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Zhang JK, Javeed S, Greenberg JK, Yakdan S, Kaleem MI, Botterbush KS, Benedict B, Dibble CF, Sun P, Sherrod B, Dailey AT, Bisson EF, Mahan M, Mazur M, Song SK, Ray WZ. Diffusion MRI Metrics Characterize Postoperative Clinical Outcomes After Surgery for Cervical Spondylotic Myelopathy. Neurosurgery 2024:00006123-990000000-01226. [PMID: 38904404 DOI: 10.1227/neu.0000000000003037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 04/16/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Advanced diffusion-weighted MRI (DWI) modeling, such as diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI), may help guide rehabilitation strategies after surgical decompression for cervical spondylotic myelopathy (CSM). Currently, however, postoperative DWI is difficult to interpret, owing to signal distortions from spinal instrumentation. Therefore, we examined the relationship between postoperative DTI/DBSI-extracted from the rostral C3 spinal level-and clinical outcome measures at 2-year follow-up after decompressive surgery for CSM. METHODS Fifty patients with CSM underwent complete clinical and DWI evaluation-followed by DTI/DBSI analysis-at baseline and 2-year follow-up. Clinical outcomes included the modified Japanese Orthopedic Association score and comprehensive patient-reported outcomes. DTI metrics included apparent diffusion coefficient, fractional anisotropy, axial diffusivity, and radial diffusivity. DBSI metrics evaluated white matter tracts through fractional anisotropy, fiber fraction, axial diffusivity, and radial diffusivity as well as extra-axonal pathology through restricted and nonrestricted fraction. Cross-sectional Spearman's correlations were used to compare postoperative DTI/DBSI metrics with clinical outcomes. RESULTS Twenty-seven patients with CSM, including 15, 7, and 5 with mild, moderate, and severe disease, respectively, possessed complete baseline and postoperative DWI scans. At 2-year follow-up, there were 10 significant correlations among postoperative DBSI metrics and postoperative clinical outcomes compared with 3 among postoperative DTI metrics. Of the 13 significant correlations, 7 involved the neck disability index (NDI). The strongest relationships were between DBSI axial diffusivity and NDI (r = 0.60, P < .001), DBSI fiber fraction and NDI (rs = -0.58, P < .001), and DBSI restricted fraction and NDI (rs = 0.56, P < .001). The weakest correlation was between DTI apparent diffusion coefficient and NDI (r = 0.35, P = .02). CONCLUSION Quantitative measures of spinal cord microstructure after surgery correlate with postoperative neurofunctional status, quality of life, and pain/disability at 2 years after decompressive surgery for CSM. In particular, DBSI metrics may serve as meaningful biomarkers for postoperative disease severity for patients with CSM.
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Affiliation(s)
- Justin K Zhang
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Saad Javeed
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Jacob K Greenberg
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Salim Yakdan
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Muhammad I Kaleem
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Kathleen S Botterbush
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Braeden Benedict
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Christopher F Dibble
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Peng Sun
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Brandon Sherrod
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Andrew T Dailey
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Erica F Bisson
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Mark Mahan
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Marcus Mazur
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Sheng-Kwei Song
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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Mohammadi M, Roohollahi F, Farahbakhsh F, Mohammadi A, Mortazavi Mamaghani E, Kankam SB, Moarrefdezfouli A, Ghamari Khameneh A, Mahmoudi MM, Baghdasaryan D, Martin AR, Harrop J, Rahimi-Movaghar V. Diffusion Tensor Imaging in Diagnosing and Evaluating Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis. Global Spine J 2024:21925682241263792. [PMID: 38877604 DOI: 10.1177/21925682241263792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Degenerative cervical myelopathy (DCM) is a common spinal cord disorder necessitating surgery. We aim to explore how effectively diffusion tensor imaging (DTI) can distinguish DCM from healthy individuals and assess the relationship between DTI metrics and symptom severity. METHODS We included studies with adult DCM patients who had not undergone decompressive surgery and implemented correlation analyses between DTI parameters and severity, or compared healthy controls and DCM patients. RESULTS 57 studies were included in our meta-analysis. At the maximal compression (MC) level, fractional anisotropy (FA) exhibited lower values in DCM patients, while apparent diffusion coefficient (ADC), mean diffusivity (MD), and radial diffusivity (RD) were notably higher in the DCM group. Moreover, our investigation into the diagnostic utility of DTI parameters disclosed high sensitivity, specificity, and area under the curve values for FA (.84, .80, .83 respectively) and ADC (.74, .84, .88 respectively). Additionally, we explored the correlation between DTI parameters and myelopathy severity, revealing a significant correlation of FA (.53, 95% CI:0.40 to .65) at MC level with JOA/mJOA scores. CONCLUSION Current guidelines for DCM suggest decompressive surgery for both mild and severe cases. However, they lack clear recommendations on which mild DCM patients might benefit from conservative treatment vs immediate surgery. ADC's role here could be pivotal, potentially differentiating between healthy individuals and DCM. While it may not correlate with symptom severity, it might predict surgical outcomes, making it a valuable imaging biomarker for clearer management decisions in mild DCM.
