Top

Published in:

01-08-2011 | Functional Neuroradiology

The role of DTI in early detection of cervical spondylotic myelopathy: a preliminary study with 3-T MRI

Authors: Batuhan Kara, Azim Celik, Selhan Karadereler, Levent Ulusoy, Kursat Ganiyusufoglu, Levent Onat, Ayhan Mutlu, Ibrahim Ornek, Mustafa Sirvanci, Azmi Hamzaoglu

Published in: Neuroradiology | Issue 8/2011

Abstract

Introduction

The radiological diagnosis of cervical spondylotic myelopathy (CSM) has to be made as soon as possible, since surgery performed in earlier stages during the course of CSM was reported to be more successful when compared with later stages. We hypothesized that diffusion tensor imaging (DTI) may detect CSM in earlier stages, before the appearance of signal increase in T2-weighted sequences.

Methods

A total of 16 patients with neurological signs and symptoms of CSM but without hyperintensity in spinal cord on T2-weighted sequences enrolled in the study. The magnetic resonance (MR) examinations were performed on a 3-T MR imaging system. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were generated on axial plane. The ADC and FA measurements in each individual were made at the level of most severe cervical canal stenosis and at a nonstenotic level. Student’s t test was used to compare FA and ADC values of the spinal cord in stenotic and nonstenotic segments. We also investigated if there was a correlation between DTI parametrics and duration of clinical symptoms by using Pearson correlation analysis.

Results

All patients showed changes in DTI parametrics at stenotic segments. While FA values of the spinal cord at the stenotic level showed a statistically significant reduction, there was a statistically significant increase in the measured ADC values (p < 0.001). There was no statistical correlation between the duration of symptoms and DTI parametrics.

Conclusion

Our preliminary findings indicate that DTI may show abnormalities in the spinal cord before the development of T2 hyperintensity on conventional sequences in patients with CSM.

Shedid D, Benzel EC (2007) Cervical spondylosis anatomy: pathophysiology and biomechanics. Neurosurgery 60:7–13

Baptiste DC, Fehlings MG (2006) Pathophysiology of cervical myelopathy. Spine J 6:190S–197SPubMedCrossRef

Lyu RK, Tang LM, Chen CJ, Chen CM, Chang HS, Wu YR (2004) The use of evoked potentials for clinical correlation and surgical outcome in cervical spondylotic myelopathy with intramedullary high signal intensity on MRI. J Neurol Neurosurg Psychiatry 75:256–261PubMed

Baron EM, Young WF (2007) Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery 60:S35–S41PubMedCrossRef

Matsuda Y, Miyazaki K, Tada K, Yasuda A, Nakayama T, Murakami H, Matsuo M (1991) Increased MR signal intensity due to cervical myelopathy. J Neurosurg 74:887–892PubMedCrossRef

Takahashi M, Yamashita Y, Sakamoto Y, Kojima R (1989) Chronic cervical cord compression: clinical significance of increased signal intensity on MR images. Radiology 173:219–224PubMed

Matsumoto M, Toyoma Y, Ishikawa M, Chiba K, Suzuki N, Fujimura Y (2000) Increased signal intensity of the spinal cord on magnetic resonance images in cervical compressive myelopathy: does it predict the outcome of conservative treatment? Spine 25:677–682PubMedCrossRef

Demir A, Ries M, Moonen CT, Vital JM, Dehais J, Arne P, Caillé JM, Dousset V (2003) Diffusion-weighted MR imaging with apparent diffusion coefficient and apparent diffusion tensor maps in cervical spondylotic myelopathy. Radiology 229:37–43PubMedCrossRef

McCormick WE, Steinmetz MP, Benzel EC (2003) Cervical spondylotic myelopathy: make the difficult diagnosis, then refer for surgery. Cleve Clin J Med 70:899–904PubMedCrossRef

10.

Montgomery DM, Brower RS (1992) Cervical spondylotic myelopathy. Clinical syndrome and natural history. Orthop Clin North Am 23:487–493PubMed

11.

Moore AP, Blumhardt LD (1997) A prospective survey of the causes of non-traumatic spastic paraparesis and tetraparesis in 585 patients. Spinal Cord 35:361–367PubMedCrossRef

12.

Yagi M, Ninomiya K, Kihara M, Horiuchi Y (2010) Long-term surgical outcome and risk factors in patients with cervical myelopathy and a change in signal intensity of intramedullary spinal cord on magnetic resonance imaging. J Neurosurg Spine 12:59–65PubMedCrossRef

13.

Chatley A, Kumar R, Jain VK, Behari S, Sahu RN (2009) Effect of spinal cord signal intensity changes on clinical outcome after surgery for cervical spondylotic myelopathy. J Neurosurg Spine 11:562–567PubMedCrossRef

14.

Matz PG, Anderson PA, Holly LT et al (2009) The natural history of cervical spondylotic myelopathy. J Neurosurg Spine 11:104–111PubMedCrossRef

15.

Rutgers DR, Toulgoat F, Cazejust J, Fillard P, Lasjaunias P, Ducreux D (2008) White matter abnormalities in mild traumatic brain injury: a diffusion tensor imaging study. AJNR Am J Neuroradiol 29:514–519PubMedCrossRef

16.

