Diffusion tensor imaging in the assessment of ossification of the posterior longitudinal ligament: a report on preliminary results in 3 cases and review of the literature

Abstract

<jats:p>Cervical spondylotic myelopathy due to ossification of the posterior longitudinal ligament (OPLL) is a common neurosurgical disease that carries high morbidity. OPLL and other degenerative processes cause narrowing of the central canal, with subsequent spinal cord injury. Repeated minor trauma and vascular aberrations have been purported to underlie cervical spondylotic myelopathy, although the exact pathophysiological mechanism is unclear. Regardless, detection of early axonal damage may allow more timely surgical intervention and prediction of functional outcome. Diffusion tensor (DT) imaging of the cervical spine is a novel technique with improved sensitivity compared with conventional anatomical MR imaging that is currently available on most clinical scanners. This review describes the theoretical basis, application, and analysis of DT imaging as it pertains to neurosurgery. Particular emphasis is placed on OPLL.</jats:p>

Correlation between diffusion tensor imaging parameters and clinical assessments in patients with cervical spondylotic myelopathy with and without high signal intensity

“…4 DTI is a reliable method for quantifying the microstructural abnormalities of the cervical spinal cord in patients with CSM, 5,[17][18][19] and many have suggested the correlation of DTI parameters with clinical severity. 20,21 In our previous study, we confirmed that DTI parameters of the cervical spinal cord in patients with high signal intensity were significantly different from those in healthy subjects. 22 DTI parameters and T2 high signal intensity are two different methods to evaluate the neurologic state of the spinal cord.…”

“…[12][13][14][15] Diffusion tensor imaging (DTI) is considered to be more advantageous than conventional MRI because it can detect and quantify microstructural abnormalities. 5,[16][17][18][19] Recently, Jones et al 20 investigated the relationship between DTI parameters and clinical assessment in patients with CSM, and found that fractional anisotropy (FA) value correlated strongly with the modified Japanese Orthopedic Association (mJOA) score and Nurick score. Wen et al 21 showed not only that FA correlated positively with mJOA score, but it may also be indicative of surgical outcome with using logistic regression analysis.…”

Diffusion Tensor Imaging in a Large Longitudinal Series of Patients With Cervical Spondylotic Myelopathy Correlated With Long-Term Functional Outcome

“…30 The development of 3T scanners, reduction in artifact, and improvement in ROI selection methods and processing are yielding DTI indices that are better reflective of the microstructure of the spinal cord and its functional status. 34 , 35 Although we were able to note significant association between baseline mJOA scores and FA values obtained at both the LMC and high cervical cord at C1-2, other studies have noted a lesser relationship at the LMC. 29 This could be due to the aforementioned progress in DTI scanning technology.…”

Diffusion Tensor Imaging Correlates with the Clinical Assessment of Disease Severity in Cervical Spondylotic Myelopathy and Predicts Outcome following Surgery

“…3 Recent reports suggest that DTI may serve as a biomarker of spinal cord injury associated with CSM. [4][5][6][7] DTI parameterizes water diffusion within tissues and reports, among other metrics, the FA of the diffusion. FA represents an estimate of the directionality of water diffusion at the voxel level.…”