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Yuan C, Chen S, Liang L, Xu X, Xiong H, Li Y, Liu T, Chen N, Chang H. High-resolution and high-fidelity diffusion tensor imaging of cervical spinal cord using 3D reduced-FOV multiplexed sensitivity encoding (3D-rFOV-MUSE). Magn Reson Med 2025; 94:166-182. [PMID: 40016879 PMCID: PMC12021329 DOI: 10.1002/mrm.30455] [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: 09/29/2024] [Revised: 12/27/2024] [Accepted: 01/16/2025] [Indexed: 03/01/2025]
Abstract
PURPOSE To develop a 3D isotropic high-resolution and high-fidelity cervical spinal cord DTI technique for addressing the current challenges existing in 2D cervical spinal cord DTI. METHODS A 3D multi-shot DWI acquisition and reconstruction technique was developed by combining 3D multiplexed sensitivity encoding (3D-MUSE) with two reduced FOV techniques, termed 3D-rFOV-MUSE, to acquire 3D cervical spinal cord DTI data using a sagittal thin slab. A self-referenced 2D ghost correction method and a 2D navigator-based inter-shot phase correction were integrated into the reconstruction framework to simultaneously eliminate Nyquist ghost and aliasing artifacts. Cardiac triggering was used during data acquisition to minimize the influence of cerebrospinal fluid pulsation. In vivo experiments were conducted on five healthy subjects at a 1.5 T MRI scanner for evaluating the feasibility of 3D cervical spinal cord DTI using 3D-rFOV-MUSE in terms of geometric fidelity, reconstruction performance, and SNR efficiency. RESULTS A 3D-rFOV-MUSE can achieve high-resolution cervical spinal cord DTI at 1.0 mm isotropic resolution. The integration of reduced FOV and multi-shot acquisitions can improve the geometric fidelity of 3D cervical spinal cord DTI. Compared with routine 2D single-shot diffusion-weighed EPI (2D-ss-EPI), the proposed technique can mitigate through-plane partial volume effect and enable multi-planar data reformation for cervical spinal cord DTI, with effective reductions of distortions and improved signal-to-noise ratio. CONCLUSION We demonstrated the feasibility of high-resolution and high-fidelity 3D cervical spinal cord DTI at 1.0 mm isotropic resolution using 3D-rFOV-MUSE technique, which may potentially improve the quantitative assessment of cervical spinal cord DTI biomarkers.
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Affiliation(s)
- Chenglang Yuan
- Department of Biomedical EngineeringThe Chinese University of Hong Kong
Hong KongChina
| | - Shihui Chen
- Department of Biomedical EngineeringThe Chinese University of Hong Kong
Hong KongChina
- Multi‐Scale Medical Robotics CenterHong KongChina
| | - Liyuan Liang
- Department of Biomedical EngineeringThe Chinese University of Hong Kong
Hong KongChina
- Multi‐Scale Medical Robotics CenterHong KongChina
| | - Xiaorui Xu
- Department of Diagnostic RadiologyThe University of Hong KongHong KongChina
| | - Hailin Xiong
- Department of Biomedical EngineeringThe Chinese University of Hong Kong
Hong KongChina
| | - Yi Li
- Department of Biomedical EngineeringThe Chinese University of Hong Kong
Hong KongChina
| | - Tianbaige Liu
- Department of Biomedical EngineeringThe Chinese University of Hong Kong
Hong KongChina
| | - Nan‐Kuei Chen
- Department of Biomedical EngineeringUniversity of ArizonaTucsonArizonaUSA
| | - Hing‐Chiu Chang
- Department of Biomedical EngineeringThe Chinese University of Hong Kong
Hong KongChina
- Multi‐Scale Medical Robotics CenterHong KongChina
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Prabhakar S, Shahi P, Hussain MT, Tiwari M, Gerber C, Basu A. Utility of Diffusion Tensor Imaging in Predicting Outcomes Following Surgical Treatment of Degenerative Cervical Myelopathy. Neurol India 2025; 73:292-297. [PMID: 40176219 DOI: 10.4103/neurol-india.neurol-india-d-24-00271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 09/24/2024] [Indexed: 04/04/2025]
Abstract
BACKGROUND The utility of diffusion tensor imaging (DTI) in predicting surgical outcomes in degenerative cervical myelopathy (DTI) remains controversial. OBJECTIVE To identify the preoperative clinical and radiological factors associated with poor outcomes following surgical treatment of DCM. METHODS AND MATERIAL This prospective cohort study included patients who underwent surgery for DCM. MRI parameters (compression ratio, CR; transverse area, TA; signal-intensity ratio, SIR) and DTI parameters (fractional anisotropy, FA; apparent diffusion coefficient, ADC; relative anisotropy, RA; volume ratio, VR) were assessed preoperatively. Demographic and operative data were collected. Based on the improvement in modified Japanese Orthopaedic Association (mJOA) score at 4 months, patients were categorized as group A (good surgical outcome) and group B (poor surgical outcome). Univariate and regression analyses were performed to identify risk factors and predictors, respectively, of poor surgical outcome. RESULTS Sixty-six patients were included. Thirty-eight patients belonged to group A (good outcome) and 28 patients belonged to group B (poor outcome). There was no significant difference between the two groups in demographic and operative variables. FA was found to be significantly less in group B compared to group A (550 vs. 610, P = 0.04). No significant difference was seen in RA, CR, TA, SIR, ADC, and VR between the two groups. On regression analysis, no independent predictor of poor outcome could be identified. CONCLUSIONS Preoperative FA was found to be significantly lower in patients with poor outcome following surgical treatment for DCM.
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Affiliation(s)
- Selvin Prabhakar
- Department of Spine Surgery, Institute of Neurosciences Kolkata (INK), Kolkata, West Bengal, India
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Wang X, Tian X, Zhang Y, Zhao B, Wang N, Gao T, Zhang L. Predictive value of dynamic diffusion tensor imaging for surgical outcomes in patients with cervical spondylotic myelopathy. BMC Med Imaging 2024; 24:260. [PMID: 39354411 PMCID: PMC11445957 DOI: 10.1186/s12880-024-01428-9] [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: 04/11/2024] [Accepted: 09/16/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) is the most common chronic spinal cord injury with poor surgical and neurologic recovery in the advanced stages of the disease. DTI parameters can serve as important biomarkers for CSM prognosis. The study aimed to investigate the predictive value of dynamic diffusion tensor imaging (DTI) for the postoperative outcomes of CSM. METHODS One hundred and five patients with CSM who underwent surgery were included in this study. Patients were assessed using the Modified Japanese Orthopedic Association Score (mJOA) before and one year after surgery and then divided into groups with good (≥ 50%) and poor (< 50%) prognoses according to the rate of recovery. All patients underwent preoperative dynamic magnetic resonance imaging of the cervical spine, including T2WI and DTI in natural(N), extension (E), and flexion (F) positions. ROM, Cross-sectional area, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were measured at the narrowest level in three neck positions. Univariate and multivariate logistic regression were used to identify risk factors for poor postoperative recovery based on clinical characteristics, dynamic T2WI, and DTI parameters. Predictive models were developed for three different neck positions. RESULTS Forty-four (41.9%) patients had a good postoperative prognosis, and 61 (58.1%) had a poor prognosis. Univariate analysis showed statistically significant differences in diabetes, number of compression segments, preoperative mJOA score, cross-sectional area ((Area-N), (Area-E), (Area-F)), ADC((ADC-N), (ADC-E), (ADC-F)) and FA (((FA-N), (FA-E), (FA-F)) (p < 0.05). Multivariable logistic regression showed that natural neck position: Area-N ([OR] 0.226; [CI] 0.069-0.732, p = 0.013),FA-N([OR]3.028;[CI]1.12-8.19,p = 0.029); extension ne-ck position: Area-E([OR]0.248;[CI]0.076-0.814,p = 0.021), FA-E([OR]4.793;[CI]1.737-13.228,p = 0.002);And flextion neck postion: Area-F([OR] 0.288; [CI] 0.095-0.87, p = 0.027),FA-F ([OR] 2.964; [CI] 1.126-7.801, p = 0.028) were independent risk factors for poor prognosis.The area under the curve (AUC) of the prediction models in the natural neck position, extension neck position, and flexion neck positions models were 0.708[(95% CI:0.608∼0.808), P < 0.001]; 0.738 [(95% CI:0.641∼0.835), P < 0.001]; 0.703 [(95% CI:0.602∼0.803), P < 0.001], respectively. CONCLUSION Dynamic DTI can predict postoperative outcomes in CSM. Reduced FA in the extension position is a valid predictor of poor postoperative neurological recovery in patients with CSM.
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Affiliation(s)
- Xiaoyun Wang
- Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Xiaonan Tian
- CT Room, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yujin Zhang
- Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Baogen Zhao
- Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Ning Wang
- Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Ting Gao
- Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Li Zhang
- Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, 050000, People's Republic of China.
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Wang J, Huang J, Cui B, Yang H, Tian D, Ma J, Duan W, Dong H, Chen Z, Lu J. Diffusion Tensor Imaging Identifies Cervical Spondylosis, Myelitis, and Spinal Cord Tumors. Diagnostics (Basel) 2024; 14:1225. [PMID: 38928642 PMCID: PMC11202471 DOI: 10.3390/diagnostics14121225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) has been increasingly recognized for its capability to study microstructural changes in the neuropathology of brain diseases. However, the optimal DTI metric and its diagnostic utility for a variety of spinal cord diseases are still under investigation. PURPOSE To evaluate the diagnostic efficacy of DTI metrics for differentiating between cervical spondylosis, myelitis, and spinal tumors. METHODS This retrospective study analyzed DTI scans from 68 patients (22 with cervical spondylosis, 23 with myelitis, and 23 with spinal tumors). DTI indicators, including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD), were calculated. The Kruskal-Wallis test was used to compare these indicators, followed by Receiver Operating Characteristic (ROC) curve analysis, to evaluate the diagnostic efficacy of each indicator across disease pairs. Additionally, we explored the correlations of DTI indicators with specific clinical measurements. RESULTS FA values were significantly lower in tumor patients compared to those with cervical spondylosis (p < 0.0001) and myelitis (p < 0.05). Additionally, tumor patients exhibited significantly elevated MD and RD values relative to the spondylosis and myelitis groups. ROC curve analysis underscored FA's superior discriminative performance, with an area under the curve (AUC) of 0.902 for differentiating tumors from cervical spondylosis, and an AUC of 0.748 for distinguishing cervical myelitis from spondylosis. Furthermore, a significant negative correlation was observed between FA values and Expanded Disability Status Scores (EDSSs) in myelitis patients (r = -0.62, p = 0.002), as well as between FA values and Ki-67 scores in tumor patients (r = -0.71, p = 0.0002). CONCLUSION DTI indicators, especially FA, have the potential in distinguishing spondylosis, myelitis, and spinal cord tumors. The significant correlation between FA values and clinical indicators highlights the value of FA in the clinical assessment and prognosis of spinal diseases and may be applied in diagnostic protocols in the future.