Huang J, Friedland RP, Auchus AP (2007) Diffusion tensor imaging of normal-appearing white matter in mild cognitive impairment and early Alzheimer disease: preliminary evidence of axonal degeneration in the temporal lobe. AJNR Am J Neuroradiol 28:1943–1948PubMedCrossRef

17.

Yu CS, Lin FC, Li KC, Jiang TZ, Zhu CZ, Qin W, Sun H, Chan P (2006) Diffusion tensor imaging in the assessment of normal-appearing brain tissue damage in relapsing neuromyelitis optica. AJNR Am J Neuroradiol 27:1009–1015PubMed

18.

Jellison BJ, Field AS, Medow J, Lazar M, Salamat MS, Alexander AL (2004) Diffusion tensor imaging of cerebral white matter: a pictorial review of physics, fiber tract anatomy, and tumor imaging patterns. AJNR Am J Neuroradiol 25:356–369PubMed

19.

Shanmuganathan K, Gullapalli RP, Zhuo J, Mirvis SE (2008) Diffusion tensor MR imaging in cervical spine trauma. AJNR Am J Neuroradiol 29:655–659PubMedCrossRef

20.

Mamata H, Jolesz FA, Maier SE (2005) Apparent diffusion coefficient and fractional anisotropy in spinal cord: age and cervical spondylosis-related changes. J Magn Reson Imaging 22:38–43PubMedCrossRef

21.

Facon D, Ozanne A, Fillard P, Lepeintre JF, Tournoux-Facon C, Ducreux D (2005) MR diffusion tensor imaging and fiber tracking in spinal cord compression. AJNR Am J Neuroradiol 26:1587–1594PubMed

22.

Hori M, Okubo T, Aoki S, Kumagai H, Araki T (2006) Line scan diffusion tensor MRI at low magnetic field strength: feasibility study of cervical spondylotic myelopathy in an early clinical stage. J Magn Reson Imaging 23:183–188PubMedCrossRef

23.

Castillo M, Arbelaez A, Fisher LL, Smith JK, Mukherji SK (1999) Diffusion weighted imaging in patients with cervical spondylosis. Int J Neuroradiol 5:79–85

24.

Ries M, Jones RA, Dousset V, Moonen CT (2000) Diffusion tensor MRI of the spinal cord. Magn Reson Med 44:884–892PubMedCrossRef

25.

Cercignani M, Horsfield MA, Agosta F, Filippi M (2003) Sensitivity-encoded diffusion tensor MR imaging of the cervical cord. AJNR Am J Neuroradiol 24:1254–1256PubMed

26.

Xiangshui M, Xiangjun C, Xiaoming Z, Qingshi Z, Yi C, Chuanqiang Q, Xiangxing M, Chuanfu L, Jinwen H (2010) 3 T magnetic resonance diffusion tensor imaging and fibre tracking in cervical myelopathy. Clin Radiol 65:465–473PubMedCrossRef

27.

Beaulieu C (2002) The basis of anisotropic water diffusion in the nervous system—a technical review. NMR Biomed 15:435–455PubMedCrossRef

28.

Hesseltine SM, Law M, Babb J, Rad M, Lopez S, Ge Y, Johnson G, Grossman RI (2006) Diffusion tensor imaging in multiple sclerosis: assessment of regional differences in the axial plane within normal-appearing cervical spinal cord. AJNR Am J Neuroradiol 27:1189–1193PubMed

29.

Kim DH, Vaccaro AR, Henderson FC, Benzel EC (2003) Molecular biology of cervical myelopathy and spinal cord injury: role of oligodendrocyte apoptosis. Spine J 3:510–519PubMedCrossRef

30.

Yu WR, Baptiste DC, Liu T, Odrobina E, Stanisz GJ, Fehlings MG (2009) Molecular mechanisms of spinal cord dysfunction and cell death in the spinal hyperostotic mouse: implications for the pathophysiology of human cervical spondylotic myelopathy. Neurobiol Dis 33:149–163PubMedCrossRef

31.

Thurnher MM, Law M (2009) Diffusion-weighted imaging, diffusion-tensor imaging, and fiber tractography of the spinal cord. Magn Reson Imaging Clin N Am 17:225–244PubMedCrossRef

Title: The role of DTI in early detection of cervical spondylotic myelopathy: a preliminary study with 3-T MRI
Authors: Batuhan Kara
Azim Celik
Selhan Karadereler
Levent Ulusoy
Kursat Ganiyusufoglu
Levent Onat
Ayhan Mutlu
Ibrahim Ornek
Mustafa Sirvanci
Azmi Hamzaoglu
Publication date: 01-08-2011
Publisher: Springer-Verlag
Published in: Neuroradiology / Issue 8/2011
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-011-0844-4

At a glance: The STEP trials

Springer Medicine

The role of DTI in early detection of cervical spondylotic myelopathy: a preliminary study with 3-T MRI

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2011

Osborn AG, Ross, Crim J, Salzman K, Blaser S: Expert differential diagnoses: brain and spine

Comparison of volumetric methods for tumor measurements on two and three dimensional MRI in adult glioblastoma

Microstructural brain injury in post-concussion syndrome after minor head injury

Diffusion tensor MR imaging (DTI) metrics in the cervical spinal cord in asymptomatic HIV-positive patients

Entorhinal cortex volume measured with 3T MRI is positively correlated with the Wechsler Memory Scale-Revised logical/verbal memory score for healthy subjects

European Society of Neuroradiology (ESNR)