Kitamura Mitsuhiro, Maki Satoshi, Koda Masao, Furuya Takeo, Iijima Yasushi, Saito Junya, Miyamoto Takuya, Shiga Yasuhiro, Inage Kazuhide, Orita Sumihisa, Takahashi Hiroshi, Matsumoto Koji, Masuda Yoshitada, Yamazaki Masashi, Ohtori Seiji
Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuou-ku, Chiba City, Chiba 260-8670, Japan.
Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuou-ku, Chiba City, Chiba 260-8670, Japan.
J Clin Neurosci. 2020 Apr;74:194-198. doi: 10.1016/j.jocn.2019.05.018. Epub 2019 Jun 11.
Previous studies have reported the utility of diffusion tensor imaging (DTI) as an imaging biomarker for the severity of myelopathy and subsequent surgical outcome in patients with degenerative cervical myelopathy (DCM). We hypothesized that DTI may reflect neurological recovery following surgery. The purpose of this study was to evaluate the ability of DTI to assess the post-operative alteration of neural status in patients with DCM as well as to predict post-operative recovery. We enrolled 15 patients with DCM who underwent decompression surgery. The Japanese Orthopaedic Association (JOA) score was evaluated before and 1 year after surgery. The participants were examined using DTI on a 3.0 T magnetic resonance scanner before, and 1 year after surgery. Fractional anisotropy (FA) and mean diffusivity (MD) were assessed for both time points. The correlations between the pre- and post-operative FA and MD values and the pre- and post-operative JOA scores were analyzed. Although the JOA score improved significantly after surgery from 8.9 to 12.3, there was no significant change between the pre- and post-operative FA and MD values. The post-operative outcomes after 1 year moderately correlated with the pre-operative FA values (Spearman's ρ = 0.55, p = 0.03 and Spearman's ρ = 0.56, p = 0.03 for change and recovery rate of the JOA score, respectively). However, there was no correlation between the post-operative FA and post-operative JOA scores nor between MD and clinical outcomes. DTI cannot be utilized as a biomarker for post-operative alterations of neural status of the spinal cord; however, pre-operative DTI may be useful as a predictor of surgical outcomes.
以往的研究报道了弥散张量成像（DTI）作为一种影像学生物标志物，可用于评估退行性颈椎脊髓病（DCM）患者脊髓病的严重程度及后续手术结果。我们推测DTI可能反映手术后的神经恢复情况。本研究的目的是评估DTI评估DCM患者术后神经状态改变以及预测术后恢复情况的能力。我们纳入了15例接受减压手术的DCM患者。在手术前和术后1年评估日本骨科协会（JOA）评分。在手术前和术后1年，使用3.0 T磁共振扫描仪对参与者进行DTI检查。评估两个时间点的分数各向异性（FA）和平均扩散率（MD）。分析术前和术后FA及MD值与术前和术后JOA评分之间的相关性。尽管术后JOA评分从8.9显著提高到12.3，但术前和术后FA及MD值之间无显著变化。术后1年的结果与术前FA值中度相关（JOA评分变化率和恢复率的Spearman's ρ分别为0.55，p = 0.03和Spearman's ρ为0.56，p = 0.03）。然而，术后FA与术后JOA评分之间以及MD与临床结果之间均无相关性。DTI不能用作脊髓神经状态术后改变的生物标志物；然而，术前DTI可能有助于预测手术结果。
