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open access

Vol 56, No 4 (2022)
Research Paper
Submitted: 2021-10-21
Accepted: 2022-02-07
Published online: 2022-04-26
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Diagnostic value of diffusion tensor imaging in patients with clinical signs of cervical spondylotic myelopathy

Monika Skotarczak1, Jarosław Dzierżanowski2, Mariusz Kaszubowski3, Paweł J. Winklewski45, Alexander Romanowski6, Edyta Szurowska1, Arkadiusz Szarmach1
DOI: 10.5603/PJNNS.a2022.0031
·
Pubmed: 35471632
·
Neurol Neurochir Pol 2022;56(4):341-348.
Affiliations
  1. 2nd Department of Radiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
  2. Department of Neurosurgery, Faculty of Medicine, Medical University of Gdansk, Poland
  3. Department of Economic Sciences, Faculty of Management and Economics, Gdansk University of Technology, Gdansk, Poland
  4. Department of Human Physiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
  5. Department of Clinical Anatomy and Physiology, Faculty of Health Sciences, Pomeranian University of Slupsk, Slupsk, Poland
  6. Department of Psychiatry and Psychotherapy, Helios Clinic Hettstedt, Germany

open access

Vol 56, No 4 (2022)
Research papers
Submitted: 2021-10-21
Accepted: 2022-02-07
Published online: 2022-04-26

Abstract

Aim of the study. The aim of this study was to assess the diagnostic value of diffusion tensor imaging (DTI) in patients with symptoms of cervical myelopathy. Detailed goals included determining the diagnostic effectiveness of quantitative parameters, i.e. fractional anisotropy (FA) and apparent diffusion coefficient (ADC), in the diagnosis of cervical myelopathy, and the correlation between these parameters and clinical symptoms.

Clinical rationale for the study. The demonstration of an ischaemic focus in the spinal cord by standard magnetic resonance imaging (MRI) methods is associated with already accomplished spinal cord damage, and of course limited treatment options. Therefore, finding a new examination protocol that allows early diagnosis of myelopathic focus, before the onset of full neurological symptoms, has become a priority in the diagnosis and treatment of spine diseases. Such an examination increases the chances of correctly qualifying the patient for conservative vs. surgical treatment.

Material and methods. Between 2013 and 2017, 128 adults with clinical signs of cervical myelopathy were examined, and were divided into four symptomatic subgroups. A control group consisted of 37 healthy volunteers. DTI values were measured at the level of C2/C3, and at the most severe stenosis of the spine.

Results. In patients with cervical spondylotic myelopathy (CSM), the ADC values were significantly higher (p < 0.001), and FA values were significantly lower (p < 0.001), than in healthy volunteers at the stenotic level. There were significant differences in DTI parameters between the clinical subgroups (p < 0.001).

Conclusions and clinical implications. Changes in DTI parameters indicate a microstructural disorder of the core which is not visible in a structural MRI. FA and ADC values measured at the level of the most severe stenosis of the spinal canal allow the differentiation of patients with myelopathy of varying degrees of clinical severity. Extending standard MRI to include assessment of FA and ADC may be helpful in deciding treatment modalities (conservative vs. surgical) for patients with visible canal stenosis without full neurological symptoms. This may be useful in selecting patients for urgent rehabilitative treatment. This study is a starting point for further research, i.e. an evaluation of the extent of FA and ADC lesion withdrawal after surgical treatment.

Abstract

Aim of the study. The aim of this study was to assess the diagnostic value of diffusion tensor imaging (DTI) in patients with symptoms of cervical myelopathy. Detailed goals included determining the diagnostic effectiveness of quantitative parameters, i.e. fractional anisotropy (FA) and apparent diffusion coefficient (ADC), in the diagnosis of cervical myelopathy, and the correlation between these parameters and clinical symptoms.

Clinical rationale for the study. The demonstration of an ischaemic focus in the spinal cord by standard magnetic resonance imaging (MRI) methods is associated with already accomplished spinal cord damage, and of course limited treatment options. Therefore, finding a new examination protocol that allows early diagnosis of myelopathic focus, before the onset of full neurological symptoms, has become a priority in the diagnosis and treatment of spine diseases. Such an examination increases the chances of correctly qualifying the patient for conservative vs. surgical treatment.

Material and methods. Between 2013 and 2017, 128 adults with clinical signs of cervical myelopathy were examined, and were divided into four symptomatic subgroups. A control group consisted of 37 healthy volunteers. DTI values were measured at the level of C2/C3, and at the most severe stenosis of the spine.

Results. In patients with cervical spondylotic myelopathy (CSM), the ADC values were significantly higher (p < 0.001), and FA values were significantly lower (p < 0.001), than in healthy volunteers at the stenotic level. There were significant differences in DTI parameters between the clinical subgroups (p < 0.001).

Conclusions and clinical implications. Changes in DTI parameters indicate a microstructural disorder of the core which is not visible in a structural MRI. FA and ADC values measured at the level of the most severe stenosis of the spinal canal allow the differentiation of patients with myelopathy of varying degrees of clinical severity. Extending standard MRI to include assessment of FA and ADC may be helpful in deciding treatment modalities (conservative vs. surgical) for patients with visible canal stenosis without full neurological symptoms. This may be useful in selecting patients for urgent rehabilitative treatment. This study is a starting point for further research, i.e. an evaluation of the extent of FA and ADC lesion withdrawal after surgical treatment.

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Keywords

cervical spondylotic myelopathy, magnetic resonance imaging, diffusion tensor imaging, spinal canal stenosis

About this article
Title

Diagnostic value of diffusion tensor imaging in patients with clinical signs of cervical spondylotic myelopathy

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 56, No 4 (2022)

Article type

Research Paper

Pages

341-348

Published online

2022-04-26

Page views

4414

Article views/downloads

630

DOI

10.5603/PJNNS.a2022.0031

Pubmed

35471632

Bibliographic record

Neurol Neurochir Pol 2022;56(4):341-348.

Keywords

cervical spondylotic myelopathy
magnetic resonance imaging
diffusion tensor imaging
spinal canal stenosis

Authors

Monika Skotarczak
Jarosław Dzierżanowski
Mariusz Kaszubowski
Paweł J. Winklewski
Alexander Romanowski
Edyta Szurowska
Arkadiusz Szarmach

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