1
|
Miyazaki M, Ishihara T, Kanezaki S, Hirakawa M, Iwasaki T, Abe T, Tsumura H. Relationship between K-line distance and surgical outcome in cases of laminoplasty for cervical ossification of the posterior longitudinal ligament. Medicine (Baltimore) 2022; 101:e31605. [PMID: 36451404 PMCID: PMC9704886 DOI: 10.1097/md.0000000000031605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Although previous studies indicate that changes in cervical alignment after laminoplasty and dynamic factors influence surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL), the relationship between the surgical outcomes, the distance between the kyphosis-line (K-line) and OPLL, and dynamic factors have not yet been quantitatively evaluated. The purpose of the present study was to analyze the relationship between ΔK-line distance and surgical outcomes in cases of laminoplasty for OPLL of the cervical spine. We retrospectively reviewed 46 consecutive patients (33 men and 13 women) with cervical OPLL who underwent laminoplasty. "K-line distance" was measured as the minimum interval between the K-line and OPLL on lateral radiographs. The following factors were analyzed: K-line distance in neutral, flexion, and extension neck positions, ΔK-line distance, preoperative C2-7 range of motion (ROM), preoperative segmental ROM, preoperative C2-7 lordotic angle, occupying ratio of the OPLL, disease duration, preoperative and postoperative Japanese Orthopaedic Association (JOA) score, and recovery rate. Patients were divided into flexion K-line (+) and flexion K-line (-) groups. We then analyzed the influence of the K-line distance on surgical outcomes and conducted multivariate analysis to analyze the factors affecting surgical outcomes. The JOA score recovery rate in the flexion K-line (-) group was significantly lower than that in the flexion K-line (+) group (P = .024). The ΔK-line distance was significantly negatively correlated with the JOA score recovery rate (r = -0.531, P < .001). Additionally, multivariate analysis showed that ΔK-line distance (OR = -2.143, P = .015) was negatively correlated with the JOA score recovery rate. The ΔK-line distance is considered useful for the quantitative evaluation of dynamic factors and static compression factors due to OPLL through the measurement of dynamic radiographic images.
Collapse
Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
- * Correspondence: Masashi Miyazaki, Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (e-mail: )
| | - Toshinobu Ishihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Hirakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| |
Collapse
|
2
|
Changes in diffusion tensor imaging indices of the lumbosacral enlargement correlate with cervical spinal cord changes and clinical assessment in patients with cervical spondylotic myelopathy. Clin Neurol Neurosurg 2019; 186:105282. [PMID: 31569059 DOI: 10.1016/j.clineuro.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/03/2019] [Accepted: 02/09/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We examined whether changes in diffusion tensor imaging (DTI) indices of the lumbosacral enlargement are similar to those at the cervical level, and correlate with clinical assessments in patients with cervical spondylotic myelopathy (CSM). PATIENTS AND METHODS Patients with CSM and healthy volunteers (40-42/group) received DTI scans at both lumbosacral enlargement and cervical spinal cord. Modified Japanese Orthopedic Association (mJOA) score was also recorded for those with CSM. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values of DTI in the two groups were compared. We also examined the correlation between DTI indices (ADC and FA) of the lumbosacral enlargement and those of the cervical spinal cord, and between DTI indices and mJOA in the CSM group. RESULTS Compared with the values of healthy subjects, the ADC values of patients with CSM were significantly increased, and FA values were significantly decreased at both cervical spinal cord and lumbosacral enlargement. Changes in FA value of the cervical cord showed a positive correlation to those of the lumbosacral enlargement in the CSM group. Importantly, a linear correlation was detected between mJOA score and DTI indices (ADC and FA) of the cervical cord, as well as FA value of the lumbosacral enlargement in the CSM group. CONCLUSION DTI indices, especially FA, of the lumbosacral enlargement correlate with clinical assessments of patients with CSM, and hence may be useful for evaluating the severity of cervical cord injury.
