Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China.
Eur Spine J. 2020 Jun;29(6):1219-1226. doi: 10.1007/s00586-020-06381-z. Epub 2020 Apr 4.
To investigate whether multi-shot diffusion-weighted imaging (ms-DWI) could be applied in diagnosis and quantitative evaluation of cervical spondylotic myelopathy (CSM).
Thirty-three normal volunteers and 78 patients with CSM were included in this study. The apparent diffusion coefficient (ADC) values were measured at C2-C7 levels on sagittal section ADC map. The intraclass correlation coefficient (ICC) and Bland and Altman plot and Spearman coefficient were used to quantify the reproducibility of test and retest and inter-rater reliability. Pearson correlations were calculated to compare lADC and rADC versus mJOA and NDI scores. Receiver operating characteristic curve and the area under the curve (AUC) were applied to evaluate the diagnostic reliability.
There was no statistically significant difference between ADC values obtained from normal volunteers at C2-C7 levels (P < 0.05). The ICC and spearman coefficient of lADC and rADC indicated excellent test-retest and inter-rater reliability. The mean lADC and rADC were significantly higher from patients than that from volunteers (all P < 0.01). The lADC had moderate to good correlations with mJOA and NDI (all P < 0.0001). Moreover, rADC had good to excellent correlations with mJOA and NDI (all P < 0.0001). Comparing AUCs, rADC was significantly superior in diagnosis which participants were CSM than lADC (P = 0.0118).
The ms-DWI could be applied in diagnosis and quantitive assessment of CSM according to lADC and rADC. A new parameter, rADC, could be served as a diagnostic indice for CSM, which may quantitively reflect the severity of CSM. These slides can be retrieved under Electronic Supplementary Material.
探讨多回波弥散加权成像（ms-DWI）能否应用于诊断和定量评估脊髓型颈椎病（CSM）。
本研究纳入了 33 名正常志愿者和 78 名 CSM 患者。在矢状位 ADC 图上测量 C2-C7 水平的表观弥散系数（ADC）值。采用组内相关系数（ICC）和 Bland 和 Altman 图以及 Spearman 系数来量化测试和复测以及观察者间可靠性的可重复性。Pearson 相关系数用于比较 lADC 和 rADC 与 mJOA 和 NDI 评分的相关性。受试者工作特征曲线和曲线下面积（AUC）用于评估诊断可靠性。
在 C2-C7 水平，正常志愿者的 ADC 值之间无统计学差异（P < 0.05）。lADC 和 rADC 的 ICC 和 Spearman 系数表明测试-复测和观察者间的可靠性良好。患者的平均 lADC 和 rADC 明显高于志愿者（均 P < 0.01）。lADC 与 mJOA 和 NDI 具有中度至良好相关性（均 P < 0.0001）。此外，rADC 与 mJOA 和 NDI 具有良好至极好相关性（均 P < 0.0001）。比较 AUC，rADC 在诊断 CSM 患者时明显优于 lADC（P = 0.0118）。
根据 lADC 和 rADC，ms-DWI 可应用于 CSM 的诊断和定量评估。新参数 rADC 可作为 CSM 的诊断指标，可定量反映 CSM 的严重程度。这些幻灯片可以在电子补充材料中检索到。
