Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Systems Neuroscience and Pain Laboratory, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA.
World Neurosurg. 2020 Dec;144:e939-e947. doi: 10.1016/j.wneu.2020.09.148. Epub 2020 Oct 1.
We assessed the prognostic value of the preoperative magnetization transfer ratio (MTR) and morphometrics of the spinal cord in patients with degenerative cervical myelopathy (DCM) in a longitudinal cohort study.
Thirteen subjects with DCM underwent 3T magnetization transfer imaging. The MTR was calculated for the spinal cord regions and specific white matter tracts. Morphometric measures were extracted. Clinical (modified Japanese Orthopaedics Association [mJOA] and Nurick scale scores) and health-related quality of life scores were assessed before and after cervical decompression surgery. The association between the magnetic resonance imaging (MRI) metrics and postoperative recovery was assessed (Spearman's correlation). Receiver operating characteristics were used to assess the accuracy of MRI metrics in identifying ≥50% recovery in function.
Preoperative anterior cord MTRs were associated with recovery in mJOA scores (ρ = 0.608; P = 0.036; area under the curve [AUC], 0.66). Preoperative lateral cord MTR correlated with the neck disability index (ρ = 0.699; P = 0.011) and pain interference scale (ρ = 0.732; P = 0.007). Preoperative rubrospinal tract MTR was associated with mJOA score recovery (ρ = 0.573; P = 0.041; AUC, 0.86). Preoperative corticospinal tract and reticulospinal MTRs were related to recovery in pain interference scores (ρ = 0.591; P = 0.033; and ρ = 0.583; P = 0.035, respectively). Eccentricity of the cord was associated with Nurick scores (ρ = 0.606; P = 0.028) and mJOA scores (ρ = 0.651; P = 0.025; AUC, 0.92).
Preoperative MTR and eccentricity measurements of the spinal cord have prognostic value in assessing the response to surgery and recovery in patients with DCM. Advanced MRI and atlas-based postprocessing techniques can inform interventions and advance the healthcare received by patients with DCM.
我们通过一项纵向队列研究，评估术前磁化传递率（MTR）和脊髓形态计量学对退行性颈椎病（DCM）患者的预后价值。
13 例 DCM 患者行 3T 磁化传递成像。计算脊髓区域和特定白质束的 MTR。提取形态计量学测量值。在颈椎减压手术后评估临床（改良日本骨科协会[mJOA]和 Nurick 量表评分）和健康相关生活质量评分。使用 Spearman 相关性评估 MRI 指标与术后恢复的相关性。采用受试者工作特征曲线评估 MRI 指标识别功能恢复≥50%的准确性。
术前前索 MTR 与 mJOA 评分的恢复相关（ρ=0.608；P=0.036；曲线下面积[AUC]，0.66）。术前侧索 MTR 与颈部残疾指数（ρ=0.699；P=0.011）和疼痛干扰量表（ρ=0.732；P=0.007）相关。术前红核脊髓束 MTR 与 mJOA 评分的恢复相关（ρ=0.573；P=0.041；AUC，0.86）。术前皮质脊髓束和网状脊髓束 MTR 与疼痛干扰评分的恢复相关（ρ=0.591；P=0.033；和 ρ=0.583；P=0.035）。脊髓偏心与 Nurick 评分（ρ=0.606；P=0.028）和 mJOA 评分（ρ=0.651；P=0.025；AUC，0.92）相关。
术前脊髓 MTR 和偏心测量对评估 DCM 患者手术反应和恢复具有预后价值。高级 MRI 和基于图谱的后处理技术可为干预措施提供信息，并改善 DCM 患者的医疗保健。
