From the Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong.
Radiology. 2014 Jan;270(1):197-204. doi: 10.1148/radiol.13121885. Epub 2013 Oct 28.
To explore the value of diffusion-tensor (DT) imaging in addressing the severity of cervical spondylotic myelopathy (CSM) and predicting the outcome of surgical treatment.
From July 2009 to May 2012, 65 volunteers were recruited for this institutional review board-approved study, and all gave informed consent; 20 volunteers were healthy subjects (age range, 41-62 years), and 45 were patients with CSM (age range, 43-86 years). Anatomic and DT 3.0-T magnetic resonance images were obtained. Surgical decompression was performed in 22 patients with CSM, and patients were followed up for 6 months to 2 years. The clinical severity of myelopathy and postoperative recovery were assessed by using the modified Japanese Orthopaedic Association (mJOA) score. A recovery ratio (comparison of postoperative with preoperative mJOA score) of more than 50% indicated a good clinical outcome of surgery. DT findings, patient age, T2 high signal intensity (HSI), and somatosensory evoked potential (SEP) were analyzed by using a logistic regression model to predict the surgical outcome of patients with CSM.
A significant difference in cervical cord mean fractional anisotropy (FA) was found between healthy subjects and patients with CSM (0.65 ± 0.05 [standard deviation] vs 0.52 ± 0.13, P < .001). FA values were significantly correlated with the severity of neurologic dysfunction indicated by mJOA score (r(2) = 0.327, P = .016). Logistic regression analysis showed that mean FA (P = .030) and FA at the C2 vertebra (P = .035) enabled prediction of good surgical outcome; however, preoperative mJOA (P = .927), T2 HSI (P = .176), SEP amplitude (P = .154), and latency (P = .260) did not.
FA is a biomarker for the severity of myelopathy and for subsequent surgical outcome.
探讨弥散张量（DT）成像在评估颈椎脊髓病（CSM）严重程度和预测手术治疗效果中的价值。
本研究经机构审查委员会批准，于 2009 年 7 月至 2012 年 5 月共纳入 65 名志愿者，所有志愿者均签署了知情同意书。其中 20 名志愿者为健康对照（年龄 4162 岁），45 名志愿者为 CSM 患者（年龄 4386 岁）。所有志愿者均行解剖学和 3.0-T 磁共振 DT 成像检查。对 22 例 CSM 患者行手术减压治疗，术后随访 6 个月至 2 年。采用改良日本矫形协会（mJOA）评分评估患者术前和术后的脊髓病严重程度和术后恢复情况。术后 mJOA 评分较术前提高 50%以上者为手术疗效良好。采用 logistic 回归模型分析 DT 表现、患者年龄、T2 高信号（HSI）和体感诱发电位（SEP）等指标，以预测 CSM 患者的手术预后。
健康对照组和 CSM 组的颈髓平均各向异性分数（FA）值存在显著差异（0.65±0.05 比 0.52±0.13，P<0.001）。FA 值与 mJOA 评分（r²=0.327，P=0.016）所示神经功能障碍严重程度呈显著相关性。logistic 回归分析显示，颈髓平均 FA 值（P=0.030）和 C2 椎体 FA 值（P=0.035）有助于预测手术疗效良好，而术前 mJOA 评分（P=0.927）、T2 HSI（P=0.176）、SEP 波幅（P=0.154）和潜伏期（P=0.260）则无此作用。
FA 是脊髓病严重程度和术后手术效果的生物标志物。
