LD∩FA (considered positive when both the LD and FA results were positive), and RD∩FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard.ResultsThe MD, LD, and RD cut-off values were 1.079 × 10-3, 1.719 × 10-3, and 0.749 × 10-3 mm2/sec, respectively, and that of FA was 0.475. Sensitivity, specificity, positive predictive value and negative predictive value were: 100 (4/4), 44.8 (13/29), 20 (4/20), and 100 (13/13) for MD; 100 (4/4), 27.6 (8/29), 16 (4/25), and 100 (8/8) for FA; 100 (4/4), 58.6 (17/29), 25 (4/16), and 100 (17/17) for MD∩FA; 100 (4/4), 68.9 (20/29), 30.8 (4/13), and 100 (20/20) for LD∩FA; and 75 (3/4), 68.9 (20/29), 25 (3/12), and 95.2 (20/21) for RD∩FA in percentage value. Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD∩FA (p = 0.024) and MD and RD∩FA (p = 0.024).ConclusionFractional anisotropy combined with MD, RD, or LD is expected to be more useful than FA and MD for diagnosing CSM in patients who show deformed spinal cords without signal changes on MRI.

Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression

“…Further, spinal cord T2 hyperintensity is considered an important risk factor by the spine care community (Wilson et al, 2013), and diffusion tensor imaging (DTI) parameters have shown the capacity to differentiate cervical myelopathy patients not only from normal individuals (Chen et al, 2016;Guan et al, 2015;Lee et al, 2015) but also from nonmyelopathic cervical cord compression cases (Kerkovsky et al, 2012), and further to correlate with severity of myelopathy (Rajasekaran et al, 2014), the segments of the cervical cord involved (Suetomi et al, 2016), and to predict postsurgical outcome (Arima et al, 2015). A re-evaluation of the predictive model describing the risk of progression of NMDCCC to symptomatic myelopathy (Bednarik et al, 2008) was thus indicated, in a sample also including completely asymptomatic subjects with less severe stages of degenerative cervical cord compression and with the use of DTI parameters to validate the previous model.…”

Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal

“…Regarding the DTA studies, one reviewer experienced in DTA studies selected eligible articles according to criteria established elsewhere ( 9 ) with additional confirmation by another DTA expert in cases of ambiguity. Of the initial 124 candidate articles, 63 articles ( 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 ) were finally included. Regarding the studies that analyzed reliability, eligible articles were chosen by consensus after review by two of four independent reviewers experienced in the relevant methodology.…”

The usage of tractography of the spinal cord as a predictor of neurological disorders regression in patients with severe cervical spine and spinal cord injury

“…Seungbo Lee і співавт., після аналізу результатів МРТ пацієнтів з компресійною мієлопатією на рівні ШВХ, виявили, що величина FA знижується паралельно зі збільшенням ступеня стенозу хребтового каналу [13]. У низці досліджень продемонстровано клінічну кореляцію між зменшенням значення FA і тяжкістю ХСМТ [14].…”