Collapse
|
3
|
Predictive value of flexion and extension diffusion tensor imaging in the early stage of cervical myelopathy. Neuroradiology 2018; 60:1181-1191. [PMID: 30232516 DOI: 10.1007/s00234-018-2097-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/06/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Diffusion tensor imaging (DTI) in flexion (F) and extension (E) may serve as a sensitive diagnostic tool in early symptoms of myelopathy. The aim of this study was to compare values of water diffusion parameters on dynamic cervical DTI in early stage of myelopathy. METHODS Study enrolled 10 patients with an early stage of cervical myelopathy, in grade I/II of Nurick classification. All subjects were scanned with flexion-extension 3T MRI. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), RD (radial diffusivity), AD (axial diffusivity) and TRACEW (trace diffusion) were measured at C2, compression level (CL) and C7. Parameters were compared between 3 levels and F and E positions. RESULTS Flexion DTI revealed significant difference only for TRACEW between C2 and C7 (105.8 ± 18.9 vs. 83.7 ± 14, respectively; p = 0.0029). Extension DTI showed differences for ADC between CL and C7 (1378.9 ± 381.8 vs. 1227.2 ± 269.2; p = 0.001), reduced FA from 664.6 ± 56.3 at C2 down to 553.1 ± 75.5 (p = 0.001) at CL and 584.7 ± 40.7 at C7 (p = 0.002). Differences of RD in E were significant through all levels and reached 612.9 ± 105.1, 955.3 ± 319.4 and 802.1 ± 194.1 at C2, CL and C7, respectively. TRACEW lowered from 92.3 ± 14.4 at C2 to 66.9 ± 21.1 at CL (p = 0.0001) and 64.4 ± 15.5 at C7 (p = 0.0002). Comparison of DTI between F and E showed differences for all parameters except AD. RD was significantly higher in E at CL (p = 0.003) and C7 (0.013), but TRACEW increased in F at CL by 27.4% (p = 0.001) and at C7 by 23.1% (p = 0.013). FA was reduced at CL in E (p = 0.027) and similarly ADC in F (p = 0.048). CONCLUSION 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.
Collapse
|
4
|
Ibrahim HIA, Saleh A. Role of DTI in cases of cervical spondylosis presented with compression myelopathy: Could it explain the clinical radiological mismatch?! THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
5
|
Rao A, Soliman H, Kaushal M, Motovylyak O, Vedantam A, Budde MD, Schmit B, Wang M, Kurpad SN. Diffusion Tensor Imaging in a Large Longitudinal Series of Patients With Cervical Spondylotic Myelopathy Correlated With Long-Term Functional Outcome. Neurosurgery 2018. [DOI: 10.1093/neuros/nyx558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Fractional anisotropy (FA) of the high cervical cord correlates with upper limb function in acute cervical cord injury. We investigated the correlation between preoperative FA at the level of maximal compression and functional recovery in a group of patients after decompressive surgery for cervical spondylotic myelopathy (CSM).
OBJECTIVE
To determine the usefulness of FA as a biomarker for severity of CSM and as a prognostic biomarker for improvement after surgery.
METHODS
Patients received diffusion tensor imaging (DTI) scans preoperatively. FA values of the whole cord cross-section at the level of maximal compression and upper cervical cord (C1-2) were calculated. Functional status was measured using the modified Japanese Orthopedic Association (mJOA) scale preoperatively and at follow-up up to 2 yr. Regression analysis between FA and mJOA was performed. DTI at C4-7 was obtained in controls.
RESULTS
Forty-four CSM patients enrolled prior to decompression were compared with 24 controls. FA at the level of maximal compression correlated positively with preoperative mJOA score. Preoperative FA correlated inversely with recovery throughout the postoperative period. This was statistically significant at 12 mo postoperation and nearly so at 6 and 24 mo. Patients with preoperative FA <0.55 had a statistically significant difference in outcome compared to FA >0.55.
CONCLUSION
In the largest longitudinal study of this kind, FA promises a valid biomarker for severity of CSM and postoperative improvement. FA is an objective measure of function and could provide a basis for prognosis. FA is particularly useful if preoperative values are less than 0.55.
