MR Classification System Based on Axial Images for Cervical Compressive Myelopathy

You, Ja Yeon; Lee, Joon Woo; Lee, Eugene; Lee, Guen Young; Yeom, Jin Sup; Kang, Heung Sik

doi:10.1148/radiol.2015142384

Cited by 37 publications

(36 citation statements)

References 25 publications

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“…6 Most studies that described the significance of T2WI signal changes focused on sagittal imaging, but a classification system based on axial image characteristics was also described recently. 132 The authors defined the following 4 types of changes: Type 0, normal pattern; Type 1, diffuse pattern; Type 2, fuzzy focal pattern; and Type 3, discrete focal pattern. 132 However, this classification remains to be validated.…”

Section: Myelopathy-intramedullary Cord Signal Change Characteristicsmentioning

confidence: 99%

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

Nouri

Martín

Mikulis

et al. 2016

FOC

159

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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Section: Myelopathy-intramedullary Cord Signal Change Characteristicsmentioning

confidence: 99%

“…132 The authors defined the following 4 types of changes: Type 0, normal pattern; Type 1, diffuse pattern; Type 2, fuzzy focal pattern; and Type 3, discrete focal pattern. 132 However, this classification remains to be validated.…”

Section: Myelopathy-intramedullary Cord Signal Change Characteristicsmentioning

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

159

124

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“…The %GM T2 signal hyperintensity on a single axial section at the most affected level of the injury center (referred to as "lesion center") provided the strongest correlation with clinical measures of motor impairment and recovery. The value of assessing the transverse extent of T2 abnormality on a single axial section at the injury center has been similarly demonstrated in the setting of acute traumatic SC injury and compressive myelopathy, 18,27 suggesting that the transverse extent of injury in the SC on MR imaging carries significant diagnostic and prognostic information in a variety of pathologies. This result is significant because it allows for a more focused, rapid evaluation of the MR imaging findings centered at the injury center.…”

Section: Discussionmentioning

confidence: 98%

MRI Atlas-Based Measurement of Spinal Cord Injury Predicts Outcome in Acute Flaccid Myelitis

McCoy

Talbott

Wilson

et al. 2016

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Recent advances in spinal cord imaging analysis have led to the development of a robust anatomic template and atlas incorporated into an open-source platform referred to as the Spinal Cord Toolbox. Using the Spinal Cord Toolbox, we sought to correlate measures of GM, WM, and cross-sectional area pathology on T2 MR imaging with motor disability in patients with acute flaccid myelitis.

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“…The linear parameters including transverse diameter (TD), central sagittal diameter (CSD) and sagittal diameter (SD) were measured, and the Central_Ratio, Compression_Ratio and 1/4-Lateral_Compression_Ratio were calculated. ( Figure. 2) The Ax-CCM classi cation system is de ned as follows [8]: type 0 = normal signal intensity of spinal cord without any intramedullary T2 hyperintensity, type 1 = diffuse pattern of intramedullary T2 hyperintensity occupying more than two-thirds of axial dimension of spinal cord with an obscure and faint border, type 2 = focal intermedullary T2 hyperintensity with an obscure and faint border, type 3 = focal intramedullary T2 hyperintensity with a well-de ned and distinct margin.…”

Section: Imaging Methods and Analysis Protocolmentioning

confidence: 99%

“…[7] The size and pattern of intramedullary spinal cord signal intensity changes are also related to the severity of impairment in patients with CSM. [8] Dynamic X-ray is frequently used to evaluate cervical segmental instability among CSM patients and its results also correlate with the preoperative symptoms and surgical outcomes. [9,10] However, correlating imaging ndings with the clinical picture is complicated by the increasingly wide-range of measurements on radiographs including MRI and dynamic X-ray.…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging and Dynamic X-ray's correlations with Dynamic Electrophysiological Findings in Cervical Spondylotic Myelopathy: a retrospective cohort study.

Lin

Chen

et al. 2020

Preprint

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Background Dynamic somatosensory evoked potentials (DSSEP) can be used to disclose abnormalities of ascending sensory pathways at dynamic positions and diagnose cervical spondylotic myelopathy (CSM). However, radiographic tests including magnetic resonance imaging (MRI) and dynamic X-ray are used much more widely in the management of CSM. Our study aims to clarify the correlations between several radiographic parameters and the DSSEP results, and further determine their reliability with clinical data. Methods We retrospectively enrolled 38 CSM patients with surgical intervention. DSSEP tests were performed before surgery. Amplitude ratios of DSSEP N13 and N20 waves at extension and flexion were calculated and recorded as N13_E, N20_E, N13_F, N20_F respectively. Baseline severity was evaluated with the modified Japanese Orthopedic Association (mJOA) score and the Nurick grades. Prognosis was evaluated based on the 2-year recovery rate. Sagittal diameter and transverse areas of the cord and canal were measured and the Spinal cord/Canal Area Ratio were calculated. The compressive ratios at the compressed site (Compression_Ratio), central (Central_Ratio) and 1/4-lateral points (1/4-Lateral_Compression_Ratio), and intramedullary T2 hyperintensity patterns (Ax-CCM types) were also collected from MRI axial images. Dynamic X-rays were used to test for segmental instability of the cervical spine. The correlations between radiologic findings, DSSEP data, and clinical assessments were investigated. Results We found that DSSEP N13_E and N13_F correlated with the Compression_Ratio, Central_Ratio, 1/4-Lateral_Compression_Ratio (Pearson, p < 0.05) and Ax-CCM types (ANOVA, p < 0.05) in MRI axial images and cervical segmental instability in dynamic X-ray (t-test, p < 0.05). Apart from the 1/4-Lateral_Compression_Ratio, these radiographic parameters above also correlated with the baseline clinical assessments (Spearman or ANOVA or t-test, p < 0.05) and postoperative recovery rate (Pearson or ANOVA or t-test, p < 0.05). Conclusions We found that the preoperative Compression_Ratio, Central_Ratio and 1/4-Lateral_Compression_Ratio in MRI and cervical segmental instability in dynamic X-ray could reflect the dynamic neural dysfunction of the spinal cord. Different Ax-CCM types corresponded to different DSSEP results at extension and flexion, suggesting divergent pathophysiology. These radiographic parameters could help evaluate disease severity and predict postoperative prognosis. Trial registration: The trial was retrospectively registered on April 30th, 2020 and the registration number is "[2020]151".

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MR Classification System Based on Axial Images for Cervical Compressive Myelopathy

Abstract: The Ax-CCM system showed good interobserver agreement, and the type 2 pattern was correlated with poor preoperative neurologic status and less postoperative improvement.

Cited by 37 publications

References 25 publications

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

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

MRI Atlas-Based Measurement of Spinal Cord Injury Predicts Outcome in Acute Flaccid Myelitis

Magnetic Resonance Imaging and Dynamic X-ray's correlations with Dynamic Electrophysiological Findings in Cervical Spondylotic Myelopathy: a retrospective cohort study.

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