Perfusion-Weighted Magnetic Resonance Imaging of the Spinal Cord in Cervical Spondylotic Myelopathy

Uemura, Kazuya; Matsumura, Akira; Isobe, Takeshi; Anno, Izumi; Kawamura, Hisao; Minami, Manabu; Tsukada, Atsuro

doi:10.2176/nmc.46.581

Cited by 11 publications

(11 citation statements)

References 34 publications

(40 reference statements)

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“…Instead, two studies have investigated spinal cord perfusion in DCM using dynamic susceptibility contrast (DSC) imaging with IV gadolinium, demonstrating that the degree of ischemia and hypoxia correlated with neurological status (mJOA), 109 and that post-operative improvement in perfusion corresponds with neurological recovery. 110 …”

Section: Quantitative Imaging Techniquesmentioning

confidence: 99%

Imaging and Electrophysiology for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 9]

Martín

Tetreault

Nouri

et al. 2021

Global Spine Journal

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Study Design Narrative review. Objective The current review aimed to describe the role of existing techniques and emerging methods of imaging and electrophysiology for the management of degenerative cervical myelopathy (DCM), a common and often progressive condition that causes spinal cord dysfunction and significant morbidity globally. Methods A narrative review was conducted to summarize the existing literature and highlight future directions. Results Anatomical magnetic resonance imaging (MRI) is well established in the literature as the key imaging tool to identify spinal cord compression, disc herniation/bulging, and inbuckling of the ligamentum flavum, thus facilitating surgical planning, while radiographs and computed tomography (CT) provide complimentary information. Electrophysiology techniques are primarily used to rule out competing diagnoses. However, signal change and measures of cord compression on conventional MRI have limited utility to characterize the degree of tissue injury, which may be helpful for diagnosis, prognostication, and repeated assessments to identify deterioration. Early translational studies of quantitative imaging and electrophysiology techniques show potential of these methods to more accurately reflect changes in spinal cord microstructure and function. Conclusion Currently, clinical management of DCM relies heavily on anatomical MRI, with additional contributions from radiographs, CT, and electrophysiology. Novel quantitative assessments of microstructure, perfusion, and function have the potential to transform clinical practice, but require robust validation, automation, and standardization prior to uptake.

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Section: Quantitative Imaging Techniquesmentioning

confidence: 99%

Imaging and Electrophysiology for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 9]

Martín

Tetreault

Nouri

et al. 2021

Global Spine Journal

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“…A recent 3T study, in 22 DSCC patients with or without myelopathy, identified a significant relationship (p < 0.05) of DSC markers with the anteroposterior diameter and mJOA scale and suggested that the degree of ischemia and hypoxia correlates with compression severity and clinical status, respectively [103]. Another 1.5T DSC study, in 14 DCM patients, then showed improvement in the spinal perfusion after surgical decompression [104] and pseudo-continuous arterial spin labeling, which, unlike DSC and DCE, does not require an intravenous contrast agent, revealed secondary alteration of cerebral blood flow perfusion in DCM patients [105].…”

Section: Perfusion Weighted Imagingmentioning

confidence: 97%

“…Chronic DSCC reduces blood flow in spinal arteries and results in chronic SC ischemia in histological and animal models [1,71], which is a vital factor in DCM pathogenesis. While perfusion imaging methods, including dynamic susceptibility contrast (DSC), dynamic contrast-enhanced (DCE), and arterial spin labeling perfusion imaging, are commonly used in brain studies, there have been sparse applications in the SC [103][104][105]. A recent 3T study, in 22 DSCC patients with or without myelopathy, identified a significant relationship (p < 0.05) of DSC markers with the anteroposterior diameter and mJOA scale and suggested that the degree of ischemia and hypoxia correlates with compression severity and clinical status, respectively [103].…”

Section: Perfusion Weighted Imagingmentioning

confidence: 99%

Quantitative MR Markers in Non-Myelopathic Spinal Cord Compression: A Narrative Review