Collapse
Affiliation(s)
- Avinash Rao
- University of Wisconsin School of Medi-cine and Public Health, Madison, Wisconsin
| | - Hesham Soliman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mayank Kaushal
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - Olesya Motovylyak
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - Aditya Vedantam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - Marjorie Wang
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
6
|
Liu Y, Kong C, Cui L, Yuan X, Zhao P, Zhang Y, Guan Y, Chen X. Correlation between diffusion tensor imaging parameters and clinical assessments in patients with cervical spondylotic myelopathy with and without high signal intensity. Spinal Cord 2017; 55:1079-1083. [PMID: 28872149 DOI: 10.1038/sc.2017.75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 05/03/2017] [Accepted: 05/22/2017] [Indexed: 12/16/2022]
Abstract
STUDY DESIGN A cross-sectional observational study. OBJECTIVES The aim of this study is to compare the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) between patients with cervical spondylotic myelopathy (CSM) with and without high T2-weighted signal intensity, and to correlate each parameter with clinical assessments. SETTING CSM is a common cause of spinal cord dysfunction. The significance of T2 high signal intensity in the prognosis of CSM remains controversial. METHODS Diffusion tensor imaging was performed at the cervical spinal cord in 40 patients with CSM and 42 healthy subjects. Patients with high signal intensity were separated from those without high signal intensity. ADC and FA values were compared among different groups, and the correlation between each parameter and the modified Japanese Orthopedic Association (mJOA) score was examined. RESULTS The ADC and FA values of C2/3 differed significantly from those of C5/6 and C6/7 in healthy subjects. Patients with CSM had a higher ADC but a lower FA value than did healthy subjects. In all patients with CSM, there was a negative linear correlation between ADC and mJOA score, but FA value correlated positively with mJOA score. Secondary analysis suggested that FA value in patients with high signal intensity was lower than that in patients without high signal intensity. FA value showed a positive linear correlation with mJOA score in the patients with high signal intensity but not in the patients without high signal intensity. CONCLUSIONS Patients with high signal intensity may have more severe spinal cord injury than patients without high signal intensity, and FA may be a useful indicator of functional status in patients with CSM with high signal intensity.
Collapse
Affiliation(s)
- Y Liu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - C Kong
- Department of Orthopedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - L Cui
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - X Yuan
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - P Zhao
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Y Zhang
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Y Guan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - X Chen
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Spinal Diffusion Tensor Imaging in Evaluation of Preoperative and Postoperative Severity of Cervical Spondylotic Myelopathy: Systematic Review of Literature. World Neurosurg 2017; 99:150-158. [DOI: 10.1016/j.wneu.2016.11.141] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/26/2016] [Accepted: 11/28/2016] [Indexed: 11/20/2022]
|
8
|
Toktas ZO, Tanrıkulu B, Koban O, Kilic T, Konya D. Diffusion tensor imaging of cervical spinal cord: A quantitative diagnostic tool in cervical spondylotic myelopathy. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2016; 7:26-30. [PMID: 27041882 PMCID: PMC4790144 DOI: 10.4103/0974-8237.176617] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Diffusion tensor imaging (DTI) is a novel magnetic resonance imaging (MRI) technique potentially able to evaluate the microscopic structural organization of white matter fibers. Aim: This study aimed to compare fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values obtained by DTI in stenotic versus nonstenotic cervical spinal segments of patients with clinical and neurological evidence of cervical spondylotic myelopathy (CSM). Materials and Methods: This prospective study included 21 patients with CSM but without T2 changes on conventional MRI. Diffusion tensor (DT) images from the stenotic and nonstenotic segments of the subjects were obtained. FA and ADC values were estimated and compared with stenotic versus nonstenotic segments. Statistical Analysis: Paired t-test was used [Statistical Package for the Social Sciences (SPSS) 12.0]. Results: In the most stenotic segments, the mean FA value was significantly lower (0.4228 ± 0.1090 vs 0.6884 ± 0.0075, P < 0.001) and the mean ADC value was significantly higher (1.312 ± 0.2405 vs 0.9183 ± 0.1477, P < 0.001) when compared to nonstenotic segments. In addition, there was a negative correlation between FA and ADC values (r = 0.63, P = 0.002). Conclusions: DTI of the cervical spine seems to be a promising novel imaging modality in patients with CSM. Advances in Knowledge: DTI may offer increased diagnostic sensitivity as compared to standard MRI and enables earlier detection of the disease.