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Affiliation(s)
| | - Faramarz Roohollahi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Yas Spine Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Farahbakhsh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aynaz Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Samuel Berchi Kankam
- Image guided Neurosurgery Lab, Department of Neurosurgery, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA
- Brain Trauma Lab, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Azin Moarrefdezfouli
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshar Ghamari Khameneh
- Department of Radiology, Advanced Diagnostic and Interventional Radiology (ADIR) Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Mahdi Mahmoudi
- Department of General Surgery, Shahid Mofateh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Allan R Martin
- Department of Neurosurgery, University of California Davis, Davis, CA, USA
| | - James Harrop
- Department of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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Shao H, Liu Q, Saeed A, Liu C, Liu WV, Zhang Q, Huang S, Zhang G, Li L, Zhang J, Zhu W, Tang X. Feasibility of diffusion tensor imaging in cervical spondylotic myelopathy using MUSE sequence. Spine J 2024:S1529-9430(24)00156-6. [PMID: 38556218 DOI: 10.1016/j.spinee.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/03/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND CONTEXT The most frequent type of spinal cord injury is cervical spondylotic myelopathy (CSM). Conventional structural magnetic resonance imaging (MRI) is the gold diagnosis standard for CSM. Diffusion tensor imaging (DTI) could reflect microstructural changes in the spinal cord by tracing water molecular diffusion in early stages of CSM. However, due to the complex local anatomical structure and small field of view of the spinal cord, the imaging effect of traditional DTI imaging on the spinal cord is limited. MUSE (MUltiplexed Sensitivity-Encoding) -DTI is a novel diffusion-weighted imaging (DWI) sequence that achieves higher signal intensity through multiple excitation acquisition. MUSE sequence may improve the quality of spinal cord DTI imaging. STUDY DESIGN Prospective study. PURPOSE This study aimed to investigate the clinical diagnosis value of a novel protocol of MUSE-DTI in patients with cervical spondylotic myelopathy (CSM). PATIENT SAMPLE From August 2021 to March 2022, a total of 60 subjects (22-71 years) were enrolled, including 51 CSM patients (22 males, 29 females) and 9 healthy subjects (4 males and 5 females). Each subject underwent a MUSE-DTI examination and a clinical Japanese Orthopedic Association (JOA) scale. OUTCOME MEASURES We measured values of FA (Fractional Anisotropy), MD (Mean Diffusivity), AD (Axial Diffusivity), and RD (Radial Diffusivity), and collected the clinical JOA scores of each subject before the MR examination. METHODS A 3.0T MR scanner (Signa Architect, GE Healthcare) performed the MUSE-DTI sequence on each subject. The cervical canal stenosis of subjects was classified from grade 0 to grade Ⅲ according to the method of an MRI grading system. FA, MD, AD, and RD maps were generated by postprocessing MUSE-DTI data on the GE workstation. Regions of interest (ROIs) were manually drawn at the C2 vertebral body level and C2/3-C6/7 intervertebral disc levels by covering the whole spinal cord. The clinical severity of myelopathy of subjects was assessed by the clinical Japanese Orthopedic Association scale (JOA). RESULTS MUSE-DTI can acquire a high-resolution diffusion image compared to traditional DTI. The FAMCL values showed a decreasing trend from grade 0 to grade Ⅲ, while the MDMCL, ADMCL, and RDMCL values showed an overall increasing trend. Significant differences in MDMCL, ADMCL, and RDMCL values were found between adjacent groups among grades Ⅰ-Ⅲ (p<.05). The ADC2 values in CSM patients (grade I-Ⅲ) were significantly lower than in healthy individuals (grade 0) (p=.019). The clinical JOA score has a significant correlation with FAMCL (p=.035), MDMCL (p<.001), ADMCL (p<.001), and RDMCL (p<.001) values. CONCLUSIONS MUSE-DTI displayed a better image quality compared to traditional DTI. MUSE-DTI parameters displayed a grade-dependent trend. All the MUSE-DTI parameters at MCL were correlated with the clinical JOA scores. The ADC2 values can reflect the secondary damage of distal spinal cord. Therefore, MUSE-DTI could be a reliable biomarker for clinical auxiliary diagnosis of spinal cord injury severity in cervical spondylotic myelopathy.