Valošek

Bednařík

Keřkovský

et al. 2022

JCM

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Degenerative spinal cord compression is a frequent pathological condition with increasing prevalence throughout aging. Initial non-myelopathic cervical spinal cord compression (NMDC) might progress over time into potentially irreversible degenerative cervical myelopathy (DCM). While quantitative MRI (qMRI) techniques demonstrated the ability to depict intrinsic tissue properties, longitudinal in-vivo biomarkers to identify NMDC patients who will eventually develop DCM are still missing. Thus, we aim to review the ability of qMRI techniques (such as diffusion MRI, diffusion tensor imaging (DTI), magnetization transfer (MT) imaging, and magnetic resonance spectroscopy (1H-MRS)) to serve as prognostic markers in NMDC. While DTI in NMDC patients consistently detected lower fractional anisotropy and higher mean diffusivity at compressed levels, caused by demyelination and axonal injury, MT and 1H-MRS, along with advanced and tract-specific diffusion MRI, recently revealed microstructural alterations, also rostrally pointing to Wallerian degeneration. Recent studies also disclosed a significant relationship between microstructural damage and functional deficits, as assessed by qMRI and electrophysiology, respectively. Thus, tract-specific qMRI, in combination with electrophysiology, critically extends our understanding of the underlying pathophysiology of degenerative spinal cord compression and may provide predictive markers of DCM development for accurate patient management. However, the prognostic value must be validated in longitudinal studies.

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“…A recent 3T study in 22 patients with cervical spondylosis with or without myelopathy identified a relationship between DSC markers and anteroposterior diameter and mJOA scale and suggested that the degree of ischemia and hypoxia correlates with compression severity and clinical status, respectively [124]. Another 1.5T DSC study in 14 DCM patients then showed improvement in the SC perfusion after surgical decompression [125] and pseudo-continuous arterial spin labelling, which, unlike DSC and DCE, does not require intravenous contrast agent, revealed secondary alteration of cerebral blood flow perfusion of DCM patients caused by SC compression [126]. Automatic compression ratio and cross-sectional area estimation outperforms manual raters 66 HC AUC, area under the curve; FA, fractional anisotropy; MD, mean diffusivity; AD, axial diffusivity; RD, radial diffusivity; f1, primary partial volume fraction (anisotropic compartment of Ball-and-Sticks model); d, Ball-and-Sticks model diffusivity; MTR, magnetic transfer ratio; 1 H-MRS, single-voxel magnetic resonance spectroscopy; WM, white matter; GM, gray matter; mJOA, modified Japanese Orthopaedic Association scale; tNAA, total N-acetylaspartate.…”

Section: Perfusion Weighted Imagingmentioning

confidence: 98%

Quantitative MR Markers in Non-Myelopathic Spinal Cord Compression: A Narrative Review

Valošek¹,

Bednařík²,

Keřkovský³

et al. 2022

Preprint

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Degenerative spinal cord (SC) compression is a frequent pathological condition with increasing prevalence throughout aging. Initial non-myelopathic cervical SC compression (NMDC) might progress over time into potentially irreversible degenerative cervical myelopathy (DCM). While quantitative MRI (qMRI) techniques demonstrated the ability to depict intrinsic tissue properties, longitudinal in-vivo biomarkers to identify NMDC patients who will eventually develop DCM are still missing. Thus, we aim to review the ability of qMRI techniques (such as diffusion MRI, diffusion tensor imaging (DTI), magnetization transfer (MT) imaging, magnetic resonance spec-troscopy (1H-MRS)) to serve as prognostic markers in NMDC. While DTI in NMDC patients con-sistently detected lower fractional anisotropy and higher mean diffusivity at compressed levels caused by demyelination and axonal injury, MT and 1H-MRS along with advanced and tract-specific diffusion MRI recently revealed microstructural alterations also rostrally pointing to Wallerian degeneration. Recent studies also disclosed significant relationship between micro-structural damage and functional deficits, assessed by qMRI and electrophysiology, respectively. Thus, tract-specific qMRI in combination with electrophysiology critically extend our under-standing of the underlying pathophysiology of degenerative SC compression and may provide predictive markers of DCM development for accurate patient management. However, the prog-nostic value must be validated in longitudinal studies.

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Perfusion-Weighted Magnetic Resonance Imaging of the Spinal Cord in Cervical Spondylotic Myelopathy

Cited by 11 publications

References 34 publications

Imaging and Electrophysiology for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 9]

Imaging and Electrophysiology for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 9]

Quantitative MR Markers in Non-Myelopathic Spinal Cord Compression: A Narrative Review

Quantitative MR Markers in Non-Myelopathic Spinal Cord Compression: A Narrative Review

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