Efficacy of diffusion tensor imaging in identification of degenerative cervical spondylotic myelopathy

Nukala, Monika; Abraham, Jini; Khandige, Ganesh; Shetty, Bharath K.; Rao, Arindam pol arjun

doi:10.1016/j.ejro.2018.08.006

Cited by 14 publications

(16 citation statements)

References 12 publications

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“…The proposed cut-off for the FA value was lower (0.46), and the ADC value was higher (1.29) at C5–C6 level, the level that was affected the most (53.8%) in our study. Similar results were reported by Nukala et al [ 23 ].…”

Section: Discussionsupporting

confidence: 92%

Quantitative Evaluation of the Diffusion Tensor Imaging Matrix Parameters and the Subsequent Correlation with the Clinical Assessment of Disease Severity in Cervical Spondylotic Myelopathy

Nischal¹,

Tripathi²,

Singh³

2021

Asian Spine J

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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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Section: Discussionsupporting

confidence: 92%

Quantitative Evaluation of the Diffusion Tensor Imaging Matrix Parameters and the Subsequent Correlation with the Clinical Assessment of Disease Severity in Cervical Spondylotic Myelopathy

Nischal¹,

Tripathi²,

Singh³

2021

Asian Spine J

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“…Our study showed that DTI is 93% more sensitive in detecting early myelopathic changes than the conventional MRI. These results are consistent with Facon et al [2], Kara et al [4], Yoo et al [6], Banaszek et al [8] and Nukala et al [9].…”

Section: Discussionsupporting

confidence: 92%

MR diffusion tensor imaging of the spinal cord: can it help in early detection of cervical spondylotic myelopathy and assessment of its severity?

Hassan

Assad²,

Belal³

2019

Egypt J Radiol Nucl Med

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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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“…The results of our study show that ADC values at C1 level are significantly higher in patients with the anterior atlanto-axial instability than in patients without instability. These results are consistent with studies concerning diffusion parameters in patients with cervical degenerative myelopathy: The researchers described higher ADC values in patients with spinal canal stenosis in comparison with the control group [12][13][14][15][16], as well as higher ADC values in the area of spinal canal stenosis than in other parts of the spinal cord [17,18]. The high diffusion coefficient at the site of the spinal cord injury can be explained by mechanical cell damage caused by repeated pressure of the vertebrae (especially the dens) on the cord.…”

Section: Discussionsupporting

confidence: 89%

Apparent diffusion coefficient as an indicator of spinal cord compression due to anterior atlanto-axial subluxation in rheumatoid arthritis patients

et al. 2019

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The aim of this retrospective study was to evaluate the apparent diffusion coefficient (ADC) as a potential parameter of spinal cord damage in cervical spine instability at the atlanto-axial level in rheumatoid arthritis (RA) patients. Methods One hundred and six RA patients were included in the study. MRI examinations were performed with 1.5T scanner. The ADC was measured at six locations in the cervical spinal cord at the height of the first six cervical vertebrae (from C-1 to C-6). The ADC values were assessed in 2 groups: with and without anterior atlanto-axial subluxation (AAS) diagnosed on plain radiographs. Correlations between ADC values and radiographic measurements and RA activity indicators were evaluated. ResultsThe ADC values at C1 level (ADC 1 ) was higher in the group with anterior AAS than in the group without AAS (p < 0.001). Statistically significant moderate positive correlation between ADC 1 and anterior atlanto-axial diameter interval AADI (rho = 0.58; p < 0.008) was found as well as statistically significant weak negative correlation between ADC 1 and posterior atlanto-axial diameter interval PADI (rho = − 0.34; p < 0.008). Conclusions The conducted study demonstrates the applicability of the ADC maps in the identification of spinal cord compression due to anterior AAS in RA patients. The results encourage the practical use of the ADC as an additional parameter in the qualification for surgical treatment.

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Efficacy of diffusion tensor imaging in identification of degenerative cervical spondylotic myelopathy

Cited by 14 publications

References 12 publications

Quantitative Evaluation of the Diffusion Tensor Imaging Matrix Parameters and the Subsequent Correlation with the Clinical Assessment of Disease Severity in Cervical Spondylotic Myelopathy

Quantitative Evaluation of the Diffusion Tensor Imaging Matrix Parameters and the Subsequent Correlation with the Clinical Assessment of Disease Severity in Cervical Spondylotic Myelopathy

MR diffusion tensor imaging of the spinal cord: can it help in early detection of cervical spondylotic myelopathy and assessment of its severity?

Apparent diffusion coefficient as an indicator of spinal cord compression due to anterior atlanto-axial subluxation in rheumatoid arthritis patients

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