2nd Department of Radiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland.
Department of Neurosurgery, Faculty of Medicine, Medical University of Gdansk, Poland.
Neurol Neurochir Pol. 2022;56(4):341-348. doi: 10.5603/PJNNS.a2022.0031. Epub 2022 Apr 26.
The aim of this study was to assess the diagnostic value of diffusion tensor imaging (DTI) in patients with symptoms of cervical myelopathy. Detailed goals included determining the diagnostic effectiveness of quantitative parameters, i.e. fractional anisotropy (FA) and apparent diffusion coefficient (ADC), in the diagnosis of cervical myelopathy, and the correlation between these parameters and clinical symptoms.
The demonstration of an ischaemic focus in the spinal cord by standard magnetic resonance imaging (MRI) methods is associated with already accomplished spinal cord damage, and of course limited treatment options. Therefore, finding a new examination protocol that allows early diagnosis of myelopathic focus, before the onset of full neurological symptoms, has become a priority in the diagnosis and treatment of spine diseases. Such an examination increases the chances of correctly qualifying the patient for conservative vs. surgical treatment.
Between 2013 and 2017, 128 adults with clinical signs of cervical myelopathy were examined, and were divided into four symptomatic subgroups. A control group consisted of 37 healthy volunteers. DTI values were measured at the level of C2/C3, and at the most severe stenosis of the spine.
In patients with cervical spondylotic myelopathy (CSM), the ADC values were significantly higher (p < 0.001), and FA values were significantly lower (p < 0.001), than in healthy volunteers at the stenotic level. There were significant differences in DTI parameters between the clinical subgroups (p < 0.001).
Changes in DTI parameters indicate a microstructural disorder of the core which is not visible in a structural MRI. FA and ADC values measured at the level of the most severe stenosis of the spinal canal allow the differentiation of patients with myelopathy of varying degrees of clinical severity. Extending standard MRI to include assessment of FA and ADC may be helpful in deciding treatment modalities (conservative vs. surgical) for patients with visible canal stenosis without full neurological symptoms. This may be useful in selecting patients for urgent rehabilitative treatment. This study is a starting point for further research, i.e. an evaluation of the extent of FA and ADC lesion withdrawal after surgical treatment.
本研究旨在评估扩散张量成像（DTI）在有颈髓病症状患者中的诊断价值。详细目标包括确定定量参数（即各向异性分数（FA）和表观扩散系数（ADC））在颈髓病诊断中的诊断效能，以及这些参数与临床症状之间的相关性。
标准磁共振成像（MRI）方法显示脊髓中的缺血灶与已完成的脊髓损伤有关，当然也与有限的治疗选择有关。因此，找到一种新的检查方案，允许在出现完全神经症状之前，即脊髓病灶发生之前，对其进行早期诊断，已成为脊柱疾病诊断和治疗的优先事项。这种检查增加了正确为患者进行保守治疗与手术治疗分类的机会。
2013 年至 2017 年间，对 128 名有颈髓病临床症状的成年人进行了检查，并将其分为四个有症状亚组。对照组由 37 名健康志愿者组成。在 C2/C3 水平和脊柱最严重狭窄处测量 DTI 值。
在有颈椎脊髓病（CSM）的患者中，与健康志愿者相比，狭窄处的 ADC 值显著升高（p<0.001），FA 值显著降低（p<0.001）。DTI 参数在临床亚组之间存在显著差异（p<0.001）。
DTI 参数的变化表明核心的微观结构紊乱，在结构 MRI 中不可见。在椎管最严重狭窄处测量的 FA 和 ADC 值可区分具有不同临床严重程度的脊髓病患者。将标准 MRI 扩展到包括 FA 和 ADC 的评估，可能有助于确定有明显管腔狭窄但无完全神经症状的患者的治疗方式（保守治疗与手术治疗）。这对于选择需要紧急康复治疗的患者可能会有所帮助。本研究是进一步研究的起点，即评估手术治疗后 FA 和 ADC 病变退缩的程度。
