Diffusion tensor imaging predicts functional impairment in mild-to-moderate cervical spondylotic myelopathy |
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| Authors: | Benjamin M Ellingson Noriko Salamon John W Grinstead Langston T Holly |
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| Institution: | 1. Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA 90024, USA;2. Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA 90024, USA;3. Department of Bioengineering, School of Engineering, University of California Los Angeles, 420 Westwood Plaza, 5121 Engineering V, Los Angeles, CA 90095, USA;4. Siemens Healthcare, 5030 NE 115th Ave, Portland OR 97208, USA;5. Department of Neurosurgery and Orthopaedics, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA 90024, USA;1. Department of Spinal Surgery, General Hospital of Chinese People''s Armed Police Forces, Beijing 100039, PR China;2. College of Medicine, University of Florida, Gainesville, FL 32610, USA;1. School of Electrical, Computer and Telecommunications Engineering, University of Wollongong, Australia;2. School of Psychology, University of Wollongong, Australia;3. College of Science and Engineering, Hamad Bin Khalifa University, Qatar;4. School of Psychology, University of Queensland, Australia;5. Queensland Brain Institute, University of Queensland, Australia;1. Department of Neurological Surgery, UCSF, San Francisco, California, USA;2. Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, New York, USA;3. Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York, USA;4. Department of Neurological Surgery, University of Virginia, Charlottesville, New York, USA;5. Department of Neurological Surgery, The University of Kansas Hospital, Kansas City, Kansas, USA;6. Swedish Medical Center, Department of Orthopaedic Surgery, Seattle, Washington, USA;8. Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA;7. Department of Neurological Surgery, University of Toronto, Toronto, Ontario, Canada |
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| Abstract: | Background contextMagnetic resonance imaging (MRI) is the standard imaging modality for the assessment of cervical spinal cord; however, MRI assessment of the spinal cord in cervical spondylotic myelopathy patients has not demonstrated a consistent association with neurologic function or outcome after surgical or medical intervention. Thus, there is a need for sensitive imaging biomarkers that can predict functional impairment in patients with advanced cervical spondylosis.PurposeTo implement diffusion tensor imaging (DTI) as an imaging biomarker for microstructural integrity and functional impairment in patients with cervical spondylosis.Study designNonrandomized, single institution study.Patient sampleForty-eight cervical spondylosis patients with or without spinal cord signal change underwent DTI of the spinal cord along with functional assessment.Outcome measuresFunctional measures of neurologic function via modified Japanese Orthopedic Association (mJOA) score.MethodsA zoomed-echoplanar imaging technique and two-dimensional spatially selective radiofrequency excitation pulse were used for DTI measurement. Fractional anisotropy (FA), mean diffusivity (MD), radial and axial diffusion (AD) coefficient, AD anisotropy, ψ, defined as AD-MD, and the standard deviation (SD) of primary eigenvector orientation were evaluated at the site of compression.ResultsResults suggest average FA, transverse apparent diffusion coefficient, ψ, and SD of primary eigenvector orientation at the spinal level of highest compression were linearly correlated with mJOA score. Receiver-operator characteristic analysis suggested FA and ψ could identify stenosis patients with mild-to-moderate symptoms with a relatively high sensitivity and specificity.ConclusionsThe results of this study support the potential use of DTI as a biomarker for predicting functional impairment in patients with cervical spondylosis. |
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| Keywords: | Diffusion tensor imaging DTI Spinal cord Cervical spondylotic myelopathy Biomarker CSM Stenosis mJOA |
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