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Affiliation(s)
- Jiyuan Wang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Jing Huang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Bixiao Cui
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Hongwei Yang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Defeng Tian
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Jie Ma
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (W.D.); (Z.C.)
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (W.D.); (Z.C.)
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (J.W.); (J.H.); (B.C.); (H.Y.); (D.T.); (J.M.)
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
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Jiang Z, Davies B, Zipser C, Margetis K, Martin A, Matsoukas S, Zipser-Mohammadzada F, Kheram N, Boraschi A, Zakin E, Obadaseraye OR, Fehlings MG, Wilson J, Yurac R, Cook CE, Milligan J, Tabrah J, Widdop S, Wood L, Roberts EA, Rujeedawa T, Tetreault L. The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis. Global Spine J 2024; 14:1369-1394. [PMID: 37903098 PMCID: PMC11289551 DOI: 10.1177/21925682231209869] [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: 11/01/2023] Open
Abstract
STUDY DESIGN Delayed diagnosis of degenerative cervical myelopathy (DCM) is likely due to a combination of its subtle symptoms, incomplete neurological assessments by clinicians and a lack of public and professional awareness. Diagnostic criteria for DCM will likely facilitate earlier referral for definitive management. OBJECTIVES This systematic review aims to determine (i) the diagnostic accuracy of various clinical signs and (ii) the association between clinical signs and disease severity in DCM? METHODS A search was performed to identify studies on adult patients that evaluated the diagnostic accuracy of a clinical sign used for diagnosing DCM. Studies were also included if they assessed the association between the presence of a clinical sign and disease severity. The QUADAS-2 tool was used to evaluate the risk of bias of individual studies. RESULTS This review identified eleven studies that used a control group to evaluate the diagnostic accuracy of various signs. An additional 61 articles reported on the frequency of clinical signs in a cohort of DCM patients. The most sensitive clinical tests for diagnosing DCM were the Tromner and hyperreflexia, whereas the most specific tests were the Babinski, Tromner, clonus and inverted supinator sign. Five studies evaluated the association between the presence of various clinical signs and disease severity. There was no definite association between Hoffmann sign, Babinski sign or hyperreflexia and disease severity. CONCLUSION The presence of clinical signs suggesting spinal cord compression should encourage health care professionals to pursue further investigation, such as neuroimaging to either confirm or refute a diagnosis of DCM.
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Affiliation(s)
- Zhilin Jiang
- King’s College Hospital, NHS Foundation Trust, London, UK
| | | | - Carl Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | | | - Allan Martin
- Department of Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Najmeh Kheram
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Andrea Boraschi
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Elina Zakin
- New York University Langone, Department of Neurology, New York, NY, USA
| | | | - Michael G. Fehlings
- University of Toronto Division of Neurosurgery and Spinal Program, Toronto, ON, Canada
| | - Jamie Wilson
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Ratko Yurac
- University del Desarrollo, Clinica Alemana de Santiago, Chile
| | | | - Jamie Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, USA
| | - Julia Tabrah
- Hounslow and Richmond Community Healthcare, Teddington, UK
| | | | - Lianne Wood
- Nottingham University Hospital, Nottingham, UK
| | | | | | - Lindsay Tetreault
- New York University Langone, Department of Neurology, New York, NY, USA
| | - AO Spine RECODE-DCM Diagnostic Criteria Incubator
- King’s College Hospital, NHS Foundation Trust, London, UK
- University of Cambridge, Cambridge, UK
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Neurosurgery, University of California Davis, Sacramento, CA, USA
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
- New York University Langone, Department of Neurology, New York, NY, USA
- Department of Surgery, Asaba Specialist Hospital, Asaba, Nigeria
- University of Toronto Division of Neurosurgery and Spinal Program, Toronto, ON, Canada
- University of Nebraska Medical Center, Omaha, NE, USA
- University del Desarrollo, Clinica Alemana de Santiago, Chile
- Duke University Medical Center, Durham, NC
- Department of Family Medicine, McMaster University, Hamilton, ON, USA
- Hounslow and Richmond Community Healthcare, Teddington, UK
- Myelopathy.org, Cambridge, UK
- Nottingham University Hospital, Nottingham, UK
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Talbott JF, Shah V, Ye AQ. Diffusion Imaging of the Spinal Cord: Clinical Applications. Radiol Clin North Am 2024; 62:273-285. [PMID: 38272620 DOI: 10.1016/j.rcl.2023.10.002] [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] [Indexed: 01/27/2024]
Abstract
Spinal cord pathologic condition often presents as a neurologic emergency where timely and accurate diagnosis is critical to expedite appropriate treatment and minimize severe morbidity and even mortality. MR imaging is the gold standard imaging technique for diagnosing patients with suspected spinal cord pathologic condition. This review will focus on the basic principles of diffusion imaging and how spinal anatomy presents technical challenges to its application. Both the promises and shortcomings of spinal diffusion imaging will then be explored in the context of several clinical spinal cord pathologies for which diffusion has been evaluated.
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Affiliation(s)
- Jason F Talbott
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Room 1X57, San Francisco, CA 94110, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital.
| | - Vinil Shah
- Department of Radiology and Biomedical Imaging, Neuroradiology Division, University of California San Francisco, 505 Parnassus Avenue, #M-391, San Francisco, CA 94143, USA
| | - Allen Q Ye
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Room 1X57, San Francisco, CA 94110, USA; Department of Radiology and Biomedical Imaging, Neuroradiology Division, University of California San Francisco, 505 Parnassus Avenue, #M-391, San Francisco, CA 94143, USA
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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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Wang C, Han X, Ma X, Jiang W, Wang J, Li S, Guo H, Tian W, Chen H. Spinal cord perfusion is associated with microstructural damage in cervical spondylotic myelopathy patients who underwent cervical laminoplasty. Eur Radiol 2024; 34:1349-1357. [PMID: 37581664 DOI: 10.1007/s00330-023-10011-9] [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: 05/17/2022] [Revised: 05/01/2023] [Accepted: 06/08/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To investigate the association between spinal cord perfusion and microstructural damage in CSM patients who underwent cervical laminoplasty using MR dynamic susceptibility contrast (DSC), diffusion tensor imaging (DTI), and neurite orientation dispersion and density imaging (NODDI) techniques. METHODS A follow-up cohort study was conducted with 53 consecutively recruited CSM patients who had undergone cervical laminoplasty 12-14 months after the surgery from April 2016 to December 2016. Twenty-one aged-matched healthy volunteers were recruited as controls. For each patient, decompressed spinal cord levels were imaged on a 3.0-T MRI scanner by diffusion and DSC sequences to quantify the degrees of microstructural damage and perfusion conditions, respectively. The diffusion data were analyzed by DTI and NODDI models to produce diffusion metrics. Classic indicator dilution model was used to quantify the DSC metrics. Mann-Whitney U test was performed for comparison of diffusion metrics between patients and healthy controls. Pearson correlation was used to explore the associations between the metrics of spinal cord perfusion and microstructural damage. RESULTS DTI metrics, neurite density, and isotropic volume fraction had significant differences between postoperative patients and healthy controls. Pearson correlation test showed that SCBV was significantly positively correlated with RD, MD, and ODI, and negatively correlated with FA and NDI. SCBF was found to be significantly positively correlated with RD and MD, and negatively correlated with FA. CONCLUSIONS Increased spinal cord perfusion quantified by DSC is associated with microstructural damage assessed by diffusion MRI in CSM patients who underwent cervical laminoplasty. CLINICAL RELEVANCE STATEMENT This study found that the spinal cord perfusion is associated with microstructural damage in postoperative cervical spondylotic myelopathy patients, indicating that high perfusion may play a role in the pathophysiological process of cervical spondylotic myelopathy and deserves more attention. KEY POINTS • Spinal cord microstructural damage can be persistent despite the compression had been relieved 12-14 months after the cervical laminoplasty in cervical spondylotic myelopathy (CSM) patients. • Spinal cord perfusion is associated with microstructural damage in CSM patients after the cervical laminoplasty. • Inflammation in the decompressed spinal cord may be a cause of increased perfusion and is associated with microstructural damage during the recovery period of CSM.
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Affiliation(s)
- Chunyao Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiao Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Beijing Research Institute of Traumatology and Orthopaedics, Beijing, China
| | - Xiaodong Ma
- Center for Magnetic Resonance Research, Radiology, Medical School of the University of Minnesota, Minnesota, USA
| | - Wen Jiang
- Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Jinchao Wang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Sisi Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
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Ni M, Li S, Wen X, Wang B, Jiang C, Zhang X, Lang N, Jiang L, Yuan H. A matched case-control study of early cervical spondylotic myelopathy based on diffusion magnetic resonance imaging. Insights Imaging 2024; 15:25. [PMID: 38270768 PMCID: PMC10811301 DOI: 10.1186/s13244-023-01579-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Early cervical spondylotic myelopathy (CSM) is challenging to diagnose and easily missed. Diffusion MRI (dMRI) has the potential to identify early CSM. METHODS Using diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI), and neurite orientation dispersion and density imaging (NODDI), a 1:1 matched case-control study was conducted to evaluate the potential of dMRI in identifying early CSM and assessing uncompressed segments of CSM patients. CSM patients and volunteers were matched by age and spinal location. The differences in dMRI parameters between groups were assessed by the paired t-test, the multicollinearity of the dMRI parameters was evaluated by the variance inflation factor (VIF), and the value of dMRI parameters in distinguishing controls from CSM patients was determined by logistic regression. The univariate t-test was used to analyse differences between CSM patients and volunteers in adjacent uncompressed areas. RESULTS In total, 56 CSM patients and 56 control volunteers were included. Paired t-tests revealed significant differences in nine dMRI parameters between groups. Multicollinearity calculated through VIF and combined with logistic regression showed that the orientation division index (ODI) was significantly positively correlated (r = 2.12, p = 0.035), and the anisotropic water fraction (AWF) was significantly negatively correlated (r = -0.98, p = 0.015). The fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), isotropic volume fraction (ISOVF), ODI, and AWF were significantly different in the upper and lower uncompressed areas at all ages. CONCLUSION dMRI can noninvasively identify early CSM patients and potentially identify the extent of CSM lesions involving the cervical spinal cord. CRITICAL RELEVANCE STATEMENT Diffusion MRI (dMRI) can identify early cervical spondylotic myelopathy (CSM) and has the potential to help determine the extent of CSM involvement. The application of dMRI can help screen for early CSM and develop clinical surgical and rehabilitation treatment plans. KEY POINTS • Diffusion MRI can differentiate between normal and early-stage cervical spondylotic myelopathy patients. • Diffusion MRI has the ability to identify the extent of spinal cord involvement in cervical spondylotic myelopathy. • Diffusion MRI enables the early screening of cervical spondylotic myelopathy and helps guide clinical treatment.
