Department of Neurological Surgery, Northwestern Feinberg School of Medicine, Chicago, IL.
Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Stanford, CA.
Spine (Phila Pa 1976). 2018 Oct 15;43(20):E1204-E1209. doi: 10.1097/BRS.0000000000002667.
Case-control.
The aim of this study was to understand the role of high-resolution magnetic resonance (MR) in identifying regional cord volume loss in cervical spondylotic myelopathy (CSM).
Preliminary studies suggest that compression of the ventral region of the cord may contribute disproportionately to CSM symptomology; however, tract-specific data are lacking in the CSM population. The current study is the first to use 3T MR imaging (MRI) images of CSM patients to determine specific volume loss at the level of detail of individual descending white matter tracts.
Twelve patients with CSM and 14 age-matched were enrolled prospectively and underwent 3-Tesla MRI of the cervical spine. Using the high-resolution images of the spinal cord, straightening and alignment with a template was performed and specific spinal cord tract volumes were measured using Spinal Cord Tool-box version 3.0.7. Modified Japanese orthopedic association (mJOA) and Nurick disability scores were collected in a prospective manner and were analyzed in relation to descending spinal tract volumes.
Having CSM was predicted by anterior/posterior diameter, eccentricity of the cord [odds ratio (OR) 0.000000621, P = 0.004], ventral reticulospinal tract volume (OR 1.167, P = 0.063), lateral corticospinal tract volume (OR 1.034, P = 0.046), rubrospinal tract volume (OR 1.072, P = 0.011), and ventrolateral reticulospinal tract volume (OR 1.474, P = 0.005) on single variable logistic regression. Single variable linear regression showed decreases in anterior/posterior spinal cord diameter (P = 0.022), ventral reticulospinal tract volumes (P = 0.007), and ventrolateral reticulospinal tract volumes (P = 0.017) to significantly predict worsening mJOA scores. Similarly, decreases in ventral reticulospinal tract volumes significantly predicted increasing Nurick scores (P = 0.039).
High-resolution 3T MRI can detect tract-specific volume loss in descending spinal cord tracts in CSM patients. Anterior/posterior spinal cord diameter, ventral reticulospinal tract, ventrolateral reticulospinal tract, lateral corticospinal tract, and rubrospinal tract volume loss are associated with CSM symptoms.
病例对照研究。
本研究旨在了解高分辨率磁共振（MR）在识别颈椎脊髓病（CSM）中脊髓容积损失的区域的作用。
初步研究表明，脊髓腹侧区域的受压可能与 CSM 症状不成比例地相关；然而，CSM 人群中缺乏束特异性数据。本研究首次使用 CSM 患者的 3T MR 成像（MRI）图像，以确定个体下行白质束细节水平的特定体积损失。
前瞻性纳入 12 例 CSM 患者和 14 例年龄匹配的患者，并进行颈椎 3T 磁共振成像。使用脊髓高分辨率图像，通过模板进行拉直和对齐，并使用 Spinal Cord Tool-box 版本 3.0.7 测量特定的脊髓束体积。前瞻性收集改良日本矫形协会（mJOA）和 Nurick 残疾评分，并与下行脊髓束体积进行分析。
CSM 由前后直径、脊髓偏心度[比值比（OR）0.000000621，P=0.004]、腹侧网状脊髓束体积（OR 1.167，P=0.063）、外侧皮质脊髓束体积（OR 1.034，P=0.046）、红核脊髓束体积（OR 1.072，P=0.011）和腹外侧网状脊髓束体积（OR 1.474，P=0.005）预测。单变量线性回归显示，脊髓前后直径（P=0.022）、腹侧网状脊髓束体积（P=0.007）和腹外侧网状脊髓束体积（P=0.017）下降显著预测 mJOA 评分恶化。同样，腹侧网状脊髓束体积下降显著预测 Nurick 评分增加（P=0.039）。
高分辨率 3T MRI 可检测 CSM 患者下行脊髓束的束特异性容积损失。脊髓前后径、腹侧网状脊髓束、腹外侧网状脊髓束、外侧皮质脊髓束和红核脊髓束容积损失与 CSM 症状相关。
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