Park Geun Seok, Kim Tae Uk, Lee Seong Jae, Hyun Jung Keun, Kim Seo Young
Department of Rehabilitation Medicine, Dankook University Hospital, Cheonan, Korea.
Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea.
Ann Rehabil Med. 2022 Aug;46(4):172-184. doi: 10.5535/arm.22053. Epub 2022 Aug 31.
To investigate the clinical usefulness of diffusion tensor imaging (DTI) and tractography in the prediction of outcomes after traumatic cervical spinal cord injury (SCI) and to assess whether the predictability is different between DTI and tractography administered before and after surgery.
Sixty-one subjects with traumatic cervical SCI were randomly assigned to preop or postop groups and received DTI accordingly. Among the patients who had DTI before surgery, we assigned 10 patients who had received repeated DTI examinations at 8 weeks after injury to the follow-up group. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained from DTI, and imaginary fiber and crossing fiber numbers were calculated from the tractography. Neurological status and functional status were assessed at 4 and 8 weeks after SCI.
The neurologic and functional statuses of both groups improved after 4 weeks. Out of the initial 61 patients who were enrolled in the study, the failure rate of DTI image analysis was significantly higher in the postop group (n=17, 41.5%) than in the preop group (n=6, 20%). The FA values and fiber numbers in the preop group tended to be higher than those in the postop group, whereas ADC values were lower in the preop group. When comparing the tractographic findings in the follow-up group, imaginary fiber numbers at the C6 and C7 levels and crossing fiber numbers from the C3 to C6 levels were significantly decreased after surgery. Several DTI and tractographic parameters (especially the ADC value at the C4 level and imaginary fiber numbers at the C6 level) showed significant correlations with neurologic and functional statuses in both the preop and postop groups. These findings were most prominent when DTI and physical examination were simultaneously performed.
Preoperative DTI and tractography demonstrated better FA and ADC values with lower interpretation failure rates than those obtained after surgery, whereas postoperative data significantly reflected the patient's clinical state at the time of evaluation. Therefore, DTI and tractography could be useful in predicting clinical outcomes after traumatic cervical SCI and should be interpreted separately before and after spine surgery.
探讨弥散张量成像（DTI）和纤维束成像在预测创伤性颈脊髓损伤（SCI）后结局中的临床应用价值，并评估术前和术后进行DTI及纤维束成像的预测能力是否存在差异。
61例创伤性颈脊髓损伤患者被随机分为术前组或术后组，并相应接受DTI检查。在术前接受DTI检查的患者中，我们将10例在伤后8周接受重复DTI检查的患者分配至随访组。从DTI中获取分数各向异性（FA）值和表观扩散系数（ADC）值，并从纤维束成像中计算虚拟纤维和交叉纤维数量。在脊髓损伤后4周和8周评估神经功能状态和功能状态。
两组患者在4周后神经功能和功能状态均有所改善。在最初纳入研究的61例患者中，术后组（n = 17，41.5%）DTI图像分析失败率显著高于术前组（n = 6，20%）。术前组的FA值和纤维数量往往高于术后组，而术前组的ADC值较低。比较随访组的纤维束成像结果时，术后C6和C7水平的虚拟纤维数量以及C3至C6水平的交叉纤维数量显著减少。术前和术后组中，几个DTI和纤维束成像参数（尤其是C4水平的ADC值和C6水平的虚拟纤维数量）与神经功能和功能状态均显示出显著相关性。当同时进行DTI和体格检查时，这些发现最为突出。
术前DTI和纤维束成像显示出比术后更好的FA和ADC值，且解释失败率更低，而术后数据显著反映了评估时患者的临床状态。因此，DTI和纤维束成像在预测创伤性颈脊髓损伤后的临床结局方面可能有用，并且在脊柱手术前后应分别进行解读。