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Affiliation(s)
- Ming Ni
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Shujing Li
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Xiaoyi Wen
- Institute of Statistics and Big Data, Renmin University of China, 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
| | - Chenyu Jiang
- 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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10
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Tounekti S, Alizadeh M, Middleton D, Harrop JS, Hiba B, Krisa L, Mekkaoui C, Mohamed FB. Metal artifact reduction around cervical spine implant using diffusion tensor imaging at 3T: A phantom study. Magn Reson Imaging 2024; 105:57-66. [PMID: 37939969 PMCID: PMC10841892 DOI: 10.1016/j.mri.2023.11.007] [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: 08/23/2023] [Accepted: 11/04/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Diffusion MRI continues to play a key role in non-invasively assessing spinal cord integrity and pre-operative injury evaluation. However, post-operative Diffusion Tensor Imaging (DTI) acquisition of patients with metal implants results in severe geometric distortion. We propose and demonstrate a method to alleviate the technical challenges facing the acquisition of DTI on post-operative cases and longitudinal evaluation of therapeutics. MATERIAL AND METHODS The described technique is based on the combination of the reduced Field-Of-View (rFOV) strategy and the phase segmented EPI, termed rFOV-PS-EPI. A custom-built phantom based on a cervical spine model with metal implants was used to collect DTI data at 3 Tesla scanner using: rFOV-PS-EPI, reduced Field-Of-View single-shot EPI (rFOV-SS-EPI), and conventional full FOV techniques including SS-EPI, PS-EPI, and readout-segmented EPI (RS-EPI). Geometric distortion, SNR, and signal void were assessed to evaluate images and compare the sequences. A two-sample t-test was performed with p-value of 0.05 or less to indicate statistical significance. RESULTS The reduced FOV techniques showed better capability to reduce distortions compared to the Full FOV techniques. The rFOV-PS-EPI method provided DTI images of the phantom at the level of the hardware whereas the conventional rFOV-SS-EPI is useful only when the metal is approximately 20 mm away. In addition, compared to the rFOV-SS-EPI technique, the suggested approach produced smaller signal voids area as well as significantly reduced geometric distortion in Circularity (p < 0.005) and Eccentricity (p < 0.005) measurements. No statistically significant differences were found for these geometric distortion measurements between the rFOV-PS-EPI DTI sequence and conventional structural T2 images (p > 0.05). CONCLUSION The combination of rFOV and a phase-segmented acquisition approach is effective for reducing metal-induced distortions in DTI scan on spinal cord with metal hardware at 3 T.
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Affiliation(s)
- Slimane Tounekti
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Mahdi Alizadeh
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Devon Middleton
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bassem Hiba
- Institut des Sciences Cognitives, CNRS UMR 5229, Université Lyon 1, Lyon, France
| | - Laura Krisa
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, PA, USA
| | - Choukri Mekkaoui
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; A.A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Feroze B Mohamed
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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11
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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: 5] [Impact Index Per Article: 5.0] [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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12
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Atchut KA, Shetty L, Ravichandran K. Role of diffusion tensor imaging in stenotic and non-stenotic spinal canal. J Med Imaging Radiat Sci 2023; 54:699-706. [PMID: 37891147 DOI: 10.1016/j.jmir.2023.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/28/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND AND PURPOSE Cervical Spondylotic Myelopathy (CSM) is a gradually escalating spinal cord disturbance set in motion by the degenerative narrowing of the vertebral canal. Routine MRI may fail to detect the subtle early alterations of the cord. MRI Diffusion Tensor Imaging (DTI) possesses the potential to detect these changes. This study intends to estimate the potential of the DTI technique in non-stenotic & stenotic spinal canals in individuals affected with CSM. METHODOLOGY Sixty-four subjects who met the requirements of the inclusion criteria were incorporated into the investigation. All subjects underwent routine MRI sequences in addition to DTI of the cervical spine region. Scalars such as Fractional Anisotropy (FA), besides Apparent Diffusion Coefficient (ADC), were computed at each cervical intervertebral fibrocartilaginous disc level for all subjects. DTI fiber tractography was then performed to qualitatively assess the microstructural integrity of the tracts. RESULTS A noteworthy difference (p<0.05) was seen in the FA parameter and ADC parameter values between the stenotic and non-stenotic groups, with the non-stenotic group having a higher mean FA and a lower ADC than the stenotic group (at the level of stenosis). A significant difference in age was seen between both groups, with most of the patients in the stenotic group belonging to 40 years and above. Tractography helped in demonstrating the morphology of the fiber tracts. CONCLUSION DTI parameters, namely FA and ADC, are sensitive to damage to the white matter and can be used to detect microstructural changes in the cord. However, standardization of the protocol is necessary when imaging the spinal canal.
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Affiliation(s)
- Kauthankar Akshada Atchut
- Department of Radiodiagnosis and Imaging, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Lathika Shetty
- Department of Radiodiagnosis and Imaging, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Kayalvizhi Ravichandran
- Medical Imaging Technology, Department of Radiodiagnosis and Imaging, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India.
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13
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Tounekti S, Alizadeh M, Middleton D, Harrop JS, Bassem H, Krisa L, Mekkaoui C, Mohamed FB. Metal Artifact Reduction Around Cervical Spine Implant Using Diffusion Tensor Imaging at 3T: A Phantom Study. RESEARCH SQUARE 2023:rs.3.rs-2665952. [PMID: 36993535 PMCID: PMC10055636 DOI: 10.21203/rs.3.rs-2665952/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Diffusion MRI continues to play a key role in non-invasively assessing spinal cord integrity and pre-operative injury evaluation. However, post-operative Diffusion Tensor Imaging (DTI) acquisition of a patient with a metal implant results in severe geometric image distortion. A method has been proposed here to alleviate the technical challenges facing the acquisition of DTI in post-operative cases and to evaluate longitudinal therapeutics. The described technique is based on the combination of the reduced Field-Of-View (rFOV) strategy and the phase segmented acquisition scheme (rFOV-PS-EPI) for significantly mitigating metal-induced distortions. A custom-built phantom based on spine model with metal implant was used to collect high-resolution DTI data at 3 Tesla scanner using a home-grown diffusion MRI pulse sequence, rFOV-PS-EPI, single-shot (rFOV-SS-EPI), and the conventional full FOV techniques including SS-EPI, PS-EPI, and the readout-segmented (RS-EPI). This newly developed method provides high-resolution images with significant reduced metal-induced artifacts. In contrast to the other techniques, the rFOV-PS-EPI allows DTI measurement at the level of the metal hardware whereas the current rFOV-SS-EPI is useful when the metal is approximately 20 mm away. The developed approach enables high-resolution DTI in patients with metal implant.
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14
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Vázquez-Sánchez F, Lloria-Gil MDC, Gómez-Menéndez AI, Isidro-Mesas F, Echavarría-Íñiguez A, Martín-Alonso J, González-Bernal J, González-Santos J, Berardi A, Tofani M, Galeoto G, García-López B. The Role of Magnetic Transcranial Stimulation in the Diagnosis and Post-Surgical Follow-Up of Cervical Spondylotic Myelopathy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3690. [PMID: 36834385 PMCID: PMC9959727 DOI: 10.3390/ijerph20043690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
Degenerative cervical myelopathy (DCM) consists of spinal cord damage due to its compression through the cervical spine. The leading cause is degenerative. The diagnosis is clinical, and the therapeutic approach is usually surgical. Confirmation of the diagnostic suspicion is done by magnetic resonance imaging (MRI); however, this test lacks functional information of the spinal cord, the abnormality of which may precede involvement in neuroimaging. Neurophysiological examination using somatosensory evoked potentials (SSEPs) and transcranial magnetic stimulation (TMS) allows for an evaluation of spinal cord function, and provides information in the diagnostic process. Its role in the post-surgical follow-up of patients undergoing decompressive surgery is being studied. We present a retrospective study of 24 patients with DCM and surgical decompression who underwent neurophysiological tests (TMS and SSEP) before, 6, and 12 months after surgery. The result of the TMS and the SSEP in the post-operative follow-up did not correlate with the clinical outcome, either subjective or measured by clinical scales at six months. We only found post-surgical improvement of central conduction times (CMCTs) in patients with severe pre-surgical motor impairment on TMS. In patients with normal pre-surgical CMCT, we found a transient worsening with return to baseline at the one-year follow-up. Most patients presented pre-surgical increased P40 latency at diagnosis. CMCT and SSEP were more related to clinical outcomes one year after the surgical procedure and were very useful in diagnosing.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Tofani
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
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15
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Wu X, Wang Y, Chang J, Zhu K, Zhang S, Li Y, Zuo J, Chen S, Jin W, Yan T, Yang K, Xu P, Song P, Wu Y, Qian Y, Shen C, Yu Y, Dong F. Remodeling of the brain correlates with gait instability in cervical spondylotic myelopathy. Front Neurosci 2023; 17:1087945. [PMID: 36816111 PMCID: PMC9932596 DOI: 10.3389/fnins.2023.1087945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Cervical spondylotic myelopathy (CSM) is a common form of non-traumatic spinal cord injury (SCI) and usually leads to remodeling of the brain and spinal cord. In CSM with gait instability, the remodeling of the brain and cervical spinal cord is unclear. We attempted to explore the remodeling of these patients' brains and spinal cords, as well as the relationship between the remodeling of the brain and spinal cord and gait instability. Methods According to the CSM patients' gait, we divided patients into two groups: normal gait patients (nPT) and abnormal gait patients (aPT). Voxel-wise z-score transformation amplitude of low-frequency fluctuations (zALFF) and resting-state functional connectivity (rs-FC) were performed for estimating brain changes. Cross-sectional area (CSA) and fractional anisotropy (FA) of the spinal cord were computed by Spinal cord toolbox. Correlations of these measures and the modified Japanese Orthopedic Association (mJOA) score were analyzed. Results We found that the zALFF of caudate nucleus in aPT was higher than that in healthy controls (HC) and lower than that in nPT. The zALFF of the right postcentral gyrus and paracentral lobule in HC was higher than those of aPT and nPT. Compared with the nPT, the aPT showed increased functional connectivity between the caudate nucleus and left angular gyrus, bilateral precuneus and bilateral posterior cingulate cortex (PCC), which constitute a vital section of the default mode network (DMN). No significantly different FA values or CSA of spinal tracts at the C2 level were observed between the HC, nPT and aPT groups. In CSM, the right paracentral lobule's zALFF was negatively correlated with the FA value of fasciculus gracilis (FCG), and the right caudate zALFF was positively correlated with the FA value of the fasciculus cuneatus (FCC). The results showed that the functional connectivity between the right caudate nucleus and DMN was negatively correlated with the CSA of the lateral corticospinal tract (CST). Discussion The activation of the caudate nucleus and the strengthening functional connectivity between the caudate nucleus and DMN were associated with gait instability in CSM patients. Correlations between spinal cord and brain function might be related to the clinical symptoms in CSM.
