Quantitative Evaluation of the Diffusion Tensor Imaging Matrix Parameters and the Subsequent Correlation with the Clinical Assessment of Disease Severity in Cervical Spondylotic Myelopathy

Abstract

Study Design: We performed a prospective observational study of 52 patients who were clinically suspected of cervical spondylotic myelopathy (CSM), based on the modified Japanese Orthopaedic Association (mJOA) score, and were referred for magnetic resonance imaging (MRI) of the cervical spine.Purpose: To evaluate the quantitative parameters of the diffusion tensor imaging (DTI) matrix (fractional anisotropy [FA] and apparent diffusion coefficient [ADC] values) and determine the subsequent correlation with the clinical assessment of disease severity in CSM.Overview of Literature: Conventional MRI is the modality of choice for the identification of cervical spondylotic changes and is known to have a low sensitivity for myelopathy changes. DTI is sensitive to disease processes that alter the water movement in the cervical spinal cord at a microscopic level beyond the conventional MRI.Methods: DTI images were processed to produce FA and ADC values of the acquired axial slices with the regions of interest placed within the stenotic and non-stenotic segments. The final quantitative radiological derivations were matched with the clinical scoring system.Results: Total 52 people (24 men and 28 women), mean age 53.16 years with different symptoms of myelopathy, graded as mild (n=11), moderate (n=25), and severe (n=16) as per the mJOA scoring system, underwent MRI of the cervical spine with DTI. In the most stenotic segments, the mean FA value was significantly lower (0.5009±0.087 vs. 0.655.7±0.104, p<0.001), and the mean ADC value was significantly higher (1.196.5±0.311 vs. 0.9370±0.284, p<0.001) than that in the non-stenotic segments. The overall sensitivity in identifying DTI metrics abnormalities was more with FA (87.5%) and ADC (75.0%) than with T2 weighted images (25%).Conclusions: In addition to the routine MRI sequences, DTI metrics (FA value better than ADC) can detect myelopathy even in patients with a mild grade mJOA score before irreversible changes become apparent on routine T2 weighted imaging and thus enhance the clinical success of decompression surgery.

Assessment of the correlation between clinical and radiological outcomes in patients suffering from mild to moderate cervical spine dysfunction symptoms: a prospective study

“…Our study also demonstrated this relationship. In addition, the present study found that the most common level to have radiological CDD was the C5–6 level, which was similar to the results of other studies [ 1 , 34 ]. Thirdly, in our study we found that the percentages of Modic changes and HIZ in all cervical spine were 0.30%, 3.9%, respectively.…”

“…The grading of Pfirrmann I 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 ( 0 the results of other studies [1,34]. Thirdly, in our study we found that the percentages of Modic changes and HIZ in all cervical spine were 0.30%, 3.9%, respectively.…”

“…JOA [20] offered a more sophisticated system to evaluate cervical dysfunction, which included motor function, sensory function and bladder function; it was sufficiently reliable, with a weighted kappa coefficient of more than 0.4 [40]. In another study, Nischal et al [34] also showed that there was a strong correlation between the mJOA scores and diffusion tensor imaging matrix parameters. More studies on the current topic are needed to confirm the results.…”

Clinical Efficacy and Safety of Anterior Cervical Decompression versus Segmental Fusion and Posterior Expansive Canal Plasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy

“…The decompression effect depends on the available buffer space of the posterior approach, and even if the posterior approach has sufficient buffer capacity, if the anterior compressor is too large, the spinal cord will still be compressed [ 35 ]. Moreover, if the spinal cord drifts back too much, it will have a certain degree of pulling effect on the nerve root, resulting in some nerve root symptoms such as numbness and pain in the upper arm [ 36 ]. To sum up, segmented anterior fusion surgery can effectively improve the symptoms of patients with multisegmented cervical spondylosis, can restore and maintain the cervical anterior column height to a certain extent, and can have a good effect on postoperative functional recovery.…”

Clinical and Research MRI Techniques for Assessing Spinal Cord Integrity in Degenerative Cervical Myelopathy—A Scoping Review

“…Specifically Dong et al found that DCM patients presenting with a higher FA score at the level of compression were the most likely group to achieve a better functional recovery after surgical decompression [ 199 ]. The conducted literature search indicated consistent findings of the correlation of FA and spinal cord integrity in DCM as well its significant role in prognosis [ 60 , 104 , 107 , 108 , 118 , 124 , 127 , 128 , 131 , 132 , 134 , 135 , 137 , 138 , 139 , 141 , 142 , 143 , 144 , 145 , 146 , 149 , 152 , 153 , 154 , 155 , 157 , 158 , 161 , 162 , 165 , 166 , 167 , 168 , 175 , 176 , 177 , 178 , 179 , 181 , 182 , 183 , 184 , 185 ]. Interestingly, Wang et al conducted a prospective longitudinal study of 93 ...…”