利用扩散张量成像预测脊髓型颈椎病的神经预后

The Prediction of Neurological Prognosis for Cervical Spondylotic Myelopathy Using Diffusion Tensor Imaging.

作者信息

Takamiya Soichiro, Iwasaki Motoyuki, Yokohama Takumi, Oura Daisuke, Niiya Yoshimasa, Fujimura Miki

机构信息

Department of Neurosurgery, Otaru General Hospital, Otaru, Japan.

Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.

出版信息

Neurospine. 2023 Mar;20(1):248-254. doi: 10.14245/ns.2244708.354. Epub 2023 Mar 31.

DOI:10.14245/ns.2244708.354

PMID:37016871

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10080413/

Abstract

OBJECTIVE

Although cervical spondylotic myelopathy (CSM) can be easily diagnosed using magnetic resonance imaging (MRI), prediction of surgical effect using preoperative radiological examinations remains difficult. In previous studies, it was reported that diffusion tensor imaging (DTI) may be used for the prediction of surgical effect; however, these studies did not consider the influences of spinal cord compression even though the values of DTI indexes can be distorted by compressive lesions in patients with CSM. Therefore, it is uncertain whether preoperative DTI indexes can actually predict the surgical effect. The aim of this study was to investigate DTI metrics that are hardly affected by spinal cord compression and can accurately predict neurological status after decompressive surgery.

METHODS

Twenty-one patients with CSM who underwent surgery and 10 healthy volunteers were enrolled in this study. The subjects underwent cervical MRI, and values of DTI indexes including axial diffusivity (AD), radial diffusivity (RD), apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were recorded at each intervertebral level. Further, the Japanese Orthopaedic Association (JOA) score of each patient with CSM was recorded before and after surgery for neurological status evaluation. Preoperative and postoperative values of DTI indexes were compared, and correlations between preoperative DTI parameters and postoperative neurological recovery were assessed.

RESULTS

After surgery, the lesion-adjacent (LA) ratios of RD and ADC increased (p = 0.04 and p = 0.062, respectively), while the LA ratio of FA decreased (p = 0.075). In contrast, the LA ratio of AD hardly changed. A negative correlation was observed between preoperative LA ratio of AD and JOA recovery rate 6 months after surgery (r = -0.379, p = 0.091). Based on preoperative LA ratio of AD, the patients were divided into a low AD group and a high AD group, and JOA recovery rate 6 months after surgery was found to be higher in the low AD group than in the high AD group (p = 0.024).

CONCLUSION

In patients with CSM, preoperative LA ratio of AD is seldom affected by spinal cord compression, and it negatively correlates with JOA recovery rate 6 months after surgery.

摘要

目的

尽管使用磁共振成像（MRI）能够轻易诊断脊髓型颈椎病（CSM），但利用术前影像学检查预测手术效果仍然困难。在以往研究中，有报道称扩散张量成像（DTI）可用于预测手术效果；然而，这些研究并未考虑脊髓压迫的影响，即便CSM患者的DTI指标值会因压迫性病变而扭曲。因此，术前DTI指标是否真的能够预测手术效果尚不确定。本研究的目的是探究几乎不受脊髓压迫影响且能够准确预测减压手术后神经状态的DTI指标。

方法

本研究纳入了21例接受手术的CSM患者和10名健康志愿者。受试者接受了颈椎MRI检查，并记录了每个椎间水平的DTI指标值，包括轴向扩散率（AD）、径向扩散率（RD）、表观扩散系数（ADC）和各向异性分数（FA）。此外，记录了每位CSM患者手术前后的日本骨科协会（JOA）评分，以评估神经状态。比较DTI指标的术前和术后值，并评估术前DTI参数与术后神经恢复之间的相关性。

结果

术后，RD和ADC的病变相邻（LA）比值升高（分别为p = 0.04和p = 0.062），而FA的LA比值降低（p = 0.075）。相比之下，AD的LA比值几乎没有变化。术前AD的LA比值与术后6个月的JOA恢复率之间存在负相关（r = -0.379，p = 0.091）。根据术前AD的LA比值，将患者分为低AD组和高AD组，发现低AD组术后6个月的JOA恢复率高于高AD组（p = 0.024）。