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Affiliation(s)
- Xianyong Wu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ying Wang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jianchao Chang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kun Zhu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Siya Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China,School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Yan Li
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Junxun Zuo
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Senlin Chen
- Department of Orthopedics, Dongcheng Branch of The First Affiliated Hospital of Anhui Medical University (Feidong People’s Hospital), Hefei, China
| | - Weiming Jin
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tingfei Yan
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kun Yang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Xu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peiwen Song
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuanyuan Wu
- Department of Medical Imaging, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Yuanyuan Wu,
| | - Yinfeng Qian
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cailiang Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China,Department of Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fulong Dong
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China,*Correspondence: Fulong Dong,
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16
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Su BW, Tadepalli V, Kamalapathy PN, Shimer A. Prognostic Factors Impacting Surgical Outcomes in Patients With Cervical Spondylotic Myelopathy. Clin Spine Surg 2022; 35:418-421. [PMID: 36447346 DOI: 10.1097/bsd.0000000000001404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022]
Abstract
The purpose of surgical decompression in patients who have CSM is to stop the progression of symptoms and hopefully improve function. It is critical to understand prognostic factors that affect the outcome. Factors intrinsic to the patient that can adversely affect outcomes include diabetes, older age, tobacco use, the presence of mental health disease, and obesity. MRI imaging findings of T2 hyperintensity and clinical duration and severity of symptoms is also associated with poorer outcomes. Patients should be counseled regarding the efficacy of decompressive procedures for CSM and given realistic expectations based on their unique biophysical profiles.
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17
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He B, Sheldrick K, Das A, Diwan A. Clinical and Research MRI Techniques for Assessing Spinal Cord Integrity in Degenerative Cervical Myelopathy-A Scoping Review. Biomedicines 2022; 10:2621. [PMID: 36289883 PMCID: PMC9599413 DOI: 10.3390/biomedicines10102621] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) manifests as the primary cause of spinal cord dysfunction and is non-traumatic, chronic and progressive in nature. Decompressive surgery is typically utilised to halt further disability and neurological dysfunction. The limitations of current diagnostic options surrounding assessment and prognostic potential render DCM still largely a clinical diagnosis. AIMS To outline the limitations of current diagnostic techniques, present evidence behind novel quantitative MRI (qMRI) techniques for assessing spinal cord integrity in DCM and suggest future directions. METHOD Articles published up to November 2021 were retrieved from Medline, EMBASE and EBM using key search terms: spinal cord, spine, neck, MRI, magnetic resonance imaging, qMRI, T1, T2, T2*, R2*, DTI, diffusion tensor imaging, MT, magnetisation transfer, SWI, susceptibility weighted imaging, BOLD, blood oxygen level dependent, fMRI, functional magnetic resonance imaging, functional MRI, MRS, magnetic resonance spectroscopy. RESULTS A total of 2057 articles were retrieved with 68 articles included for analysis. The search yielded 2 articles on Quantitative T1 mapping which suggested higher T1 values in spinal cord of moderate-severe DCM; 43 articles on DTI which indicated a strong correlation of fractional anisotropy and modified Japanese Orthopaedic Association scores; 15 articles on fMRI (BOLD) which demonstrated positive correlation of functional connectivity and volume of activation of various connections in the brain with post-surgical recovery; 6 articles on MRS which suggested that Choline/N-acetylaspartate (Cho/NAA) ratio presents the best correlation with DCM severity; and 4 articles on MT which revealed a preliminary negative correlation of magnetisation transfer ratio with DCM severity. Notably, most studies were of low sample size with short timeframes within 6 months. CONCLUSIONS Further longitudinal studies with higher sample sizes and longer time horizons are necessary to determine the full prognostic capacity of qMRI in DCM.
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Affiliation(s)
- Brandon He
- Spine Labs, St. George & Sutherland Clinical School, UNSW Faculty of Medicine, Kogarah, NSW 2217, Australia
- Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Kyle Sheldrick
- Spine Labs, St. George & Sutherland Clinical School, UNSW Faculty of Medicine, Kogarah, NSW 2217, Australia
- Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Abhirup Das
- Spine Labs, St. George & Sutherland Clinical School, UNSW Faculty of Medicine, Kogarah, NSW 2217, Australia
- Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Ashish Diwan
- Spine Labs, St. George & Sutherland Clinical School, UNSW Faculty of Medicine, Kogarah, NSW 2217, Australia
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Kogarah, NSW 2217, Australia
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18
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Muacevic A, Adler JR. Identification of Degenerative Cervical Myelopathy in the Chiropractic Office: Case Report and a Review of the Literature. Cureus 2022; 14:e30508. [PMID: 36415361 PMCID: PMC9675290 DOI: 10.7759/cureus.30508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/14/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a common cause of spinal cord dysfunction, yet it may be challenging to identify as it presents with variable symptoms. A 62-year-old woman presented to a chiropractor with a three-month exacerbation of neck pain, hand/finger numbness, and torso dysesthesia. She had previously seen primary care, physical therapy, rheumatology, and pain management. Previous cervical magnetic resonance imaging showed moderate cervical canal stenosis; however, previous providers had diagnosed her with radiculopathy and possible carpal tunnel syndrome yet had not requested neurosurgical consultation. On examination, the chiropractor identified sensorimotor deficits, hyperreflexia, and bilateral Hoffman reflexes, and referred the patient to a neurosurgeon for suspected DCM. The neurosurgeon performed an anterior cervical discectomy and fusion from C4-7. The patient's symptoms and disability level improved within two months of follow-up. We identified 11 previous cases in which a chiropractor suspected DCM which was then confirmed by a surgeon. Including the current case (i.e., 12 total), patients were older and mostly male; 50% had neck pain, 92% had hyperreflexia. Chiropractors referred each patient to a surgeon; 83% underwent cervical spine surgery. This case highlights the identification of DCM by a chiropractor and referral for neurosurgical evaluation with a positive outcome. Patients with previously undiagnosed DCM may present to chiropractors with varied symptoms and examination findings. DCM may contraindicate spinal manipulation and instead warrant surgery. Accordingly, chiropractors play a key role in the detection and referral of patients with misdiagnosed or overlooked DCM.
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Ahuja K, Ifthekar S, Mittal S, Yadav G, Venkata Sudhakar P, Sharma P, Venkata Subbaih A, Kandwal P. Role of Diffusion Tensor Imaging in neurological prognostication in Spinal Tuberculosis – A prospective pilot study. Eur J Radiol 2022; 157:110530. [DOI: 10.1016/j.ejrad.2022.110530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/16/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
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Akshiitha J R, Gopinath G, Divya M, Paarthipan N. The Role of Diffusion Tensor Tractography in Assessment of Spondylotic Myelopathy. Cureus 2022; 14:e25778. [PMID: 35706439 PMCID: PMC9187187 DOI: 10.7759/cureus.25778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Cervical spondylotic myelopathy (CSM) describes a neurological deficit related to the spinal cord due to the changes in the facet joints and discs of the cervical spine as a result of degeneration. Diagnosis is mainly dependent on imaging. Diffusion tensor tractography (DTT), being a non-invasive technique, shows better sensitivity when compared to the conventional T2WI sequence in the early detection of cervical spondylotic myelopathy (CSM). The objective was to determine the diagnostic accuracy of the apparent diffusion coefficient (ADC) in predicting high T2 signals in CSM. Methods A prospective observational study was done on 47 subjects aged between 25 and 70 years, referred to the department of radiology with clinical and imaging evidence of CSM in a tertiary care institute in Chennai. Nurick classification system was used to assess severity clinically. Diffusion-weighted imaging and DTT were done with 1.5 Tesla MRI. The primary outcome variable was a high T2 signal. Mean fractional anisotropy (FA) at the stenotic level and ADC value at a stenotic level were considered explanatory variables. The sensitivity, specificity, predictive values, and diagnostic accuracy of the screening test with the decided cut-off values along with their 95% CI were presented. P-value <0.05 was considered statistically significant. SPSS version 22 (IBM Inc., Armonk, New York) was used for statistical analysis. Results The mean age was 48.26 ± 10.28 years. The majority (72.34%) were males, the majority (42.55%) had a Nurick score of two, and 25.53% had a Nurick score of one. Twenty-six (55.32%) reported a high T2 signal, 36 (76.60%) had elevated ADC, and 11 (23.40 %) had no elevated ADC. There was a statistically significant difference in mean FA and ADC values across groups categorized as non-stenotic level and stenotic level (p-value <0.05). The ADC value had a moderately high sensitivity (76.92%) and low specificity (23.81%) in predicting high T2 signals with a diagnostic accuracy of 53.19%. Conclusion DTI parameters at stenotic level (ADC and FA values) in patients with cervical spondylosis help in the early detection of cervical cord compressive myelopathy prior to the appearance of T2 signal changes in conventional MRI, thereby improving clinical outcome and patient management.
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Chen S, Wang Y, Wu X, Chang J, Jin W, Li W, Song P, Wu Y, Zhu J, Qian Y, Shen C, Yu Y, Dong F. Degeneration of the Sensorimotor Tract in Degenerative Cervical Myelopathy and Compensatory Structural Changes in the Brain. Front Aging Neurosci 2022; 14:784263. [PMID: 35444527 PMCID: PMC9014124 DOI: 10.3389/fnagi.2022.784263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/09/2022] [Indexed: 12/19/2022] Open
Abstract
Degenerative cervical myelopathy is a progressive neurodegenerative disease, that has become increasingly prevalent in the aging population worldwide. The current study determined the factors affecting degeneration in the sensorimotor tract with degenerative cervical myelopathy and its relationship with brain structure. We divided patients into hyperintensity (HS) and non-hyperintensity (nHS) groups and measured the fractional anisotropy and apparent diffusion coefficients of the lateral corticospinal tract (CST), fasciculus gracilis and fasciculus cuneatus (FGC). Voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) techniques were used to estimate brain structure changes. Correlation of the modified Japanese Orthopaedic Association (mJOA) score, light touch, pinprick, motor score, and fractional anisotropy (FA) ratios of the CST at different levels were analyzed. Compared to healthy controls, the FA ratios of CST in the HS and nHS groups were decreased at all levels, and the apparent diffusion coefficient (ADC) ratio was increased only at C4/5 levels in the HS group. The FA ratio of FGC was decreased at the C3/4 and C4/5 levels in the HS group and only decreased at the C4/5 level in the nHS group. The ADC ratio was decreased only at the C4/5 level in the HS group. VBM analysis revealed that the volume of the precentral gyrus, postcentral gyrus, and paracentral lobule increased in patients compared to controls. TBSS analysis found no statistical significance between the sensory and motor tracts in white matter. The volume of clusters in HS and nHS groups negatively correlated with the C1/2 FA ratio of the CST. The results showed that the degeneration distance of the CST was longer than the FGC, and the degeneration distance was related to the degree of compression and spinal cord damage. Structural compensation and the neurotrophin family may lead to enlargement of the brain.
