Diagnostic potential of the diffusion tensor tractography with fractional anisotropy in the diagnosis and treatment of cervical spondylotic and posttraumatic myelopathy

Magnetic resonance diffusion tensor imaging of acute spinal cord injury in spinal trauma

Background

It was important to develop a non-invasive imaging technique for early evaluation of spinal cord integrity after injury; MRI was the method of choice for evaluation of any cord abnormalities. However, some patients have symptoms with no detectable abnormalities by MRI. The purpose of our study was to assess the role of diffusion tensor MRI in evaluating the integrity of spinal cord fibers in case of spinal trauma.

Results

Out of the studied 30 patients, conventional MRI revealed abnormalities in the spinal cord in 23 patients (76.67%), diffusion tensor tractography revealed abnormalities in the spinal cord in 27 patients (90%), the mean FA value at the level of injury (0.326±0.135) was less than the mean FA value (0.532 ± 0.074) in control group (p value < 0.001), and the mean ADC value at the level of injury (1.319 ± 0.378) was less than the mean ADC value (1.734 ± 0.768) in the control group. FA was sensitive than ADC in the detection of the spinal cord abnormalities with a sensitivity of 93.33% versus 67.66% respectively.

Conclusion

DTI can be used to detect structural changes of spinal cord white matter fibers in acute spinal cord injury. A significant decrease of fractional anisotropy and apparent diffusion coefficient has been found at the site of spinal cord injury.

The Functional Relevance of Diffusion Tensor Imaging in Patients with Degenerative Cervical Myelopathy

(1) Background: In addition to conventional magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) has been investigated as a potential diagnostic and predictive tool for patients with degenerative cervical myelopathy (DCM). In this preliminary study, we evaluated the use of quantitative DTI in the clinical practice as a possible measure to correlate with upper limbs function. (2) Methods: A total of 11 patients were enrolled in this prospective observational study. Fractional anisotropy (FA) values was extracted from DTI data before and after surgery using a GE Signa 1.5 T MRI scanner. The Nine-Hole Peg Test and a digital dynamometer were used to measure dexterity and hand strength, respectively. (3) Results: We found a significant increase of FA values after surgery, in particular below the most compressed level (p = 0.044) as well as an improvement in postoperative dexterity and hand strength. Postoperative FA values moderately correlate with hand dexterity (r = 0.4272, R₂ = 0.0735, p = 0.19 for the right hand; r = 0.2087, R₂ = 0.2265, p = 0.53 for the left hand). (4) Conclusion: FA may be used as a marker of myelopathy and could represent a promising diagnostic value in patients affected by DCM. Surgical decompression can improve the clinical outcome of these patients, especially in terms of the control of finger-hand coordination and dexterity.

Degenerative Cervical Myelopathy: Review of Surgical Outcome Predictors and Need for Multimodal Approach

Degenerative cervical myelopathy is the most common cause of spinal cord injury in the elderly population in the developed world, and it significantly affects the quality of life of patients and their caregivers. Surgery remains the only treatment option able to halt disease progression and provide neurological recovery for most patients. Although it has remained challenging to predict exactly who will experience improvement after surgery, increasingly it has been shown that clinical, imaging, and electrophysiological factors can predict, with relatively good capacity, those more likely to benefit. Clinically, the baseline neurological impairment appears to be strongly related to the outcome, and the magnetic resonance imaging findings of T1-weighted hypointensity and the length of T2-weighted hyperintensity appear to be the most prognostic. In this context, electrophysiology findings (both motor and sensory evoked potentials) have shown some predictive capacity. However, large studies are lacking. Although multivariate models have been conducted using clinical and magnetic resonance imaging data, no multimodal prediction models are available that encompass the predictive capacity of clinical, imaging, and electrophysiological data. In the present review, we examined the rationale for clinical, imaging, and electrophysiological usage in clinical practice and discussed a model of multimodal assessment for the management of degenerative cervical myelopathy.

