Banaszek A, Bladowska J, Podgórski P, Sąsiadek M J
Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
Clin Neuroradiol. 2016 Sep;26(3):265-76. doi: 10.1007/s00062-015-0467-y. Epub 2015 Sep 30.
In the article we review the current role of diffusion tensor imaging (DTI), a modern magnetic resonance (MR) technique, in the diagnosis and the management of cervical spondylotic myelopathy (CSM), the most serious complication of degenerative cervical spine disease (DCSD). The pathogenesis of DCSD is presented first with an emphasis placed on the pathological processes leading to myelopathy development. An understanding of the pathophysiological background of DCSD is necessary for appropriate interpretation of MR images, both plain and DTI. Conventional MRI is currently the imaging modality of choice in DCSD and provides useful information concerning the extent of spondylotic changes and degree of central spinal canal stenosis; however its capability in myelopathy detection is limited. DTI is a state of the art imaging method which recently has emerged in spinal cord investigations and has the potential to detect microscopic alterations which are beyond the capability of plain MRI. In the article we present the physical principles underlying DTI which determine its sensitivity, followed by an overview of technical aspects of DTI acquisition with a special consideration of spinal cord imaging. Finally, the scientific reports concerning DTI utility in DSCD are also reviewed. DTI detects spinal cord injury in the course of DCSD earlier than any other method and could be useful in predicting surgical outcomes in CMS patients, however technical and methodology improvement as well as standardization of acquisition protocols and postprocessing methods among the imaging centers are needed before its implementation in clinical practice.
在本文中，我们回顾了扩散张量成像（DTI）这一现代磁共振（MR）技术在诊断和治疗脊髓型颈椎病（CSM）中的当前作用，脊髓型颈椎病是退行性颈椎疾病（DCSD）最严重的并发症。首先介绍了DCSD的发病机制，重点是导致脊髓病发展的病理过程。了解DCSD的病理生理背景对于正确解读普通和DTI的MR图像是必要的。传统MRI目前是DCSD的首选成像方式，可提供有关脊椎关节强硬变化程度和中央椎管狭窄程度的有用信息；然而，其在检测脊髓病方面的能力有限。DTI是一种最新的成像方法，最近已出现在脊髓研究中，有潜力检测普通MRI无法检测到的微观改变。在本文中，我们介绍了决定DTI敏感性的物理原理，随后概述了DTI采集的技术方面，并特别考虑了脊髓成像。最后，还回顾了有关DTI在DSCD中效用的科学报告。DTI比任何其他方法都能更早地检测出DCSD过程中的脊髓损伤，并且在预测CMS患者的手术结果方面可能有用，然而，在其应用于临床实践之前，需要改进技术和方法，以及在各成像中心实现采集协议和后处理方法的标准化。