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Affiliation(s)
- Senlin Chen
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Ying Wang
- Department of Radiology, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Xianyong Wu
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Jianchao Chang
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Weiming Jin
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Wei Li
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Peiwen Song
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Yuanyuan Wu
- Department of Medical Imaging, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Jiajia Zhu
- Department of Radiology, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Yinfeng Qian
- Department of Radiology, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Cailiang Shen
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Fulong Dong
- Department of Orthopedics, Department of Spine Surgery, The First Affiliated Hospital of AnHui Medical University, Hefei, China
- *Correspondence: Fulong Dong
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Clinical application of diffusion tensor tractography to postoperative C5 palsy. Spinal Cord Ser Cases 2021; 7:83. [PMID: 34552046 DOI: 10.1038/s41394-021-00447-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Diagnostic study. OBJECTIVE Although C5 palsy is a well-known potential complication after cervical procedure, the exact pathophysiology remains uncertain. Diffusion tensor tractography (DTT) has recently been proposed as a useful tool to examine quantitatively and non-invasively the pathology of spinal cord disorders. The purpose of this study is to determine the clinical interest of DTT in patients with C5 palsy after cervical laminoplasty. SETTING Single university hospital. METHODS Five patients with C5 palsy out of 108 patients after cervical laminoplasty were subjected to DTT using a 1.5 Tesla magnetic resonance imaging in our hospital between 2010 and 2012. For the tractography, two regions of interest (ROI) were placed at the C5 segmental level and the bilateral C4/5 intervertebral foramen level. RESULTS The postoperative number of tract fibers at the C5 segmental spinal cord level was significantly increased compared to the preoperative number, despite the C5 palsy. Analyses of two ROIs (at the C5 segmental level and the C4/5 intervertebral foramen level) showed that the number of tract fibers at the palsy side was significantly decreased compared to the intact side. Furthermore, in the patient who spontaneously recovered from C5 palsy within postoperative 6 months, a gradual augmentation of tract fibers was identified at the palsy side. CONCLUSIONS Our findings suggest that DTT can document C5 palsy in detail, as the anatomical region between C5 segmental level and C4/5 intervertebral foramen level was potentially damaged in patients with C5 palsy after laminoplasty.
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Sharma N, Alugolu R, Gangapatnam D, Saradhi MV. Role of Diffuse Tensor Imaging in Predicting Outcomes of Decompressive Surgery in Degenerative Cervical Myelopathy—A Prospective Analysis. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1727421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Background Cervical spondylotic myelopathy is a common degenerative disorder of the cervical spine. Assessing the severity of the disease objectively remains a challenge. Advances in magnetic resonance imaging (MRI), especially diffusion tensor imaging (DTI), elucidate the damaged or compressed fiber tracts in the cord. This study is our endeavor to correlate the relationship between clinical features, radiological features with special reference to DTI, and surgical outcome in patients with degenerative cervical myelopathy.
Methods All consecutive patients of cervical spondylotic myelopathy and cord intensity changes in MRI, admitted and treated in the department of neurosurgery during the period of 2016 to 2018, were included and evaluated clinically and radiologically. The clinical evaluation included motor assessment scale (MAS), 30 meters walking, and hand grip. Radiological investigations included additional DTI in 3T MRI and clinical outcome was measured postoperatively after 12 months by modified Japanese Orthopedic Association (mJOA) recovery ratio and MAS scores.
Results The patients age ranged from 30 to 80 years and the mean age of the study population was 55.95 ± 10 years. Patients with fractional anisotropy (FA) < 0.5 had higher grade of Nurick, that is, grade 5 in 4.3%, grade 4 in 65.2%, and grade 3 in 27.1% compared with grade 5 in 0%, grade 4 in 23.5%, and grade 3 in 47.1% in FA > 0.5. Mean mJOA recovery ratio in the group FA > 0.5 was 57.32 whereas it was 38.78 in FA < 0.5.
Conclusion DTI serves as a potential biomarker for predicting the surgical outcome in degenerative cervical myelopathy cases and thereby making the surgical decision precise. FA can be a potential quantitative tool to predict the functional outcome following decompressive surgery for degenerative cervical myelopathy conditions, in particular lower FA values carries poor prognosis.
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Affiliation(s)
- Neeraj Sharma
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rajesh Alugolu
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Dinesh Gangapatnam
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Mudumba Vijaya Saradhi
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
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Cheng SJ, Tsai PH, Lee YT, Li YT, Chung HW, Chen CY. Diffusion Tensor Imaging of the Spinal Cord. Magn Reson Imaging Clin N Am 2021; 29:195-204. [PMID: 33902903 DOI: 10.1016/j.mric.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Spinal cord often is regarded as one of the last territories in the central nervous system where diffusion tensor imaging (DTI) can be used to probe white matter architecture. This article reviews current progress in spinal cord DTI, starting with anatomic properties and technical challenges that make spinal cord DTI a difficult task. Several possibilities offered by advanced pulse sequences that might overcome the difficulties are addressed, with associated trade-offs and limitations. Potential clinical assistance also is discussed in various spinal cord pathologies, such as myelopathy due to external compression, spinal cord tumors, acute ischemia, traumatic injury, and so forth.
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Affiliation(s)
- Sho-Jen Cheng
- Department of Medical Imaging, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan
| | - Ping-Huei Tsai
- Department of Medical Imaging and Radiological Sciences, Chung-Shan Medical University, No.110, Sec.1, Jianguo N. Road, Taichung 40201, Taiwan
| | - Yun-Ting Lee
- Translational Imaging Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan
| | - Yi-Tien Li
- Translational Imaging Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan
| | - Hsiao-Wen Chung
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, No.1, Sec.4, Roosevelt Road, Taipei 10617, Taiwan; Department of Electrical Engineering, National Taiwan University, No.1, Sec.4, Roosevelt Road, Taipei 10617, Taiwan.
| | - Cheng-Yu Chen
- Department of Medical Imaging, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan; Translational Imaging Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan
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Nischal N, Tripathi S, Singh JP. Quantitative Evaluation of the Diffusion Tensor Imaging Matrix Parameters and the Subsequent Correlation with the Clinical Assessment of Disease Severity in Cervical Spondylotic Myelopathy. Asian Spine J 2020; 15:808-816. [PMID: 33189108 PMCID: PMC8696054 DOI: 10.31616/asj.2020.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/18/2020] [Indexed: 11/24/2022] Open
Abstract
Study Design We performed a prospective observational study of 52 patients who were clinically suspected of cervical spondylotic myelopathy (CSM), based on the modified Japanese Orthopaedic Association (mJOA) score, and were referred for magnetic resonance imaging (MRI) of the cervical spine. Purpose To evaluate the quantitative parameters of the diffusion tensor imaging (DTI) matrix (fractional anisotropy [FA] and apparent diffusion coefficient [ADC] values) and determine the subsequent correlation with the clinical assessment of disease severity in CSM. Overview of Literature Conventional MRI is the modality of choice for the identification of cervical spondylotic changes and is known to have a low sensitivity for myelopathy changes. DTI is sensitive to disease processes that alter the water movement in the cervical spinal cord at a microscopic level beyond the conventional MRI. Methods DTI images were processed to produce FA and ADC values of the acquired axial slices with the regions of interest placed within the stenotic and non-stenotic segments. The final quantitative radiological derivations were matched with the clinical scoring system. Results Total 52 people (24 men and 28 women), mean age 53.16 years with different symptoms of myelopathy, graded as mild (n=11), moderate (n=25), and severe (n=16) as per the mJOA scoring system, underwent MRI of the cervical spine with DTI. In the most stenotic segments, the mean FA value was significantly lower (0.5009±0.087 vs. 0.655.7±0.104, p<0.001), and the mean ADC value was significantly higher (1.196.5±0.311 vs. 0.9370±0.284, p<0.001) than that in the non-stenotic segments. The overall sensitivity in identifying DTI metrics abnormalities was more with FA (87.5%) and ADC (75.0%) than with T2 weighted images (25%). Conclusions In addition to the routine MRI sequences, DTI metrics (FA value better than ADC) can detect myelopathy even in patients with a mild grade mJOA score before irreversible changes become apparent on routine T2 weighted imaging and thus enhance the clinical success of decompression surgery.
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Affiliation(s)
- Neha Nischal
- Department of Radiology, Medanta-The Medicity, Gurugram, India
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Zhang H, Guan L, Hai Y, Liu Y, Ding H, Chen X. Multi-shot echo-planar diffusion tensor imaging in cervical spondylotic myelopathy. Bone Joint J 2020; 102-B:1210-1218. [PMID: 32862690 DOI: 10.1302/0301-620x.102b9.bjj-2020-0468.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIMS The aim of this study was to use diffusion tensor imaging (DTI) to investigate changes in diffusion metrics in patients with cervical spondylotic myelopathy (CSM) up to five years after decompressive surgery. We correlated these changes with clinical outcomes as scored by the Modified Japanese Orthopedic Association (mJOA) method, Neck Disability Index (NDI), and Visual Analogue Scale (VAS). METHODS We used multi-shot, high-resolution, diffusion tensor imaging (ms-DTI) in patients with cervical spondylotic myelopathy (CSM) to investigate the change in diffusion metrics and clinical outcomes up to five years after anterior cervical interbody discectomy and fusion (ACDF). High signal intensity was identified on T2-weighted imaging, along with DTI metrics such as fractional anisotropy (FA). MJOA, NDI, and VAS scores were also collected and compared at each follow-up point. Spearman correlations identified correspondence between FA and clinical outcome scores. RESULTS Significant differences in mJOA scores and FA values were found between preoperative and postoperative timepoints up to two years after surgery. FA at the level of maximum cord compression (MCL) preoperatively was significantly correlated with the preoperative mJOA score. FA postoperatively was also significantly correlated with the postoperative mJOA score. There was no statistical relationship between NDI and mJOA or VAS. CONCLUSION ms-DTI can detect microstructural changes in affected cord segments and reflect functional improvement. Both FA values and mJOA scores showed maximum recovery two years after surgery. The DTI metrics are significantly associated with pre- and postoperative mJOA scores. DTI metrics are a more sensitive, timely, and quantifiable surrogate for evaluating patients with CSM and a potential quantifiable biomarker for spinal cord dysfunction. Cite this article: Bone Joint J 2020;102-B(9):1210-1218.
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Affiliation(s)
- Hanwen Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Li Guan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongtao Ding
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Chen
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Microstructural Changes in Compressed Cervical Spinal Cord Are Consistent With Clinical Symptoms and Symptom Duration. Spine (Phila Pa 1976) 2020; 45:E999-E1005. [PMID: 32706563 DOI: 10.1097/brs.0000000000003480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE To investigate the association between microstructural changes measured by diffusion tensor imaging (DTI) and clinical symptoms and their duration in patients with cervical spondylotic myelopathy (CSM) affected by single level. SUMMARY OF BACKGROUND DATA No report was reported regarding the association between the microstructural changes and the symptoms and their duration at single-level spinal cord compression. METHODS Twenty-nine consecutive patients with CSM and 29 normal subjects were enrolled in this study. DTI with tractography was performed on the cervical spinal cord. Clinical symptoms were evaluated using modified Japanese Orthopaedic Association (mJOA) scores for each patient, and the duration of clinical symptoms was noted based on the earliest instance of limb pain or numbness or weakness or bladder dysfunction. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated from tractography images. RESULTS The mean FA value of the cervical compressed spinal cord was significantly lower than the FA of the normal population (P < 0.001). The mean ADC value in the cervical compressed spinal cord was obviously higher than those of normal cervical spinal cord (P < 0.001). In the CSM patients, a significant positive association was observed between FA values and mJOA scores (P < 0.001). However, there were a notable negative association between mJOA scores and ADC values (P < 0.001), and between mJOA scores and symptom duration (P < 0.001). CONCLUSION These results illustrate DTI can measure the micostructural changes of cervical spinal cord and DTI parameters are potential biomarkers for spinal cord dysfunction in patients with CSM. LEVEL OF EVIDENCE 3.