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Affiliation(s)
- Haoyue Shao
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiufeng Liu
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Azzam Saeed
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaoxu Liu
- Department of Orthopedics, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Qiya Zhang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuting Huang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guiling Zhang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Li
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaxuan Zhang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangyu Tang
- Department of Radiology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Ni M, Wen X, Zhang M, Jiang C, Li Y, Wang B, Zhang X, Zhao Q, Lang N, Jiang L, Yuan H. Predictive Value of the Diffusion Magnetic Resonance Imaging Technique for the Postoperative Outcome of Cervical Spondylotic Myelopathy. J Magn Reson Imaging 2024; 59:599-610. [PMID: 37203312 DOI: 10.1002/jmri.28789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Diffusion magnetic resonsance imaging (dMRI) can potentially predict the postoperative outcome of cervical spondylotic myelopathy (CSM). PURPOSE To explore preoperative dMRI parameters to predict the postoperative outcome of CSM through multifactor correlation analysis. STUDY TYPE Prospective. POPULATION Post-surgery CSM patients; 102 total, 73 male (52.42 ± 10.60 years old) and 29 female (52.0 ± 11.45 years old). FIELD STRENGTH/SEQUENCE 3.0 T/Turbo spin echo T1/T2-weighted, T2*-weighted multiecho gradient echo and dMRI. ASSESSMENT Spinal cord function was evaluated using modified Japanese Orthopedic Association (mJOA) scoring at different time points: preoperative and 3, 6, and 12 months postoperative. Single-factor correlation and t test analyses were conducted based on fractional anisotropy (FA), mean diffusivity, intracellular volume fraction, isotropic volume fraction, orientation division index, increased signal intensity, compression ratio, age, sex, symptom duration and operation method, and multicollinearity was calculated. The linear quantile mixed model (LQMM) and the linear mixed-effects regression model (LMER) were used for multifactor correlation analysis using the combinations of the above variables. STATISTICAL TESTS Distance correlation, Pearson's correlation, multiscale graph correlation and t tests were used for the single-factor correlation analyses. The variance inflation factor (VIF) was used to calculate multicollinearity. LQMM and LMER were used for multifactor correlation analyses. P < 0.05 was considered statistically significant. RESULTS The single-factor correlation between all variables and the postoperative mJOA score was weak (all r < 0.3). The linear relationship was stronger than the nonlinear relationship, and there was no significant multicollinearity (VIF = 1.10-1.94). FA values in the LQMM and LMER models had a significant positive correlation with the mJOA score (r = 5.27-6.04), which was stronger than the other variables. DATA CONCLUSION The FA value based on dMRI significantly positively correlated with CSM patient postoperative outcomes, helping to predict the surgical outcome and formulate a treatment plan before surgery. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ming Ni
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Xiaoyi Wen
- Institute of Statistics and Big Data, Renmin University of China, Beijing, China
| | - Mengze Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Chenyu Jiang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yali Li
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ben Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | | | - Qiang Zhao
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
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Mohammadi M, Roohollahi F, Mahmoudi MM, Mohammadi A, Mohamadi M, Kankam SB, Ghamari Khameneh A, Baghdasaryan D, Farahbakhsh F, Martin AR, Harrop J, Rahimi-Movaghar V. Correlation Between Pre-Operative Diffusion Tensor Imaging Indices and Post-Operative Outcome in Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis. Global Spine J 2024:21925682231225634. [PMID: 38168663 DOI: 10.1177/21925682231225634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The correlation between pre-operative diffusion tensor imaging (DTI) metrics and post-operative clinical outcomes in patients with degenerative cervical myelopathy (DCM) has been widely investigated with different studies reporting varied findings. We conducted a systematic review to determine the association between DTI metric and clinical outcomes after surgery. METHODS We identified relevant articles that investigated the relationship between pre-operative DTI indices and post-operative outcome in DCM patients by searching PubMed/MEDLINE, Web of Science, Scopus, and