Collapse
Affiliation(s)
- Zafer Orkun Toktas
- Department of Neurosurgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Bahattin Tanrıkulu
- Department of Neurosurgery, Marmara University Research and Training Hospital, Istanbul, Turkey
| | - Orkun Koban
- Department of Neurosurgery, Marmara University Institute of Neurological Sciences, Istanbul, Turkey
| | - Turker Kilic
- Department of Neurosurgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Deniz Konya
- Department of Neurosurgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| |
Collapse
|
9
|
Lee S, Lee YH, Chung TS, Jeong EK, Kim S, Yoo YH, Kim IS, Yoon CS, Suh JS, Park JH. Accuracy of Diffusion Tensor Imaging for Diagnosing Cervical Spondylotic Myelopathy in Patients Showing Spinal Cord Compression. Korean J Radiol 2015; 16:1303-12. [PMID: 26576120 PMCID: PMC4644752 DOI: 10.3348/kjr.2015.16.6.1303] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 07/21/2015] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the performance of diffusion tensor imaging (DTI) for the diagnosis of cervical spondylotic myelopathy (CSM) in patients with deformed spinal cord but otherwise unremarkable conventional magnetic resonance imaging (MRI) findings. Materials and Methods A total of 33 patients who underwent MRI of the cervical spine including DTI using two-dimensional single-shot interleaved multi-section inner volume diffusion-weighted echo-planar imaging and whose spinal cords were deformed but showed no signal changes on conventional MRI were the subjects of this study. Mean diffusivity (MD), longitudinal diffusivity (LD), radial diffusivity (RD), and fractional anisotropy (FA) were measured at the most stenotic level. The calculated performance of MD, FA, MD∩FA (considered positive when both the MD and FA results were positive), LD∩FA (considered positive when both the LD and FA results were positive), and RD∩FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard. Results The MD, LD, and RD cut-off values were 1.079 × 10-3, 1.719 × 10-3, and 0.749 × 10-3 mm2/sec, respectively, and that of FA was 0.475. Sensitivity, specificity, positive predictive value and negative predictive value were: 100 (4/4), 44.8 (13/29), 20 (4/20), and 100 (13/13) for MD; 100 (4/4), 27.6 (8/29), 16 (4/25), and 100 (8/8) for FA; 100 (4/4), 58.6 (17/29), 25 (4/16), and 100 (17/17) for MD∩FA; 100 (4/4), 68.9 (20/29), 30.8 (4/13), and 100 (20/20) for LD∩FA; and 75 (3/4), 68.9 (20/29), 25 (3/12), and 95.2 (20/21) for RD∩FA in percentage value. Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD∩FA (p = 0.024) and MD and RD∩FA (p = 0.024). Conclusion Fractional anisotropy combined with MD, RD, or LD is expected to be more useful than FA and MD for diagnosing CSM in patients who show deformed spinal cords without signal changes on MRI.
Collapse
Affiliation(s)
- Seungbo Lee
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Young Han Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Tae-Sub Chung
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Eun-Kee Jeong
- Department of Radiology, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT 84112, USA
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Yeon Hwa Yoo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | | | - Choon-Sik Yoon
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Jin-Suck Suh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jung Hyun Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| |
Collapse
|
10
|
Guan X, Fan G, Wu X, Gu G, Gu X, Zhang H, He S. Diffusion tensor imaging studies of cervical spondylotic myelopathy: a systemic review and meta-analysis. PLoS One 2015; 10:e0117707. [PMID: 25671624 PMCID: PMC4363894 DOI: 10.1371/journal.pone.0117707] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/30/2014] [Indexed: 11/19/2022] Open
Abstract
A meta-analysis was conducted to assess alterations in measures of diffusion tensor imaging (DTI) in the patients of cervical spondylotic myelopathy (CSM), exploring the potential role of DTI as a diagnosis biomarker. A systematic search of all related studies written in English was conducted using PubMed, Web of Science, EMBASE, CINAHL, and Cochrane comparing CSM patients with healthy controls. Key details for each study regarding participants, imaging techniques, and results were extracted. DTI measurements, such as fractional anisotropy (FA), apparent diffusion coefficient (ADC), and mean diffusivity (MD) were pooled to calculate the effect size (ES) by fixed or random effects meta-analysis. 14 studies involving 479 CSM patients and 278 controls were identified. Meta-analysis of the most compressed levels (MCL) of CSM patients demonstrated that FA was significantly reduced (ES -1.52, 95% CI -1.87 to -1.16, P < 0.001) and ADC was significantly increased (ES 1.09, 95% CI 0.89 to 1.28, P < 0.001). In addition, a notable ES was found for lowered FA at C2-C3 for CSM vs. controls (ES -0.83, 95% CI -1.09 to -0.570, P < 0.001). Meta-regression analysis revealed that male ratio of CSM patients had a significant effect on reduction of FA at MCL (P = 0.03). The meta-analysis of DTI studies of CSM patients clearly demonstrated a significant FA reduction and ADC increase compared with healthy subjects. This result supports the use of DTI parameters in differentiating CSM patients from health subjects. Future researches are required to investigate the diagnosis performance of DTI in cervical spondylotic myelopathy.
