High‐resolution diffusion tensor imaging in cervical spondylotic myelopathy: a preliminary follow‐up study

Abstract

Diffusion imaging is a promising technique as it can provide microstructural tissue information and thus potentially show viable changes in spinal cord. However, the traditional single-shot imaging method is limited as a result of various image artifacts. In order to improve measurement accuracy, we used a newly developed, multi-shot, high-resolution, diffusion tensor imaging (DTI) method to investigate diffusion metric changes and compare them with T -weighted (T2W) images before and after decompressive surgery for cervical spondylotic myelopathy (CSM). T2W imaging, single-shot DTI and multi-shot DTI were employed to scan seven patients with CSM before and 3 months after decompressive surgery. High signal intensities were scored using the T2 W images. DTI metrics, including fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD), were quantified and compared pre- and post-surgery. In addition, the relationship between imaging metrics and neurological assessments was examined. The reproducibility of multi-shot DTI was also assessed in 10 healthy volunteers. Post-surgery, the mean grade of cervical canal stenosis was reduced from grade 3 to normal after 3 months. Compared with single-shot DTI, multi-shot DTI provided better images with lower artifact levels, especially following surgery, as a result of reduced artifacts from metal implants. The new method also showed acceptable reproducibility. Both FA and RD values from the new acquisition showed significant differences post-surgery (FA, p = 0.026; RD, p = 0.048). These changes were consistent with neurological assessments. In contrast, T2W images did not show significant changes before and after surgery. Multi-shot diffusion imaging showed improved image quality over single-shot DWI, and presented superior performance in diagnosis and recovery monitoring for patients with CSM compared with T2W imaging. DTI metrics can reflect the pathological conditions of spondylotic spinal cord quantitatively and may serve as a sensitive biomarker for potential CSM management.

The Correlation between Functional Connectivity of the Primary Somatosensory Cortex and Cervical Spinal Cord Microstructural Injury in Patients with Cervical Spondylotic Myelopathy

“…Therefore, our method of measurement was more accurate. Compared with the HC group, the ADC values of the CSM group increased, while the FA values decreased, which was consistent with the previous studies [ 39 – 43 ]. We thought the chronic compression of the cervical spinal might lead to chronic ischemia hypoxia.…”

The Evaluation and Prediction of Laminoplasty Surgery Outcome in Patients with Degenerative Cervical Myelopathy Using Diffusion Tensor MRI

“…We found that DTI metrics were significantly different between patients before surgery and healthy subjects, findings consistent with those in previous studies. 4,7,10,15 Before surgery, DTI metrics including AD, RD, and FA for the C2 level were significantly correlated with the preoperative mJOA, while DTI metrics for the MC or the average of AC levels were not. AD, RD, and FA for C2 before the operation were significantly correlated with the postoperative mJOA recovery rate.…”

“…3,4 The ADC is higher and FA values are lower in patients with DCM than in healthy individuals, 5,6 and there are significant differences between preoperation and postoperation. 7,8 In addition, it has been shown that FA is significantly correlated with clinical assessment of the modified Japanese Orthopedic Association scale (mJOA), [9][10][11][12][13] the most frequently used clinical assessment for patients with DCM.…”

Diagnostic Value of T1 Slope in Degenerative Cervical Spondylotic Myelopathy

“…The incidence of cervical spine degenerative disease has been rising owing to the increasing aging population. Diagnosing DCSM has traditionally relied on presence of clinical symptoms, including clumsy hands, paralysis of the lower extremities, gait disturbances, urinary/bowel incontinence and severe neurological dysfunction disturbances, urinary/bowel incontinence, and severe neurological dysfunction [ 1 , 2 ]. Magnetic resonance imaging (MRI) is the most widely used method for the diagnosis of DCSM, as it can reveal morphological changes and degree of compression of the cervical spinal cord, as well as provide pathological information through T2-weighted (T2W) imaging.…”