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

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.

Clinical and Research MRI Techniques for Assessing Spinal Cord Integrity in Degenerative Cervical Myelopathy—A Scoping Review

“…Specifically Dong et al found that DCM patients presenting with a higher FA score at the level of compression were the most likely group to achieve a better functional recovery after surgical decompression [ 199 ]. The conducted literature search indicated consistent findings of the correlation of FA and spinal cord integrity in DCM as well its significant role in prognosis [ 60 , 104 , 107 , 108 , 118 , 124 , 127 , 128 , 131 , 132 , 134 , 135 , 137 , 138 , 139 , 141 , 142 , 143 , 144 , 145 , 146 , 149 , 152 , 153 , 154 , 155 , 157 , 158 , 161 , 162 , 165 , 166 , 167 , 168 , 175 , 176 , 177 , 178 , 179 , 181 , 182 , 183 , 184 , 185 ]. Interestingly, Wang et al conducted a prospective longitudinal study of 93 ...…”

A meta‐analysis of the role of diffusion tensor imaging in cervical spinal cord compression

“…33 Therefore, FA may serve as a biomarker for early CSCC diagnosis by identifying microstructural alterations. 19,28,34 Multiple clinical and methodological confusion may affect the quantitative detection of DTI. Hui et al 35 revealed that the FA values varied with the b-value when monitoring neurological tissue changes in a rat model.…”

“…Of these 20 studies, one that recorded FA ratio 12 and another without pooled FA values in the experimental group 13 were excluded. Moreover, four studies only recorded FA values at the most compression level (MCL), [14][15][16][17] three had insufficient data, [18][19][20] and one contained erroneous data, 21 all of which were eliminated. The detailed procedure for selecting and excluding studies is shown in the PRISMA diagram (Figure 1).…”

The Role of Diffusion Tensor Tractography in Assessment of Spondylotic Myelopathy

“…They concluded that the mean fractional anisotropy values were significantly associated with the anteroposterior diameter of the spinal canal and with space available for the spinal cord index. FA values can help in the early detection of cervical cord compressive myelopathy before the appearance of changes in conventional MRI, thereby improving the clinical outcome and helping in deciding on treatment plans [ 15 ]. The manifestation in T2WI is a high signal inside the cord.…”

“…Therefore, there is a need to identify an alternative for early and accurate detection of spinal cord changes. Diffusion tensor imaging (DTI), with its ability to detect microstructural changes in the spinal cord, can become an alternative or adjunct for T2W image (T2WI) [ 14 , 15 ]. Diffusion tensor tractography (DTT) is an application of MRI diffusion tensor imaging, a non-invasive technique which measures the random motion of water molecules, thereby providing information about cellular integrity.…”