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Noguerol TM, Barousse R, Amrhein TJ, Royuela-del-Val J, Montesinos P, Luna A. Optimizing Diffusion-Tensor Imaging Acquisition for Spinal Cord Assessment: Physical Basis and Technical Adjustments. Radiographics 2020; 40:403-427. [DOI: 10.1148/rg.2020190058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Teodoro Martín Noguerol
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Rafael Barousse
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Timothy J. Amrhein
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Javier Royuela-del-Val
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Paula Montesinos
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
| | - Antonio Luna
- From the MRI Section, Department of Radiology, SERCOSA, Health Time, Carmelo Torres 2, 23007, Jaén, Spain (T.M.N., A.L.); Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina (R.B.); Department of Radiology, Duke University Medical Center, Durham, N.C. (T.J.A.); RESSALTA, Health Time, Córdoba, Spain (J.R.d.V.); and Philips Iberia, Madrid, Spain (P.M.)
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Hassan TAAEH, Assad RE, Belal SA. MR diffusion tensor imaging of the spinal cord: can it help in early detection of cervical spondylotic myelopathy and assessment of its severity? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0072-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this study is to evaluate the potential application of MR diffusion tensor imaging (with calculation of fractional anisotropy (FA) values) in assessment of the spondylotic cervical spinal canal compromise and comparison with the information issued from conventional MR sequences for early detection of cervical spondylotic myelopathy (CSM). Thirty patients (11 males and 19 females) were included in this study; age ranged from 22 to 70 years (mean age = 44). All patients had conventional and diffusion tensor imaging (DTI) examinations of the cervical spine for detection and assessment of degree of cervical cord myelopathy. FA values of the whole cord circumference and at 3, 6, 9, 12 o’clock positions of the normal cord (opposite to C2), opposite to the most affected disc, and below the level of the most affected disc were measured.
Results
High statistically significant P values were obtained when comparing the FA values of the normal cord with the cord opposite to the most affected disc, the normal cord with the cord below the affected disc and the cord at the level of the most affected disc with the cord below the level of the most affected disc.
Conclusions
DTI of the cervical spinal cord with FA measurement in patients with cervical spondylosis helps in early detection of cervical cord compressive myelopathy prior to appearance of changes in conventional MRI, which can improve the clinical outcome and help in treatment plans.
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Rall JM, Gebremariam FA, Joubert G. Imaging findings of penetrating spinal cord injuries secondary to stab wounds on magnetic resonance imaging in a tertiary trauma unit, South Africa. SA J Radiol 2019; 23:1761. [PMID: 31754543 PMCID: PMC6837822 DOI: 10.4102/sajr.v23i1.1761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/19/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In South Africa, the leading cause of spinal cord injuries is motor vehicle accidents, followed by violence-related injuries, including gunshot injuries and stab wounds. Controversy regarding management persists. Magnetic resonance imaging (MRI) is the gold standard to rule out surgical causes of neurological deficit. OBJECTIVES To determine the spectrum of imaging findings in penetrating spinal cord injuries, specifically related to stab wounds, in a Tertiary Academic Hospital in the Free State province and whether these imaging findings influenced immediate surgical decision-making and outcomes of patients. METHOD Consecutive sampling was used to retrospectively select patients who presented with spinal penetrating injuries secondary to stab wounds during the period 01 August 2013-30 September 2016 and received MRI investigation. Fifty-six patients were included. Magnetic resonance imaging investigations were reviewed by the authors, with documentation of MRI findings, relevant patient demographics and clinical information into Excel spread sheets. Statistical analysis was performed by the Biostatistics Department of the University of the Free State. RESULTS The most common MRI finding was a high signal intensity wound tract (96.6%), followed by cord signal changes (91.1%) and cord oedema (82.1%). Thirty-nine extra-axial collections were diagnosed in 30 penetrating injuries, of which only one had spinal compressive effects. Four patients (7.1%) demonstrated pseudo-meningoceles. None of the included patients had an indication for emergency spinal surgery on review of imaging. CONCLUSION Magnetic resonance imaging findings did not alter the surgical course of action in our study patients. Despite this, MRI is a valuable modality in evaluation of penetrating spinal cord injuries in the post-traumatic phase (<24 h) for the presence of pseudo-meningoceles that pose an infection and delayed complication risk.
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Affiliation(s)
- Jacolien M Rall
- Department of Clinical Imaging Sciences, University of the Free State, Bloemfontein, South Africa
| | - Fekade A Gebremariam
- Department of Clinical Imaging Sciences, University of the Free State, Bloemfontein, South Africa
| | - Gina Joubert
- Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
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Juliano AF, Policeni B, Agarwal V, Burns J, Bykowski J, Harvey HB, Hoang JK, Hunt CH, Kennedy TA, Moonis G, Pannell JS, Parsons MS, Powers WJ, Rosenow JM, Schroeder JW, Slavin K, Whitehead MT, Corey AS. ACR Appropriateness Criteria ® Ataxia. J Am Coll Radiol 2019; 16:S44-S56. [PMID: 31054758 DOI: 10.1016/j.jacr.2019.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 01/14/2023]
Abstract
Ataxia can result from an abnormality in the cerebellum, spinal cord, peripheral nerves, and/or vestibular system. Pathology involving the brain, such as infarct or hydrocephalus, can also present with ataxia as part of the symptom constitution, or result in symptoms that mimic ataxia. Clinical evaluation by history and careful neurological examination is important to help with lesion localization, and helps determine where imaging should be focused. In the setting of trauma with the area of suspicion in the brain, a head CT without intravenous contrast is the preferred initial imaging choice. If vascular injury is suspected, CTA of the neck can be helpful. When the area of suspicion is in the spine, CT or MRI of the spine can be considered to assess for bony or soft-tissue injury, respectively. In the setting of ataxia unrelated to recent trauma, MRI is the preferred imaging modality, tailored to assess the brain or spine depending on the area of suspected pathology. The use of intravenous contrast is generally helpful. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Amy F Juliano
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Vikas Agarwal
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | - Jenny K Hoang
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Gul Moonis
- Columbia University Medical Center, New York, New York
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; neurosurgical consultant
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Zhang C, Ding Q, He H, Peng Y, Li C, Mai J, Li JS, Zhong J, Chang MW. Nanoporous hollow fibers as a phantom material for the validation of diffusion magnetic resonance imaging. J Appl Polym Sci 2019. [DOI: 10.1002/app.47617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Chunchen Zhang
- Key Laboratory for Biomedical Engineering of Education Ministry of China; Zhejiang University; Hangzhou 310027 People's Republic of China
- Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal; Zhejiang University; Hangzhou 310027 People's Republic of China
| | - Qiuping Ding
- Key Laboratory for Biomedical Engineering of Education Ministry of China; Zhejiang University; Hangzhou 310027 People's Republic of China
- Center for Brain Imaging Science and Technology, College of Biomedical Engineering and Instrumental Science; Zhejiang University; Hangzhou 310027 People's Republic of China
| | - Hongjian He
- Key Laboratory for Biomedical Engineering of Education Ministry of China; Zhejiang University; Hangzhou 310027 People's Republic of China
- Center for Brain Imaging Science and Technology, College of Biomedical Engineering and Instrumental Science; Zhejiang University; Hangzhou 310027 People's Republic of China
| | - Yu Peng
- College of Civil Engineering and Architecture; Zhejiang University; Hangzhou 310027 People's Republic of China
| | - Chen Li
- Key Laboratory for Biomedical Engineering of Education Ministry of China; Zhejiang University; Hangzhou 310027 People's Republic of China
- Center for Brain Imaging Science and Technology, College of Biomedical Engineering and Instrumental Science; Zhejiang University; Hangzhou 310027 People's Republic of China
| | - John Mai
- Alfred E. Mann Institute for Biomedical Engineering; University of Southern California; California Los Angeles 90089
| | - Jing-Song Li
- Key Laboratory for Biomedical Engineering of Education Ministry of China; Zhejiang University; Hangzhou 310027 People's Republic of China
| | - Jianhui Zhong
- Key Laboratory for Biomedical Engineering of Education Ministry of China; Zhejiang University; Hangzhou 310027 People's Republic of China
- Center for Brain Imaging Science and Technology, College of Biomedical Engineering and Instrumental Science; Zhejiang University; Hangzhou 310027 People's Republic of China
| | - Ming-Wei Chang
- Key Laboratory for Biomedical Engineering of Education Ministry of China; Zhejiang University; Hangzhou 310027 People's Republic of China
- Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal; Zhejiang University; Hangzhou 310027 People's Republic of China
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Yang HE, Kim SW, Yoo WK. Diffusion Metrics as a Potential Prognostic Biomarker in Cervical Myelopathy. BRAIN & NEUROREHABILITATION 2019. [DOI: 10.12786/bn.2019.12.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hea-Eun Yang
- Department of Physical Medicine and Rehabilitation, VHS Medical Center, Seoul, Korea
| | - Seok Woo Kim
- Spine Center, Hallym University Sacred Heart Hospital, Anyang, Korea
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Anyang, Korea
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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: 0.4] [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.
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Jiang W, Han X, Guo H, Ma XD, Wang J, Cheng X, Yu A, Song Q, Shi K, Dai J. Usefulness of conventional magnetic resonance imaging, diffusion tensor imaging and neurite orientation dispersion and density imaging in evaluating postoperative function in patients with cervical spondylotic myelopathy. J Orthop Translat 2018; 15:59-69. [PMID: 30310766 PMCID: PMC6176747 DOI: 10.1016/j.jot.2018.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022] Open
Abstract
Objective The objective of this study was to evaluate the usefulness of T2 high signal intensity (T2-HSI) and decreased anteroposterior diameter (APD), diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) in evaluating postoperative cervical cord function. Methods The study included 57 postoperative cervical spondylotic myelopathy patients. Clinical evaluation and functional recovery assessments were performed using the modified Japanese Orthopaedic Association (mJOA) score and recovery rate. The presence of T2-HSI and decreased APD was recorded for exploring the relevance. Spearman correlation was applied to investigate the relationships between DTI and NODDI metrics and mJOA score. Multiple comparisons of T2 signal intensity, APD and diffusion metrics were evaluated by using multiple linear regression. Results Only the recovery rate was significantly different between T2-HSI and non-T2-HSI (nT2-HSI) patients (χ2 = 4.466, p = 0.045). Significant differences were not observed between cervical cords with and without decreased APD. Diffusion metrics, including fractional anisotropy (p = 0.0005), mean diffusivity (p = 0.0008), radial diffusivity (p = 0.0003) and intracellular volume fraction (p = 0.001), were significantly correlated with mJOA score. The ability of T2 signal intensity (p = 0.421) and APD (p = 0.420) to evaluate the postoperative function was inferior to that of fractional anisotropy (p = 0.002), mean diffusivity (p = 0.001), radial diffusivity (p = 0.001) and intracellular volume fraction (p = 0.004). Conclusion Conventional magnetic resonance imaging signs could be considered as a reference to make an approximate assessment, whereas DTI and NODDI could be better quantitative tools for evaluating the postoperative function and may help in interpreting residual symptoms. The translational potential of this article DTI and NODDI could provide reliable postoperative evaluation and analysis for cervical spondylotic myelopathy patients.
