Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA.
Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, USA.
Eur Spine J. 2024 Jan;33(1):133-154. doi: 10.1007/s00586-023-07990-0. Epub 2023 Nov 5.
PURPOSE: Cervical Spondylotic Myelopathy (CSM) is a degenerative condition that leads to loss of cervical spinal cord (CSC) integrity. Various spinal cord Magnetic Resonance Imaging (MRI) methods can identify and characterize the extent of this damage. This systematic review aimed to evaluate the diagnostic, biomarker, and predictive utilities of different spinal cord MRI methods in clinical research studies of CSM. The aim was to provide a comprehensive understanding of the progress in this direction for future studies and effective diagnosis and management of CSM. METHODS: A comprehensive literature search was conducted on PubMed and EMBASE from 2010 to 2022 according to PRISMA guidelines. Studies with non-human subjects, less than 3T magnetic field strength, non-clinical design, or not quantitatively focusing on the structural integrity of CSC were excluded. The extracted data from each study included demographics, disease severity, MRI machine characteristics, quantitative metrics, and key findings in terms of diagnostic, biomarker, and predictive utilities of each MRI method. The risk of bias was performed using the guide from AHRQ. The quality of evidence was assessed separately for each type of utility for different MRI methods using GRADE. RESULTS: Forty-seven studies met the inclusion criteria, utilizing diffusion-weighted imaging (DTI) (n = 39), magnetization transfer (MT) (n = 6), MR spectroscopy (n = 3), and myelin water imaging (n = 1), as well as a combination of MRI methods (n = 12). The metric fractional anisotropy (FA) showed the highest potential in all facets of utilities, followed by mean diffusivity. Other promising metrics included MT ratio and intracellular volume fraction, especially in multimodal studies. However, the level of evidence for these promising metrics was low due to a small number of studies. Some studies, mainly DTI, also reported the usefulness of spinal cord MRI in mild CSM. CONCLUSIONS: Spinal cord MRI methods can potentially facilitate the diagnosis and management of CSM by quantitatively interrogating the structural integrity of CSC. DTI is the most promising MRI method, and other techniques have also shown promise, especially in multimodal configurations. However, this field is in its early stages, and more studies are needed to establish the usefulness of spinal cord MRI in CSM.
目的：颈椎脊髓病（CSM）是一种导致颈椎脊髓（CSC）完整性丧失的退行性疾病。各种脊髓磁共振成像（MRI）方法可以识别和描述这种损伤的程度。本系统评价旨在评估不同脊髓 MRI 方法在 CSM 临床研究中的诊断、生物标志物和预测效用。目的是为未来的研究以及 CSM 的有效诊断和管理提供对这一方向进展的全面了解。
方法：根据 PRISMA 指南，在 2010 年至 2022 年期间在 PubMed 和 EMBASE 上进行了全面的文献检索。排除了非人体受试者、磁场强度小于 3T、非临床设计或没有定量关注 CSC 结构完整性的研究。从每项研究中提取的数据包括人口统计学、疾病严重程度、MRI 机器特征、定量指标以及每种 MRI 方法在诊断、生物标志物和预测效用方面的关键发现。使用 AHRQ 指南进行偏倚风险评估。使用 GRADE 分别评估每种 MRI 方法在不同效用类型方面的证据质量。
结果：符合纳入标准的研究有 47 项，其中使用弥散加权成像（DTI）（n=39）、磁化传递（MT）（n=6）、磁共振波谱（n=3）和髓鞘水成像（n=1），以及 MRI 方法组合（n=12）。各方面效用中，各向异性分数（FA）显示出最大的潜力，其次是平均弥散度。其他有前途的指标包括 MT 比和细胞内体积分数，特别是在多模态研究中。然而，由于研究数量较少，这些有前途的指标的证据水平较低。一些研究，主要是 DTI，还报告了脊髓 MRI 在轻度 CSM 中的有用性。
结论：脊髓 MRI 方法通过定量研究 CSC 的结构完整性，有可能有助于 CSM 的诊断和管理。DTI 是最有前途的 MRI 方法，其他技术也显示出前景，特别是在多模态配置中。然而，该领域仍处于早期阶段，需要更多的研究来确定脊髓 MRI 在 CSM 中的有用性。
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