Collapse
Affiliation(s)
- Xiaofei Guan
- Department of Orthopedics, Shanghai Tenth People’s
Hospital, Tongji University School of Medicine, Shanghai,
China
| | - Guoxin Fan
- Department of Orthopedics, Shanghai Tenth People’s
Hospital, Tongji University School of Medicine, Shanghai,
China
| | - Xinbo Wu
- Department of Orthopedics, Shanghai Tenth People’s
Hospital, Tongji University School of Medicine, Shanghai,
China
| | - Guangfei Gu
- Department of Orthopedics, Shanghai Tenth People’s
Hospital, Tongji University School of Medicine, Shanghai,
China
| | - Xin Gu
- Department of Orthopedics, Shanghai Tenth People’s
Hospital, Tongji University School of Medicine, Shanghai,
China
| | - Hailong Zhang
- Department of Orthopedics, Shanghai Tenth People’s
Hospital, Tongji University School of Medicine, Shanghai,
China
| | - Shisheng He
- Department of Orthopedics, Shanghai Tenth People’s
Hospital, Tongji University School of Medicine, Shanghai,
China
| |
Collapse
|
11
|
Diffusion Tensor Imaging of the Anterior Cruciate Ligament Graft After Reconstruction. J Comput Assist Tomogr 2015; 39:244-9. [DOI: 10.1097/rct.0000000000000198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Hendrix P, Griessenauer CJ, Cohen-Adad J, Rajasekaran S, Cauley KA, Shoja MM, Pezeshk P, Tubbs RS. Spinal diffusion tensor imaging: A comprehensive review with emphasis on spinal cord anatomy and clinical applications. Clin Anat 2014; 28:88-95. [DOI: 10.1002/ca.22349] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 10/28/2013] [Indexed: 12/14/2022]
Affiliation(s)
- Philipp Hendrix
- Department of Neurosurgery; University of Alabama at Birmingham; Birmingham Alabama
| | | | - Julien Cohen-Adad
- Department of Biomedical Engineering; Ecole Polytechnique de Montreal; Quebec Canada
| | | | - Keith A. Cauley
- Department of Radiology; Columbia-Presbyterian Medical Center; New York New York
| | | | - Parham Pezeshk
- Department of Radiology; Veterans Affairs Long Beach Healthcare System; University of California Irvine, California
| | - R. Shane Tubbs
- Department of Pediatric Neurosurgery; Children's Hospital; Birmingham Alabama
| |
Collapse
|
13
|
Yang X, Li M, Chen D, Shi D, Zhou Z, Zhu B, Jiang Q. Diffusion Tensor Imaging for Anatomical and Quantitative Evaluation of the Anterior Cruciate Ligament and ACL Grafts. J Comput Assist Tomogr 2014; 38:489-94. [DOI: 10.1097/rct.0000000000000078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Ellingson BM, Salamon N, Holly LT. Advances in MR imaging for cervical spondylotic myelopathy. 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 2013; 24 Suppl 2:197-208. [PMID: 23917647 DOI: 10.1007/s00586-013-2915-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 05/22/2013] [Accepted: 07/12/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To outline the pathogenesis of cervical spondylotic myelopathy (CSM), the correlative abnormalities observed on standard magnetic resonance imaging (MRI), the biological implications and current status of diffusion tensor imaging (DTI), and MR spectroscopy (MRS) as clinical tools, and future directions of MR technology in the management of CSM patients. METHODS A systematic review of the pathogenesis and current state-of-the-art in MR imaging technology for CSM was performed. RESULTS CSM is caused by progressive, degenerative, vertebral column abnormalities that result in spinal cord damage related to both primary mechanical and secondary biological injuries. The T2 signal change on conventional MRI is most commonly associated with neurological deficits, but tends not to be a sensitive predictor of recovery of function. DTI and MRS show altered microstructure and biochemistry that reflect patient-specific pathogenesis. CONCLUSION Advanced imaging techniques, including DTI and MRS, show higher sensitivity to microstructural and biochemical changes within the cord, and may aid in management of CSM patients.
