Institute of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland.
Department of Psychiatry, Geriatric Psychiatry, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland.
Spine (Phila Pa 1976). 2023 Aug 1;48(15):1041-1046. doi: 10.1097/BRS.0000000000004667. Epub 2023 Apr 5.
Multicenter prospective observational study.
Diffusion tensor imaging in flexion extension improves the diagnosis of degenerative cervical myelopathy (DCM). We aimed to provide an imaging biomarker for the detection of DCM.
DCM is the most common form of spinal cord dysfunction in adults; however, imaging surveillance for myelopathy remains poorly characterized.
Symptomatic DCM patients were examined in maximum neck flexion-extension and neutral positions in a 3T-magnetic resonance imaging scanner and allocated to 2 groups: (1) Patients with visible intramedullary hyperintensity (IHIS) on T2-weighted imaging (IHIS+, n = 10); and (2) Patients without IHIS (IHIS-, n = 11). Range of motion, space available for the spinal cord, apparent diffusion coefficient (ADC), axial diffusivity (AD), radial diffusivity, and fractional anisotropy were measured and compared between the neck positions and between the groups as well as between control (C2/3) and pathologic segments.
Significant differences between the control level (C2/3) and pathologic segments were appreciated for the IHIS+ group at neutral neck position in AD; at flexion in ADC and AD; and at neck extension in ADC, AD, and fractional anisotropy values. For the IHIS- group, significant differences between the control level (C2/3) and pathologic segments were found only for ADC values in neck extension. When comparing diffusion parameters between groups, radial diffusivity was significantly different in all 3 neck positions.
Significant increases in ADC values between the control and pathologic segments were found for both groups in neck extension only. This may serve as a diagnostic tool to identify early changes in the spinal cord related to myelopathy to indicate potentially reversible spinal cord injury and support the indication for surgery in select circumstances.
多中心前瞻性观察研究。
屈伸位弥散张量成像可提高退行性颈脊髓病（DCM）的诊断准确性。本研究旨在提供一种影像学生物标志物，用于 DCM 的检测。
DCM 是成人脊髓功能障碍最常见的形式；然而，脊髓病的影像学监测仍特征不明。
在 3T 磁共振成像扫描仪中，对有症状的 DCM 患者进行最大颈椎屈伸位和中立位检查，并将其分为 2 组：（1）T2 加权成像上可见脊髓内高信号（IHIS）的患者（IHIS+，n=10）；（2）无 IHIS 的患者（IHIS-，n=11）。在颈椎屈伸位测量并比较两组间及与对照组（C2/3）间的活动范围、脊髓可用空间、表观扩散系数（ADC）、轴突弥散系数（AD）、径向弥散系数和各向异性分数。
在中立位时，IHIS+组颈段病变节段与对照组（C2/3）的 AD 值存在显著差异；在颈椎前屈时，IHIS+组的 ADC 和 AD 值存在显著差异；在颈椎伸展时，IHIS+组的 ADC、AD 和各向异性分数值存在显著差异。在 IHIS-组中，仅在颈椎伸展时，颈段病变节段与对照组（C2/3）的 ADC 值存在显著差异。当比较两组间的弥散参数时，在所有 3 个颈椎位置，径向弥散系数均存在显著差异。
两组患者在颈椎伸展时，病变节段与对照组（C2/3）间的 ADC 值均显著增加。这可能是一种诊断工具，用于识别与脊髓病相关的脊髓早期变化，以提示潜在的可逆转脊髓损伤，并在某些情况下支持手术指征。
