Predictive value of flexion and extension diffusion tensor imaging in the early stage of cervical myelopathy

Abstract

Dynamic DTI of the cervical spine is feasible and can detect subtle spinal cord damage of functional relevance in cervical myelopathy. A marked increase of RD and decrease of FA and TRACEW values in extension were found to be indicative for an early structural cord injury in myelopathy.

A Diagnostic Biomarker for Cervical Myelopathy Based on Dynamic Magnetic Resonance Imaging

“…Statistically significant increases in ADC values were found for both groups at neck extension, independent of the presence of an IHIS sign. Our finding suggests that ADC at extension may serve as a biomarker for the early onset of myelopathy as ADC values are high in early myelopathy and lower in later stages 11 …”

“…Our finding suggests that ADC at extension may serve as a biomarker for the early onset of myelopathy as ADC values are high in early myelopathy and lower in later stages. 11 In a healthy population, no significant spinal cord narrowing is produced in neck extension and no alterations in ADC values have been reported. 6 However, when the white matter tracts are disrupted or the permeability of axonal membranes is increased, the ADC will increase.…”

“…Even though our sample size was relatively small, our results are aligned with prior work. 3,4,6,11 Increased ADC values are associated with clinical findings of neurological impairment 14,15 , and potentially worse postoperative outcomes. Our findings may have clinical value in diagnosing early changes of cervical myelopathy: ADC in extension could also serve as a marker in patients who might benefit from early surgical decompression.…”

“…Increases in ADC may indicate potentially reversible spinal cord injury, 11 which is of clinical importance to prevent deterioration and permanent damage at an early time point. Our findings are consistent with previous work indicating that ADC is of diagnostic value in the early assessment of traumatic spinal cord injury and may serve as a potential indicator of such events 12,13 …”

CORR Insights®: Lower Urinary Tract Symptoms and Urinary Bother Are Common in Patients Undergoing Elective Cervical Spine Surgery

“…More detailed clinical studies examining patients with advanced imaging are necessary. Diffusion tensor imaging is a new modality that has shown promise in the evaluation of myelopathy [1,4] and may be useful to help define specific imaging findings associated with bladder dysfunction. In addition, comparing bladder function after in a prospective study would help strengthen the relationship between spinal cord compression and urinary bother.…”