Valošek Jan, Bednařík Petr, Keřkovský Miloš, Hluštík Petr, Bednařík Josef, Svatkova Alena
Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic.
Department of Radiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic.
J Clin Med. 2022 Apr 20;11(9):2301. doi: 10.3390/jcm11092301.
Degenerative spinal cord compression is a frequent pathological condition with increasing prevalence throughout aging. Initial non-myelopathic cervical spinal cord compression (NMDC) might progress over time into potentially irreversible degenerative cervical myelopathy (DCM). While quantitative MRI (qMRI) techniques demonstrated the ability to depict intrinsic tissue properties, longitudinal in-vivo biomarkers to identify NMDC patients who will eventually develop DCM are still missing. Thus, we aim to review the ability of qMRI techniques (such as diffusion MRI, diffusion tensor imaging (DTI), magnetization transfer (MT) imaging, and magnetic resonance spectroscopy (H-MRS)) to serve as prognostic markers in NMDC. While DTI in NMDC patients consistently detected lower fractional anisotropy and higher mean diffusivity at compressed levels, caused by demyelination and axonal injury, MT and H-MRS, along with advanced and tract-specific diffusion MRI, recently revealed microstructural alterations, also rostrally pointing to Wallerian degeneration. Recent studies also disclosed a significant relationship between microstructural damage and functional deficits, as assessed by qMRI and electrophysiology, respectively. Thus, tract-specific qMRI, in combination with electrophysiology, critically extends our understanding of the underlying pathophysiology of degenerative spinal cord compression and may provide predictive markers of DCM development for accurate patient management. However, the prognostic value must be validated in longitudinal studies.
退行性脊髓压迫是一种常见的病理状况，随着年龄增长其患病率不断上升。最初的非脊髓病性颈脊髓压迫（NMDC）可能会随着时间推移进展为潜在不可逆的退行性颈椎病（DCM）。虽然定量磁共振成像（qMRI）技术已证明能够描绘组织的内在特性，但仍缺乏用于识别最终会发展为DCM的NMDC患者的纵向体内生物标志物。因此，我们旨在综述qMRI技术（如扩散磁共振成像、扩散张量成像（DTI）、磁化传递（MT）成像和磁共振波谱（H-MRS））作为NMDC预后标志物的能力。虽然NMDC患者的DTI始终在受压节段检测到较低的各向异性分数和较高的平均扩散率，这是由脱髓鞘和轴突损伤引起的，但MT和H-MRS以及先进的、针对特定神经束的扩散磁共振成像最近揭示了微观结构改变，也向头侧提示了华勒变性。最近的研究还分别通过qMRI和电生理学评估揭示了微观结构损伤与功能缺陷之间的显著关系。因此，针对特定神经束的qMRI与电生理学相结合，极大地扩展了我们对退行性脊髓压迫潜在病理生理学的理解，并可能为准确的患者管理提供DCM发展的预测标志物。然而，预后价值必须在纵向研究中得到验证。
