Usefulness of diffusion tensor MR imaging in the assessment of intramedullary changes of the cervical spinal cord in different stages of degenerative spine disease

Abstract

Purpose The aim of this study was to evaluate the usefulness of diffusion tensor imaging (DTI) in the detection of cervical spinal cord integrity alterations in different stages of degenerative spine disease, as well as to compare DTI parameters with selected cervical spinal stenosis measurements. Methods One hundred and thirty-two symptomatic patients (mean age 53.58 years) with different stages of cervical spondylosis and twenty-five control subjects (mean age 45.78 years) were enrolled in the study. DTI was performed with a 1.5 T MR scanner. Three hundred and forty-nine spine segments from C2/C3 to C5/C6 were evaluated and divided into five groups according to the degree of spinal cord compression. The values of fractional anisotropy (FA) and apparent diffusion coefficient at each level were calculated and their correlations with the degree of stenosis were analyzed.Results FA values differed significantly (p \ 0.0001) at all levels between the control group and patients with cervical degenerative disease, including subjects without spinal cord compression visible on plain MR images. A significant (p \ 0.01) positive correlation between the mean FA values and anteroposterior diameter of the spinal canal as well as space available for the spinal cord index was demonstrated at all investigated levels. Conclusion DTI is capable of revealing impairment of the cervical spinal cord microstructure at the very early stage of degenerative spine disease, even prior to spinal cord compression visible on plain MR. Anteroposterior spinal canal diameter as well as space available for the cord index is well related to spinal cord tissue integrity defined by DTI.

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

“…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].…”

Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques

“…A recent systematic review of the literature 59 identified a total of 25 studies that used these techniques to study DCM; 22 used DTI, 3 used MRS, and 1 used MT (in combination with DTI). 10,17,21,22,24,25,30,35,36,39,46,52,53,55,56,58,73,93,104,112,116,124,125,129,136 No clinical studies that used MWF or fMRI were identified. Among the identified DCM studies, the DTI metric fractional anisotropy (FA), a number that ranges from 0 for isotropic diffusion (same in all directions) to 1 for anisotropic (all in 1 direction), seemed to have the strongest results.…”

Spinal Cord MR Diffusion Properties in Patients with Degenerative Cervical Cord Compression

“…Several authors have described significant changes in DTI parameters in patients with degenerative cervical cord compression (DCCC) . However, certain recent reports indicate an apparent physiological variability in scalar diffusion parameters between cervical spinal cord levels (SCLs) and these parameters may also correlate significantly with age .…”