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Affiliation(s)
- Wen Jiang
- Department of Radiology, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, China
| | - Xiao Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiao Dong Ma
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jinchao Wang
- Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, No. 31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - Aihong Yu
- Department of Radiology, Beijing Jishuitan Hospital, No. 31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - Qingpeng Song
- Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31 Xinjiekoudongjie, Xicheng District, Beijing, China
| | - Kaining Shi
- Integrated Solution Center, Philips Healthcare China, 16-2-7, Tianzelu, Chaoyang District, Beijing, China
| | - Jianping Dai
- Department of Radiology, Beijing Tian Tan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, China
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Sun W, Tan J, Li Z, Lu S, Li M, Kong C, Hai Y, Gao C, Liu X. Evaluation of Hyperbaric Oxygen Treatment in Acute Traumatic Spinal Cord Injury in Rats Using Diffusion Tensor Imaging. Aging Dis 2018; 9:391-400. [PMID: 29896427 PMCID: PMC5988594 DOI: 10.14336/ad.2017.0726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/26/2017] [Indexed: 11/10/2022] Open
Abstract
This study aimed to evaluate the therapeutic effect of hyperbaric oxygen (HBO) on acute spinal cord injury (SCI) by measuring the in vivo diffusion tensor imaging (DTI) parameters apparent diffusion coefficient (ADC) and fractional anisotropy (FA) and observing diffusion tensor tractography (DTT) of fiber bundle morphology. The rats were randomly divided into sham-operated (SH), SCI, and SCI and hyperbaric oxygen treatment (SCI + HBO) groups (n = 6 in each group). The Basso-Bettie-Bresnahan (BBB) score was used to evaluate motor function recovery, and DTI was performed on days 3, 7, 14, and 21 after surgery. BBB scores and FA values decreased significantly after SCI, while the two values significantly improved in the SCI + HBO group compared with the SCI group on days 7, 14, and 21. ADC increased significantly on days 14 and 21 postoperatively in the SCI group compared with the SH group but did not significantly differ between the SCI and SCI + HBO groups at any time point. BBB scores had the same variation trend with ADC values and FA values in all three groups. In the SH group, DTT showed a well-organized spinal cord, but the spinal cord showed interruptions at sites of injury after SCI. In conclusion, HBO promotes the recovery of neuronal function after SCI. Parameters of DTI, especially FA, can quantitatively evaluate the efficacy of HBO treatment in SCI, while DTT enables the visualization of the fiber tracking of spinal cord tracts.
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Affiliation(s)
- Wenzhi Sun
- 1Department of Orthopaedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing 100020, China
| | - Jiewen Tan
- 2Department of Hyperbaric Oxygen, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510520, China
| | - Zhuo Li
- 3Department of Hyperbaric Oxygen, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Shibao Lu
- 1Department of Orthopaedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing 100020, China
| | - Man Li
- 4Departments of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Chao Kong
- 1Department of Orthopaedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing 100020, China
| | - Yong Hai
- 5Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Chunjin Gao
- 3Department of Hyperbaric Oxygen, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Xuehua Liu
- 3Department of Hyperbaric Oxygen, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Dong F, Wu Y, Song P, Qian Y, Wang Y, Xu L, Yin M, Zhang R, Tao H, Ge P, Liu C, Zhang H, Zhu J, Shen C, Yu Y. A preliminary study of 3.0-T magnetic resonance diffusion tensor imaging in 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 2018; 27:1839-1845. [DOI: 10.1007/s00586-018-5579-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/05/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
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Ellingson BM, Salamon N, Woodworth DC, Yokota H, Holly LT. Reproducibility, temporal stability, and functional correlation of diffusion MR measurements within the spinal cord in patients with asymptomatic cervical stenosis or cervical myelopathy. J Neurosurg Spine 2018; 28:472-480. [PMID: 29424671 DOI: 10.3171/2017.7.spine176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to quantify the reproducibility, temporal stability, and functional correlation of diffusion MR characteristics in the spinal cord in patients with cervical stenosis with or without myelopathy. The association between longitudinal diffusion tensor imaging (DTI) measurements and serial neurological function assessment was explored at both the group and individual level. METHODS Sixty-six nonoperatively treated patients with cervical stenosis were prospectively followed (3 months to > 5 years) using synchronous serial MRI and functional outcome assessment. A total of 183 separate MRI examinations were performed, separated by at least 3 months, and each patient had a minimum of 2 MRI scans (range 2-5 scans). Anatomical and DTI measurements were performed within the spinal cord at the C1-2 region as well as at the area of highest compression. Coefficients of variance (COVs) were compared across measurements in both reference tissue and areas of compression for anatomical measurements, fractional anisotropy (FA), and mean diffusivity (MD). The correlation between diffusion MR measures at the site of compression and evaluations of neurological function assessed using the modified Japanese Orthopaedic Association (mJOA) scale at multiple time points was evaluated. RESULTS The COVs for anatomical measurements (Torg ratio and canal diameter) were between 7% and 10%. The median COV for FA measurements at the site of compression was 9%, and for reference tissue at C1-2 it was 6%. The median COV for MD at the site of compression was approximately 12%, and for reference tissue at C1-2 it was 10%. The FA and MD measurements of C1-2 averaged 0.61 and 0.91 μm2/msec, respectively, whereas the FA and MD measurements at the site of compression averaged 0.51 and 1.26 μm2/msec, respectively. Both FA (slope = 0.037; R2 = 0.3281, p < 0.0001) and MD (slope = -0.074; R2 = 0.1101, p = 0.0084) were significantly correlated with the mJOA score. The FA decreased by approximately 0.032 units per mJOA unit decrease (R2 = 0.2037, p < 0.0001), whereas the MD was increased by approximately 0.084 μm2/msec for every mJOA unit decrease (R2 = 0.1016, p < 0.0001). CONCLUSIONS Quantitative DTI measurements of the spinal cord in patients with cervical stenosis with or without myelopathy have a median COV of 5%-10%, similar to anatomical measurements. The reproducibility of these measurements and significant correlation with functional outcome status suggest a potential role in the evaluation and longitudinal surveillance of nonoperatively treated patients. With respect to the specific DTI measurements, FA within the spinal cord appears slightly more sensitive to neurological function and more stable than measures of MD. Therefore, DTI of the spinal cord may be a clinically feasible imaging technique for longitudinally monitoring patients with cervical spondylotic myelopathy.
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Affiliation(s)
- Benjamin M Ellingson
- Departments of1Radiological Sciences.,4Psychiatry and Biobehavioral Sciences, and
| | | | | | | | - Langston T Holly
- 5Neurosurgery and Orthopaedics, David Geffen School of Medicine; and
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Ganau M, Holly LT, Mizuno J, Fehlings MG. Future Directions and New Technologies for the Management of Degenerative Cervical Myelopathy. Neurosurg Clin N Am 2018; 29:185-193. [DOI: 10.1016/j.nec.2017.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
UNLABELLED : Imaging is important in the evaluation of patients with degenerative disease and infectious processes. There are numerous conditions that can manifest as low back pain (LBP) or neck pain in a patient, and in many cases, the cause may be multifactorial. Clinical history and physical examination are key components in the evaluation of such patients; however, physical examination has variable sensitivity and specificity. Although studies have demonstrated that uncomplicated acute LBP and/or radiculopathy are self-limited conditions that do not warrant any imaging, neuroimaging can provide clear anatomic delineation of potential causes of the patient's clinical presentation. Various professional organizations have recommendations for imaging of LBP, which generally agree that an imaging study is not indicated for patients with uncomplicated LBP or radiculopathy without a red flag (eg, neurological deficit such as major weakness or numbness in lower extremities, bowel or bladder dysfunction, saddle anesthesia, fever, history of cancer, intravenous drug use, immunosuppression, trauma, or worsening symptoms). Different imaging modalities have a complementary role in the diagnosis of pathologies affecting the spine. In this review, we discuss the standard nomenclature for lumbar disk pathology and the utility of various clinical imaging techniques in the evaluation of LBP/neck pain for potential neurosurgical management. The imaging appearance of spinal infections and potential mimics also is reviewed. Finally, we discuss advanced neuroradiological techniques that offer greater microstructural and functional information. ABBREVIATIONS ADC, apparent diffusion coefficientDTI, diffusion tensor imagingDWI, diffusion-weighted imagingDOM, diskitis-osteomyelitisLBP, low back painMRM, magnetic resonance myelographySNA, spinal neuroarthropathySPECT, single-positron emission computed tomographySTIR, short tau inversion recovery.
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Affiliation(s)
- Lubdha M Shah
- Departments of *Radiology and Imaging Sciences and ‡Neurosurgery, University of Utah, Salt Lake City, Utah; §Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
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Guan L, Chen X, Hai Y, Ma X, He L, Wang G, Yuan C, Guo H. High-resolution diffusion tensor imaging in cervical spondylotic myelopathy: a preliminary follow-up study. NMR IN BIOMEDICINE 2017; 30:e3769. [PMID: 28703331 DOI: 10.1002/nbm.3769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 06/07/2023]
Abstract
Diffusion imaging is a promising technique as it can provide microstructural tissue information and thus potentially show viable changes in spinal cord. However, the traditional single-shot imaging method is limited as a result of various image artifacts. In order to improve measurement accuracy, we used a newly developed, multi-shot, high-resolution, diffusion tensor imaging (DTI) method to investigate diffusion metric changes and compare them with T2 -weighted (T2W) images before and after decompressive surgery for cervical spondylotic myelopathy (CSM). T2W imaging, single-shot DTI and multi-shot DTI were employed to scan seven patients with CSM before and 3 months after decompressive surgery. High signal intensities were scored using the T2 W images. DTI metrics, including fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD), were quantified and compared pre- and post-surgery. In addition, the relationship between imaging metrics and neurological assessments was examined. The reproducibility of multi-shot DTI was also assessed in 10 healthy volunteers. Post-surgery, the mean grade of cervical canal stenosis was reduced from grade 3 to normal after 3 months. Compared with single-shot DTI, multi-shot DTI provided better images with lower artifact levels, especially following surgery, as a result of reduced artifacts from metal implants. The new method also showed acceptable reproducibility. Both FA and RD values from the new acquisition showed significant differences post-surgery (FA, p = 0.026; RD, p = 0.048). These changes were consistent with neurological assessments. In contrast, T2W images did not show significant changes before and after surgery. Multi-shot diffusion imaging showed improved image quality over single-shot DWI, and presented superior performance in diagnosis and recovery monitoring for patients with CSM compared with T2W imaging. DTI metrics can reflect the pathological conditions of spondylotic spinal cord quantitatively and may serve as a sensitive biomarker for potential CSM management.
