Utility of Diffusion and Magnetization Transfer MRI in Cervical Spondylotic Myelopathy: A Pilot Study

Abstract

Diffusion tensor imaging (DTI) and magnetization transfer (MT) magnetic resonance imaging (MRI) can help detect spinal cord pathology, and tract-specific analysis of their parameters, such as fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD), radial diffusivity (RD) and MT ratio (MTR), can give microstructural information. We performed the tract-based acquisition of MR parameters of three major motor tracts: the lateral corticospinal (CS), rubrospinal (RuS) tract, and lateral reticulospinal (RS) tract as well as two major sensory tracts, i.e., the fasciculus cuneatus (FC) and spinal lemniscus, to detect pathologic change and find correlations with clinical items. MR parameters were extracted for each tract at three levels: the most compressed lesion level and above and below the lesion. We compared the MR parameters of eight cervical spondylotic myelopathy patients and 12 normal controls and analyzed the correlation between clinical evaluation items and MR parameters in patients. RuS and lateral RS showed worse DTI parameters at the lesion level in patients compared to the controls. Worse DTI parameters in those tracts were correlated with weaker power grasp at the lesion level. FC and lateral CS showed a correlation between higher RD and lower FA and MTR with a weaker lateral pinch below the lesion level.

Extrapyramidal spinal tracts impairment in patients with degenerative cervical myelopathy evaluated with the magnetization transfer saturation technique

“…In our study, a trend towards a positive correlation between the severity of clinical symptoms and the values of MTsat within the ventral spinocerebellar tract was also revealed. These data generally con rm previously published results [11][12][13][14] . Nevertheless, the duration of the disease did not correlate with the decrease in MTsat in any spinal cord region.…”

“…In addition to conventional sequences, numerous sophisticated neuroimaging methods, such as diffusion tensor imaging (DTI), magnetization transfer (MT), myelin water fraction (MWF), and magnetic resonance spectroscopy (MRS), offer in-depth quantitative information on microstructural alterations in the spinal cord, providing an enhanced understanding of the disease pathophysiology 6,7 . Several studies have explored the application of these techniques in patients with DCM to assess spinal cord injury severity and predict the outcome of surgical interventions 2,6,[8][9][10][11] . However, unfortunately, the ability to monitor DCM development and predict the potential for recovery is still limited, even with advanced neuroimaging techniques.…”

Utility of MRI in Quantifying Tissue Injury in Cervical Spondylotic Myelopathy

“…Recently, the Spinal Cord Toolbox (SCT) [138] has been increasingly utilized to help automate the segmentation process at the level of tracts, using a probabilistic approach. Several studies have utilized it [81,84,[94][95][96]. Another utility of the SCT is using atlases, e.g., PAM50, to perform group-level analysis [139].…”

“…While MTR is associated with the degree of axonal and myelin damage in the brain [88], MT has also shown potential in studying spinal cord pathologies [89][90][91][92][93]. Although MT has been employed in the spinal cord for more than twenty years, this MRI method has recently been used to study its diagnostic value [45,[94][95][96] and ability to predict recovery [94] in the spinal cord in CSM patients. When combined with other techniques, MT imaging can provide complementary useful diagnostic information.…”

“…When combined with other techniques, MT imaging can provide complementary useful diagnostic information. For example, a multimodal DTI and MT imaging study assessed tract-specific microstructural information on the spinal cord and their clinical correlations in CSM patients [96]. MWI estimates myelin content by estimating the fraction of tissue water bound to the myelin sheath.…”