EMBASE from inception until October 2023. In addition, quantitative synthesis and meta-analyses were performed. RESULTS FA was significantly correlated with postoperative JOA or mJOA across all age and follow up subgroups, changes observed in JOA or mJOA from preoperative to postoperative stages (Δ JOA or Δ mJOA) in subgroups aged 65 and above and in those with a follow-up period of 6 months or more, as well as recovery rate in all studies pooled together and also in the under-65 age bracket. Additionally, a significant correlation was demonstrated between recovery rate and ADC across all age groups. No other significant correlations were discovered between DTI parameters (MD, AD, and ADC) and post-operative outcomes. CONCLUSION DTI is a quantitative noninvasive evaluation tool that correlates with severity of DCM. However, the current evidence is still elusive regarding whether DTI metric is a validated tool for predicting the degree of post-operative recovery, which could potentially be useful in patient selection for surgery.
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Affiliation(s)
| | - Faramarz Roohollahi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Yas Spine Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Mahdi Mahmoudi
- Department of General Surgery, Shahid Mofateh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aynaz Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mobin Mohamadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samuel Berchi Kankam
- Image guided Neurosurgery Lab, Department of Neurosurgery, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA
- Brain Trauma Lab, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Afshar Ghamari Khameneh
- Department of Radiology, Advanced Diagnostic and Interventional Radiology (ADIR) Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farzin Farahbakhsh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Allan R Martin
- Department of Neurosurgery, University of California Davis, Davis, CA, USA
| | - James Harrop
- Department of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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Khan AF, Mohammadi E, Haynes G, Hameed S, Rohan M, Anderson DB, Weber KA, Muhammad F, Smith ZA. Evaluating tissue injury in cervical spondylotic myelopathy with spinal cord MRI: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:133-154. [PMID: 37926719 DOI: 10.1007/s00586-023-07990-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/02/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Cervical Spondylotic Myelopathy (CSM) is a degenerative condition that leads to loss of cervical spinal cord (CSC) integrity. Various spinal cord Magnetic Resonance Imaging (MRI) methods can identify and characterize the extent of this damage. This systematic review aimed to evaluate the diagnostic, biomarker, and predictive utilities of different spinal cord MRI methods in clinical research studies of CSM. The aim was to provide a comprehensive understanding of the progress in this direction for future studies and effective diagnosis and management of CSM. METHODS A comprehensive literature search was conducted on PubMed and EMBASE from 2010 to 2022 according to PRISMA guidelines. Studies with non-human subjects, less than 3T magnetic field strength, non-clinical design, or not quantitatively focusing on the structural integrity of CSC were excluded. The extracted data from each study included demographics, disease severity, MRI machine characteristics, quantitative metrics, and key findings in terms of diagnostic, biomarker, and predictive utilities of each MRI method. The risk of bias was performed using the guide from AHRQ. The quality of evidence was assessed separately for each type of utility for different MRI methods using GRADE. RESULTS Forty-seven studies met the inclusion criteria, utilizing diffusion-weighted imaging (DTI) (n = 39), magnetization transfer (MT) (n = 6), MR spectroscopy (n = 3), and myelin water imaging (n = 1), as well as a combination of MRI methods (n = 12). The metric fractional anisotropy (FA) showed the highest potential in all facets of utilities, followed by mean diffusivity. Other promising metrics included MT ratio and intracellular volume fraction, especially in multimodal studies. However, the level of evidence for these promising metrics was low due to a small number of studies. Some studies, mainly DTI, also reported the usefulness of spinal cord MRI in mild CSM. CONCLUSIONS Spinal cord MRI methods can potentially facilitate the diagnosis and management of CSM by quantitatively interrogating the structural integrity of CSC. DTI is the most promising MRI method, and other techniques have also shown promise, especially in multimodal configurations. However, this field is in its early stages, and more studies are needed to establish the usefulness of spinal cord MRI in CSM.