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Affiliation(s)
- Li Guan
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Chen
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaodong Ma
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Guangzhi Wang
- Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
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Abstract
MRI techniques and systems have evolved dramatically over recent years. These advances include higher field strengths, new techniques, faster gradients, improved coil technology, and more robust sequence protocols. This article reviews the most commonly used advanced MRI techniques, including diffusion-weighted imaging, magnetic resonance spectrography, diffusion tensor imaging, and cerebrospinal fluid flow tracking.
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Rutman AM, Peterson DJ, Cohen WA, Mossa-Basha M. Diffusion Tensor Imaging of the Spinal Cord: Clinical Value, Investigational Applications, and Technical Limitations. Curr Probl Diagn Radiol 2017; 47:257-269. [PMID: 28869104 DOI: 10.1067/j.cpradiol.2017.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022]
Abstract
Although diffusion-weighted imaging (DWI) has become a mainstay in modern brain imaging, it remains less utilized in the evaluation of the spinal cord. Many studies have shown promise in using DWI and diffusion-tensor imaging (DTI) for evaluation of the spinal cord; however, application has been stalled by technical obstacles and artifacts, and questions remain regarding its clinical utility on an individual examination level. This review discusses the background, concepts, and technical aspects of DWI and DTI, specifically for imaging of the spinal cord. The clinical and investigational applications of spinal cord DTI, as well as the practical difficulties and limitations of DWI and DTI for the evaluation of the spinal cord are examined.
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Affiliation(s)
- Aaron M Rutman
- Department of Radiology, University of Washington, Seattle, WA.
| | | | - Wendy A Cohen
- Department of Radiology, University of Washington, Seattle, WA
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Wang K, Chen Z, Zhang F, Song Q, Hou C, Tang Y, Wang J, Chen S, Bian Y, Hao Q, Shen H. Evaluation of DTI Parameter Ratios and Diffusion Tensor Tractography Grading in the Diagnosis and Prognosis Prediction of Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2017; 42:E202-E210. [PMID: 28207659 DOI: 10.1097/brs.0000000000001784] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort. OBJECTIVE To explore the correlations between diffusion tensor imaging (DTI) ratios and diffusion tensor tractography (DTT) grading with clinical symptoms and outcomes of cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA In addition to magnetic resonance imaging (MRI) and computed tomography, DTI may be useful in understanding pathophysiology of spinal cord in earlier stages of the CSM but it may be confounded by age and cervical level, and previous studies had small sample sizes. METHODS Controls (n = 36) and patients with CSM (n = 93) underwent magnetic resonance imaging (MRI) and DTI at the Changhai Hospital of Shanghai between September 2011 and March 2013. Apparent diffusion coefficient (ADC), fractional anisotropy (FA) of white matter (WM), and central grey matter (GM) were assessed. Patients were divided into three MRI grades: no abnormal signals; increased T2WI; and increased T2WI and low T1WI. DTT images were divided into three grades: no abnormal signals; abnormal local signal cord and disordered fiber tracts; and distortion of the spinal cord and interrupted fiber tracts. RESULTS FA and ADC both correlated with age in all three bilateral WM funiculi and GM, whereas FA and ADC ratios only showed correlation with age in the ventral funiculus (VF) and central GM. Differences were observed in ADC ratios and FA ratios from different Japanese Orthopedic Association (JOA) score subgroups and JOA recovery subgroups. For the three WM funiculi and GM, correlations between DTI ratios, JOA scores, and JOA recovery rates were consistently higher than those between DTI values, JOA scores, and JOA recovery rates (all P < 0.05). MRI grading was correlated with the JOA scores (r = -0.674, P < 0.001) but not JOA recovery rates (r = -0.197, P = 0.058), whereas DTT grading was correlated with both JOA scores (r = -0.813, P < 0.001) and JOA recovery rate (r = -0.429, P < 0.001). CONCLUSION DTI parameter ratios seemed to be less influenced by age than raw DTI results and could be more valuable than absolute DTI parameters for the evaluation of CSM. DTT grading is more valuable than MRI grading for diagnosis and prognostic prediction in CSM patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Kun Wang
- Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhi Chen
- Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fan Zhang
- Orthopedics Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qingxin Song
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Canglong Hou
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yixing Tang
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Jun Wang
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Shiyue Chen
- Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yun Bian
- Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Qiang Hao
- Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Hongxing Shen
- Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Diffusion Tensor Imaging Correlates with Short-Term Myelopathy Outcome in Patients with Cervical Spondylotic Myelopathy. World Neurosurg 2017; 97:489-494. [DOI: 10.1016/j.wneu.2016.03.075] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/23/2022]
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Oh SK, Choi KH, Yoo JY, Kim DY, Kim SJ, Jeon SR. A Phase III Clinical Trial Showing Limited Efficacy of Autologous Mesenchymal Stem Cell Therapy for Spinal Cord Injury. Neurosurgery 2016; 78:436-47; discussion 447. [PMID: 26891377 DOI: 10.1227/neu.0000000000001056] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In our previous report, 3 of 10 patients with spinal cord injury who were injected with autologous mesenchymal stem cells (MSCs) showed motor improvement in the upper extremities and in activities of daily living. OBJECTIVE To report on the results of a phase III clinical trial of autologous MSCs therapy. METHODS Patients were selected based on the following criteria: chronic American Spinal Injury Association B status patients who had more than 12 months of cervical injury, and no neurological changes during the recent 3 months of vigorous rehabilitation. We injected 1.6 × 10 autologous MSCs into the intramedullary area at the injured level and 3.2 × 10 autologous MSCs into the subdural space. Outcome data were collected over 6 months regarding neurological examination, magnetic resonance imaging with diffusion tensor imaging, and electrophysiological analyses. RESULTS Among the 16 patients, only 2 showed improvement in neurological status (unilateral right C8 segment from grade 1 to grade 3 in 1 patient and bilateral C6 from grade 3 to grade 4 and unilateral right C8 from grade 0 to grade 1 in 1 patient). Both patients with neurological improvement showed the appearance of continuity in the spinal cord tract by diffusion tensor imaging. There were no adverse effects associated with MSCs injection. CONCLUSION Single MSCs application to intramedullary and intradural space is safe, but has a very weak therapeutic effect compared with multiple MSCs injection. Further clinical trials to enhance the effect of MSCs injection are necessary.
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Affiliation(s)
- Sun Kyu Oh
- Departments of *Neurological Surgery,‡Rehabilitation Medicine, and§Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
Abstract
Imaging with computed tomography and magnetic resonance imaging is fundamental to the evaluation of traumatic spinal injury. Specifically, neuroradiologic techniques show the exact location of injury, evaluate the stability of the spine, and determine neural element compromise. This review focuses on the complementary role of different radiologic modalities in the diagnosis of patients with traumatic injuries of the spine. The role of imaging in spinal trauma classifications will be addressed. The importance of magnetic resonance imaging in the assessment of soft tissue injury, particularly of the spinal cord, will be discussed. Last, the increasing role of advanced imaging techniques for prognostication of the traumatic spine will be explored.
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Affiliation(s)
- Lubdha M. Shah
- Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Jeffrey S. Ross
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
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Wang K, Wang WT, Wang J, Chen Z, Song QX, Chen SY, Hao Q, He DW, Shen HX. Compared study of routine magnetic resonance imaging and diffusion tensor tractography on the predictive value of diagnosis and prognosis in acute cervical spinal cord injury. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Taso M, Girard OM, Duhamel G, Le Troter A, Feiweier T, Guye M, Ranjeva JP, Callot V. Tract-specific and age-related variations of the spinal cord microstructure: a multi-parametric MRI study using diffusion tensor imaging (DTI) and inhomogeneous magnetization transfer (ihMT). NMR IN BIOMEDICINE 2016; 29:817-832. [PMID: 27100385 DOI: 10.1002/nbm.3530] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/17/2016] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
Being able to finely characterize the spinal cord (SC) microstructure and its alterations is a key point when investigating neural damage mechanisms encountered in different central nervous system (CNS) pathologies, such as multiple sclerosis, amyotrophic lateral sclerosis or myelopathy. Based on novel methods, including inhomogeneous magnetization transfer (ihMT) and dedicated SC probabilistic atlas post-processing, the present study focuses on the in vivo characterization of the healthy SC tissue in terms of regional microstructure differences between (i) upper and lower cervical vertebral levels and (ii) sensory and motor tracts, as well as differences attributed to normal aging. Forty-eight healthy volunteers aged from 20 to 70 years old were included in the study and scanned at 3 T using axial high-resolution T2 *-w imaging, diffusion tensor imaging (DTI) and ihMT, at two vertebral levels (C2 and C5). A processing pipeline with minimal user intervention, SC segmentation and spatial normalization into a reference space was implemented in order to assess quantitative morphological and structural parameters (cross-sectional areas, scalar DTI and MT/ihMT metrics) in specific white and gray matter regions of interest. The multi-parametric MRI metrics collected allowed upper and lower cervical levels to be distinguished, with higher ihMT ratio (ihMTR), higher axial diffusivity (λ∥ ) and lower radial diffusivity (λ⊥ ) at C2 compared with C5. Significant differences were also observed between white matter fascicles, with higher ihMTR and lower λ∥ in motor tracts compared with posterior sensory tracts. Finally, aging was found to be associated with significant metric alterations (decreased ihMTR and λ∥ ). The methodology proposed here, which can be easily transferred to the clinic, provides new insights for SC characterization. It bears great potential to study focal and diffuse SC damage in neurodegenerative and demyelinating diseases. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Manuel Taso
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
- Aix-Marseille Université, IFSTTAR, Laboratoire de Biomécanique Appliquée (LBA), UMR T 24, Marseille, France
- Laboratoire International Associé iLab-Spine - Imagerie et Biomécanique du Rachis, Marseille, France/Montréal, Canada
| | - Olivier M Girard
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
| | - Guillaume Duhamel
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
| | - Arnaud Le Troter
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
| | | | - Maxime Guye
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
| | - Jean-Philippe Ranjeva
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
- Laboratoire International Associé iLab-Spine - Imagerie et Biomécanique du Rachis, Marseille, France/Montréal, Canada
| | - Virginie Callot
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
- Laboratoire International Associé iLab-Spine - Imagerie et Biomécanique du Rachis, Marseille, France/Montréal, Canada
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