Wang Chunyao, Han Xiao, Ma Xiaodong, Jiang Wen, Wang Jinchao, Li Sisi, Guo Hua, Tian Wei, Chen Huijun
Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Eur Radiol. 2024 Feb;34(2):1349-1357. doi: 10.1007/s00330-023-10011-9. Epub 2023 Aug 15.
To investigate the association between spinal cord perfusion and microstructural damage in CSM patients who underwent cervical laminoplasty using MR dynamic susceptibility contrast (DSC), diffusion tensor imaging (DTI), and neurite orientation dispersion and density imaging (NODDI) techniques.
A follow-up cohort study was conducted with 53 consecutively recruited CSM patients who had undergone cervical laminoplasty 12-14 months after the surgery from April 2016 to December 2016. Twenty-one aged-matched healthy volunteers were recruited as controls. For each patient, decompressed spinal cord levels were imaged on a 3.0-T MRI scanner by diffusion and DSC sequences to quantify the degrees of microstructural damage and perfusion conditions, respectively. The diffusion data were analyzed by DTI and NODDI models to produce diffusion metrics. Classic indicator dilution model was used to quantify the DSC metrics. Mann-Whitney U test was performed for comparison of diffusion metrics between patients and healthy controls. Pearson correlation was used to explore the associations between the metrics of spinal cord perfusion and microstructural damage.
DTI metrics, neurite density, and isotropic volume fraction had significant differences between postoperative patients and healthy controls. Pearson correlation test showed that SCBV was significantly positively correlated with RD, MD, and ODI, and negatively correlated with FA and NDI. SCBF was found to be significantly positively correlated with RD and MD, and negatively correlated with FA.
Increased spinal cord perfusion quantified by DSC is associated with microstructural damage assessed by diffusion MRI in CSM patients who underwent cervical laminoplasty.
This study found that the spinal cord perfusion is associated with microstructural damage in postoperative cervical spondylotic myelopathy patients, indicating that high perfusion may play a role in the pathophysiological process of cervical spondylotic myelopathy and deserves more attention.
• Spinal cord microstructural damage can be persistent despite the compression had been relieved 12-14 months after the cervical laminoplasty in cervical spondylotic myelopathy (CSM) patients. • Spinal cord perfusion is associated with microstructural damage in CSM patients after the cervical laminoplasty. • Inflammation in the decompressed spinal cord may be a cause of increased perfusion and is associated with microstructural damage during the recovery period of CSM.
采用磁共振动态磁敏感对比增强（DSC）、扩散张量成像（DTI）和神经突方向离散与密度成像（NODDI）技术，研究接受颈椎椎板成形术的脊髓型颈椎病（CSM）患者脊髓灌注与微观结构损伤之间的关联。
进行一项随访队列研究，连续纳入53例于2016年4月至2016年12月接受颈椎椎板成形术12 - 14个月后的CSM患者。招募21名年龄匹配的健康志愿者作为对照。对每位患者，在3.0-T磁共振成像扫描仪上通过扩散序列和DSC序列对减压脊髓节段进行成像，分别量化微观结构损伤程度和灌注情况。通过DTI和NODDI模型分析扩散数据以生成扩散指标。采用经典指示剂稀释模型量化DSC指标。采用曼-惠特尼U检验比较患者与健康对照之间的扩散指标。采用Pearson相关性分析探讨脊髓灌注指标与微观结构损伤之间的关联。
术后患者与健康对照之间的DTI指标、神经突密度和各向同性体积分数存在显著差异。Pearson相关性检验显示，脊髓血容量（SCBV）与径向扩散率（RD）、平均扩散率（MD）和各向异性离散度指数（ODI）显著正相关，与各向异性分数（FA）和神经突密度指数（NDI）负相关。脊髓血供分数（SCBF）与RD和MD显著正相关，与FA负相关。
在接受颈椎椎板成形术的CSM患者中，DSC量化的脊髓灌注增加与扩散磁共振成像评估的微观结构损伤相关。
本研究发现脊髓型颈椎病术后患者的脊髓灌注与微观结构损伤相关，表明高灌注可能在脊髓型颈椎病的病理生理过程中起作用，值得更多关注。
• 对于脊髓型颈椎病（CSM）患者，尽管颈椎椎板成形术后12 - 14个月压迫已解除，但脊髓微观结构损伤可能持续存在。• 颈椎椎板成形术后CSM患者的脊髓灌注与微观结构损伤相关。• 减压脊髓中的炎症可能是灌注增加的原因，并且在CSM恢复期与微观结构损伤相关。