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Affiliation(s)
- Ali Fahim Khan
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Grace Haynes
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, USA
| | - Sanaa Hameed
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Michael Rohan
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - David B Anderson
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Kenneth A Weber
- Systems Neuroscience and Pain Laboratory, Division of Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Zachary A Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA.
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Tavares S, Costa GG, Galego O, Pereira R. Can Morphometric Analysis of Cervical Spondylotic Myelopathy Be a Tool for Surgical Outcome Prediction? Int J Spine Surg 2021; 15:718-723. [PMID: 34266935 DOI: 10.14444/8094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) is one of the leading causes of degenerative cervical myelopathy and the most common cause of spinal cord dysfunction in the elderly worldwide. Although there is emerging evidence that most patients improve after surgery, the key clinical and imaging factors predicting outcome remain uncertain. Our purpose is to evaluate preoperative and postoperative morphometric parameters on magnetic resonance imaging and their relation with neurological outcome at discharge and at 12-month follow-up. METHODS Morphometric features (volume, area, and antero-posterior diameter of the major stenotic section) were acquired by manual segmentation of the spinal canal using OsiriX open-source software and confronted with neurological outcome (at discharge and 12 months after surgery) using Nurick's scale. RESULTS Fifty-five patients (21 females and 34 males) with a mean age of 64.89 ± 11.95 years were analyzed. Recovery ratio was 2.44% ± 2.40% at discharge and 11.74% ± 2.50% at follow-up. Statistical analysis revealed a significant difference (P < .001) between Nurick's scale at admission versus discharge, at discharge versus follow-up at 1 year, and between admission and follow-up at 1 year. Morphometric changes (difference and ratio) between preoperative and postoperative measurements were also statistically significant (P < .001, paired samples t test). When linear regression was applied, volume difference was shown to have an influence on clinical improvement (P < .05; R = 0.519). Linear regression was also applied using recovery ratio at discharge and follow-up as dependent variables, with the same conclusion: volume difference between preoperative and postoperative measurements correlates with outcome improvement at 1 year after surgery. CONCLUSIONS Acquisition of morphometric features might be useful in predicting surgical outcome in patients with CSM. This information can be used to inform patients of their long-term postoperative prognosis in the future with more accurate and standardized measurements.
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Affiliation(s)
- Sofia Tavares
- Centro Hospitalar e Universitário de Coimbra, Neurosurgery Department, Coimbra, Portugal
| | | | - Orlando Galego
- Centro Hospitalar e Universitário de Coimbra, Neuroradiology Department, Coimbra, Portugal
| | - Ricardo Pereira
- Centro Hospitalar e Universitário de Coimbra, Neurosurgery Department, Coimbra, Portugal
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Antkowiak L, Rogalska M, Stogowski P, Anuszkiewicz K, Mandera M. Clinical Application of Diffusion Tensor Imaging in Chiari Malformation Type I- Advances and Perspectives. A Systematic Review. World Neurosurg 2021; 152:124-136. [PMID: 34147690 DOI: 10.1016/j.wneu.2021.06.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) application in Chiari malformation type I (CMI) is still poorly defined. This study aimed to systematically review the literature and propose perspectives toward the clinical application of DTI in CMI. METHODS PubMed and Embase were searched for English-language articles published until October 20, 2020. Clinical studies and case series, evaluating fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), or radial diffusivity values in patients with CMI, were included. RESULTS Eight articles were included. Lower FA values were found at the syrinx level, which decreased with syrinx extent and intensity of symptoms, reflecting myelopathy severity. Decreased AD and MD in the middle cerebellar peduncles in symptomatic patients with CMI might explain the presence of cerebellar signs. Increased FA in various supratentorial structures positively correlated with pain severity. Worse performance in neuropsychological tests correlated with decreased FA, increased MD, and radial diffusivity, reflecting axonal degeneration. Postoperative FA decrease in the brainstem compression area reflects successful decompression. A positive correlation was found between the extent of tonsillar ectopia and increased FA, MD, and AD values, which could act as an early indicator of acute brainstem compression. CONCLUSIONS DTI might provide a valuable insight into the neurobiological foundation of symptomatic CMI presentation. The severity of white matter injury evident on DTI could serve as a reliable predictor of postoperative outcomes, therefore facilitating selection of appropriate surgical candidates. Postinterventional DTI reassessment might enable differentiation between unsuccessful surgical technique and irreversible myelopathy. The extent of tonsillar ectopia reflects the severity of microstructural brainstem injury.