Application of diffusion tensor tractography in the surgical treatment of brain tumors located in functional areas

The present study aimed to explore the application of diffusion tensor tractography (DTT) in the preoperative planning and prognostic evaluation of tumors located in the functional areas of the brain. A total of 42 patients diagnosed with intracranial tumors were randomly assigned to either the trial or the control group. DT imaging (DTI) was performed on the basis of preoperative conventional magnetic resonance imaging (MRI) and analyzed for patients in the trial group. Patients in the control group underwent only routine MRI scans. The effect of DTT on the prognosis of patients was evaluated by tumor resection rate and quality of life evaluation using Karnofsky performance score (KPS) comparison between the trial and control groups. There were no significant differences for total tumor removal rate in the trial group (85.71%) compared with that in the control group (71.43%) (P>0.05). The rate of postoperative symptom improvement in the trial group (85.71%) was significantly higher compared with that in the control group (47.62%) (P<0.05). The KPS value of the trial group was significantly higher postoperatively (78.57±17.40) compared with that preoperatively (66.67±16.23) (P<0.05). The KPS value of the control group postoperatively (72.38±19.21) was significantly higher compared with that preoperatively (66.67±16.00) (P<0.05). The postoperative KPS improvement rate [postoperative value-preoperative value)/preoperative value] of the trial group was significantly higher compared with that in the control group. In conclusion, the use of DTT is an effective supplement to traditional MRI, with particular relevance in preoperative planning, particularly for tumors in the functional area of the brain, and can significantly improve the prognostic function of patients.

Isolated Pediatric Intramedullary Schwannoma: Case Report and Review of Literature

BACKGROUND

Intramedullary (IM) schwannomas are rare entities representing 0.3%-1% of intramedullary tumors and 1.1% of spinal schwannomas. Beside many theories proposed, their rare occurrence might be related to the absence of Schwann cells in the spinal cord. Pediatric IM schwannomas are uncommon, and in the absence of neurofibromatosis they are extremely rare. To date, few cases have been reported in the literature.

CASE DESCRIPTION

We describe the case of an 8-year-old female affected by a progressive paraparesis. Neuroradiologic investigations showed an oval-shaped mass at the level of T10-T11. The patient underwent surgery, performed under neurophysiologic monitoring. The patient was operated on with complete removal of the lesion. The postoperative course was uneventful.

CONCLUSIONS

The clinical, neuroradiologic, and intraoperative findings are presented, along with a review of the literature. Despite the number of lesions potentially compressing the spinal cord, IM schwannoma is rare but should be taken into account in the differential diagnosis.

Effects of ASPP2 on proliferation and apoptosis of malignant spinal tumor cells

Malignant spinal tumors have rapid progression and destruct spines or other tissues, leading to metastasis of peripheral organs, causing high difficulty for surgery, recurrence and worse prognosis, thus severely affecting patient life quality and survival period. Apoptosis stimulating protein 2 of p53 (ASSP2) is one member of p53 binding protein family pro-apoptotic member, and can enhance apoptotic activity via modulating p53 pathway. Previous study found critical roles of ASPP2 in occurrence and progression of tumors, whilst the functional role of mechanism of ASPP2 on malignant spinal tumor cells has not been illustrated. Malignant spinal tumor tissue and adjacent tissues were collected for testing ASPP2 mRNA and protein expression in real-time PCR and Western blot. ASPP2 over-expression vector was used to transfect tumor cells, whilst MTT assay was employed for tumor proliferation, followed by p53 expression in Western blot. Caspase 3 activity assay was employed for testing the effect on cell apoptosis. Flow cytometry was employed for tumor cell apoptosis. Real-time PCR tested expressional change of Bcl2 and Bax. ASPP2 mRNA/protein level was significantly depressed in malignant spinal tumor tissues (P<0.05 compared to adjacent tissues). ASPP2-overexpression vector transfection tumor cells increased apoptosis and inhibited proliferation, accompanied with lower Bcl-2, higher Bax, Caspase 3 and p53 (P<0.05 compared to control group). ASPP2 is down-regulated in malignant spinal tumor tissues. ASPP2 can inhibit malignant spinal tumor cell proliferation via mediating p53 expression for cell apoptosis, thus can work as one molecular target for tumor diagnosis and prognostic analysis.