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Chernysh AA, Loftus DH, Zheng B, Arditi J, Leary OP, Fridley JS. Utility of Diffusion Tensor Imaging for Prognosis and Management of Cervical Spondylotic Myelopathy: A PRISMA Review. World Neurosurg 2024; 190:88-98. [PMID: 38986943 DOI: 10.1016/j.wneu.2024.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE As advances are made in quantitative magnetic resonance imaging, specifically diffusion tensor imaging, researchers have investigated its potential to serve as a biomarker of disease or prognosticator for postoperative recovery in the management of cervical spondylotic myelopathy. Here, we narratively review the current state of the emerging literature, describing areas of consensus and disagreement. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we queried 2 large databases for original manuscripts published in English and systematically produced a narrative review of the use of diffusion tensor imaging in the management of cervical spondylotic myelopathy. RESULTS Of the 437 manuscripts initially returned in our query, 29 met the final inclusion criteria, and data were extracted regarding diffusion tensor imaging indices and their relationships with clinical outcomes following surgery. Preoperative fractional anisotropy was most commonly found to correlate closely with postsurgical clinical outcomes, though results were mixed. CONCLUSIONS Preoperative fractional anisotropy most frequently and best correlates with functional outcomes following surgery for cervical spondylotic myelopathy, according to a review of the current literature. The findings were not universal and at times contradictory, highlighting the need for high-quality future investigations to better define the utility of diffusion tensor imaging in spinal disease.
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Affiliation(s)
- Alexander A Chernysh
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Department of Neurosurgery, Providence, Rhode Island, USA.
| | - David H Loftus
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Department of Neurosurgery, Providence, Rhode Island, USA
| | - Bryan Zheng
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Department of Neurosurgery, Providence, Rhode Island, USA
| | - Jonathan Arditi
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Department of Neurosurgery, Providence, Rhode Island, USA
| | - Owen P Leary
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Department of Neurosurgery, Providence, Rhode Island, USA
| | - Jared S Fridley
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Department of Neurosurgery, Providence, Rhode Island, USA
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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; 24:1352-1360. [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] [MESH Headings] [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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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; 14:1800-1817. [PMID: 38168663 PMCID: PMC11268306 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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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 PMCID: PMC11572101 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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Wu K, Li H, Xie Y, Zhang S, Wang X. Fractional amplitude of low-frequency fluctuation alterations in patients with cervical spondylotic myelopathy: a resting-state fMRI study. Neuroradiology 2024; 66:847-854. [PMID: 38530417 DOI: 10.1007/s00234-024-03337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE We sought to use the fractional amplitude of low-frequency fluctuation (fALFF) method to investigate the changes in spontaneous brain activity in CSM patients and their relationships with clinical features. METHODS We recruited 20 patients with CSM, and 20 healthy controls (HCs) matched for age, sex, and education status. The fALFF method was used to evaluate the altered spontaneous brain activities. The Pearson correlation analysis of fALFF and the clinical features were carried out. RESULTS Compared with HC, CSM group showed increased fALFF values in the left middle frontal gyrus, inferior parietal lobule, and right angular gyrus. Decreased fALFF values were found in the right lingual gyrus, cuneus (P < 0.05). Pearson correlation analysis shows that the fALFF values of all CSM were positively correlated with JOA score in the right angular gyrus (r = 0.518, P < 0.05). CONCLUSION CSM patients have abnormal fALFF distribution in multiple brain regions and might be an appealing alternative approach for further exploration of the pathological and neuropsychological states in CSM.
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Affiliation(s)
- Kaifu Wu
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, China
| | - Han Li
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, China
| | - Yuanliang Xie
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, China
| | - Shutong Zhang
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, China
| | - Xiang Wang
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, China.
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