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Affiliation(s)
- Lukasz Antkowiak
- Department of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Poland.
| | - Marta Rogalska
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Stogowski
- Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | | | - Marek Mandera
- Department of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Poland
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Han X, Ma X, Li D, Wang J, Jiang W, Cheng X, Li G, Guo H, Tian W. The Evaluation and Prediction of Laminoplasty Surgery Outcome in Patients with Degenerative Cervical Myelopathy Using Diffusion Tensor MRI. AJNR Am J Neuroradiol 2020; 41:1745-1753. [PMID: 32816762 DOI: 10.3174/ajnr.a6705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/09/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DTI has been proved valuable for the diagnosis of degenerative cervical myelopathy, whereas its capacity for predicting the outcome of surgery is still under debate. Here we conduct a prospective cohort study to analyze the capacity of DTI for evaluating and predicting laminoplasty surgery outcome for degenerative cervical myelopathy. MATERIALS AND METHODS We recruited 55 patients with degenerative cervical myelopathy who underwent DTI before surgery and at 3- and 6-month follow-up stages, and 20 healthy subjects. For clinical assessment, the modified Japanese Orthopedic Association scale was recorded for each patient at different stages. DTI metrics were compared between patients before surgery and healthy subjects. Spearman correlation and receiver operating characteristic were used to analyze the evaluation and prediction capacity of DTI for the modified Japanese Orthopedic Association scale, respectively. We analyzed different vertebral levels: maximal compression level, average of all compression levels, and C2 level. RESULTS DTI metrics were significantly different between patients before surgery and healthy subjects. Before surgery, DTI for the maximal compression level or DTI for the average of all compression levels had no significant correlation with the modified Japanese Orthopedic Association scale. For all stages, DTI at the C2 level was correlated with the modified Japanese Orthopedic Association scale. DTI metrics at the C2 level before surgery were significantly correlated with the postoperative modified Japanese Orthopedic Association scale recovery rate. Receiver operating characteristic analysis demonstrated that fractional anisotropy at C2 was capable of predicting the postoperative modified Japanese Orthopedic Association scale recovery rate (P = .04). CONCLUSIONS The DTI metrics before laminoplasty surgery, especially fractional anisotropy at the C2 level, have the potential for evaluating and predicting the degenerative cervical myelopathy surgery outcome.
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Affiliation(s)
- X Han
- From the Department of Spine Surgery (X.H., D.L., J.W., W.T.), Beijing Jishuitan Hospital, Beijing, China.,Beijing Institute of Traumatology and Orthopaedics (X.H.), Beijing, China
| | - X Ma
- Center for Magnetic Resonance Research (X.M.), University of Minnesota, Minneapolis, Minnesota
| | - D Li
- From the Department of Spine Surgery (X.H., D.L., J.W., W.T.), Beijing Jishuitan Hospital, Beijing, China.,National Center of Gerontology (D.L.), Beijing, China
| | - J Wang
- From the Department of Spine Surgery (X.H., D.L., J.W., W.T.), Beijing Jishuitan Hospital, Beijing, China
| | - W Jiang
- Department of Radiology (W.J., X.C., G.L.), Beijing Jishuitan Hospital, Beijing, China
| | - X Cheng
- Department of Radiology (W.J., X.C., G.L.), Beijing Jishuitan Hospital, Beijing, China
| | - G Li
- Department of Radiology (W.J., X.C., G.L.), Beijing Jishuitan Hospital, Beijing, China
| | - H Guo
- Center for Biomedical Imaging Research (H.F.), Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - W Tian
- From the Department of Spine Surgery (X.H., D.L., J.W., W.T.), Beijing Jishuitan Hospital, Beijing, China
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