Collapse
|
15
|
Jones JGA, Cen SY, Lebel RM, Hsieh PC, Law M. Diffusion tensor imaging correlates with the clinical assessment of disease severity in cervical spondylotic myelopathy and predicts outcome following surgery. AJNR Am J Neuroradiol 2012; 34:471-8. [PMID: 22821918 DOI: 10.3174/ajnr.a3199] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CSM is a common neurologic disease that results in progressive disability and eventual paralysis without appropriate treatment. Imaging plays a significant role in the evaluation of CSM and has evolved with recent technical advances. We sought to systematically explore the relationship between clinical disease severity and DTI in CSM, and to investigate the potential use of DTI in surgical decision-making models. MATERIALS AND METHODS MR imaging studies and clinical assessments were prospectively collected on 30 patients with CSM. Spearman correlations were used to investigate associations between clinical disease severity and FA at the time of diagnosis. Clinical assessment was performed using mJOA, Nurick, Short Form-36, and NDI scores. Fifteen patients with CSM subsequently underwent decompressive surgery; Spearman correlation and logistic regression were applied to this cohort to study the relationship between baseline DTI measurements and postoperative outcome. Conventional imaging (spinal cord T2 signal intensity and degree of stenosis) was evaluated for comparison with DTI. RESULTS At diagnosis, FA demonstrated a strong correlation with baseline mJOA (r = 0.62, P < .01) and Nurick (r = -0.46, P = .01) scores. After surgery, recovery of function demonstrated by improvement in NDI score was associated with higher FA values on preoperative DTI (r = -0.61, P = .04). Severely affected patients with CSM with disproportionately high FA tended to achieve greater mJOA scores after surgery compared with subjects with lower FA (P = .08). T2 signal intensity was associated with functional status at baseline but did not predict postoperative outcome; degree of stenosis lacked any significant correlation with clinical parameters. CONCLUSIONS DTI may be a useful diagnostic tool for assessing disease severity in CSM. The predictive value of DTI regarding postoperative outcome may improve surgical decision-making and facilitate health care outcomes research.
Collapse
Affiliation(s)
- J G A Jones
- Department of Radiology, USC Keck School of Medicine, Los Angeles, CA 90033, USA.
| | | | | | | | | |
Collapse
|
16
|
Orientation entropy analysis of diffusion tensor in healthy and myelopathic spinal cord. Neuroimage 2011; 58:1028-33. [PMID: 21777679 DOI: 10.1016/j.neuroimage.2011.06.072] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 06/23/2011] [Accepted: 06/24/2011] [Indexed: 11/21/2022] Open
Abstract
The majority of nerve fibers in the spinal cord run longitudinally, playing an important role in connecting the brain to the peripheral nerves. There is a growing interest in applying diffusion tensor imaging (DTI) to the evaluation of spinal cord microarchitecture. The current study sought to compare the organization of longitudinal nerve fibers between healthy and myelopathic spinal cords using entropy-based analysis of principal eigenvector mapping. A total of 22 subjects were recruited, including 14 healthy subjects, seven cervical myelopathy (CM) patients with single-level compression, and one patient suffering from multi-level compression. Diffusion tensor magnetic resonance (MR) images of the cervical spinal cord were obtained using a pulsed gradient, spin-echo echo-planar imaging (SE-EPI) sequence with a 3T MR system. Regions of interest (ROIs) were drawn manually to cover the spinal cord, and Shannon entropy was calculated in principal eigenvector maps. The results revealed no significant differences in orientation entropy values along the whole length of cervical spinal cord in healthy subjects (C2-3: 0.73±0.05; C3-4: 0.71±0.07; C4-5: 0.72±0.048; C5-6: 0.71±0.07; C6-7: 0.72±0.07). In contrast, orientation entropy values in myelopathic cord were significantly higher at the compression site (0.91±0.03), and the adjacent levels (above: 0.85±0.03; below: 0.83±0.05). This study provides a novel approach to analyze the orientation information in diffusion MR images of healthy and diseased spinal cord. These results indicate that orientation entropy can be applied to determine the contribution of each compression level to the overall disorganization of principal nerve tracts of myelopathic spinal cord in cases with multi-level compression.
Collapse
|