Mohammadi Mohammad, Roohollahi Faramarz, Farahbakhsh Farzin, Mohammadi Aynaz, Mortazavi Mamaghani Elham, Kankam Samuel Berchi, Moarrefdezfouli Azin, Ghamari Khameneh Afshar, Mahmoudi Mohamad Mahdi, Baghdasaryan Davit, Martin Allan R, Harrop James, Rahimi-Movaghar Vafa
School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Global Spine J. 2025 Jan;15(1):267-283. doi: 10.1177/21925682241263792. Epub 2024 Jun 14.
Systematic review.
Degenerative cervical myelopathy (DCM) is a common spinal cord disorder necessitating surgery. We aim to explore how effectively diffusion tensor imaging (DTI) can distinguish DCM from healthy individuals and assess the relationship between DTI metrics and symptom severity.
We included studies with adult DCM patients who had not undergone decompressive surgery and implemented correlation analyses between DTI parameters and severity, or compared healthy controls and DCM patients.
57 studies were included in our meta-analysis. At the maximal compression (MC) level, fractional anisotropy (FA) exhibited lower values in DCM patients, while apparent diffusion coefficient (ADC), mean diffusivity (MD), and radial diffusivity (RD) were notably higher in the DCM group. Moreover, our investigation into the diagnostic utility of DTI parameters disclosed high sensitivity, specificity, and area under the curve values for FA (.84, .80, .83 respectively) and ADC (.74, .84, .88 respectively). Additionally, we explored the correlation between DTI parameters and myelopathy severity, revealing a significant correlation of FA (.53, 95% CI:0.40 to .65) at MC level with JOA/mJOA scores.
Current guidelines for DCM suggest decompressive surgery for both mild and severe cases. However, they lack clear recommendations on which mild DCM patients might benefit from conservative treatment vs immediate surgery. ADC's role here could be pivotal, potentially differentiating between healthy individuals and DCM. While it may not correlate with symptom severity, it might predict surgical outcomes, making it a valuable imaging biomarker for clearer management decisions in mild DCM.
系统评价。
退行性颈椎脊髓病（DCM）是一种常见的脊髓疾病，需要进行手术治疗。我们旨在探讨扩散张量成像（DTI）能多有效地将DCM与健康个体区分开来，并评估DTI指标与症状严重程度之间的关系。
我们纳入了未接受减压手术的成年DCM患者的研究，并对DTI参数与严重程度进行相关性分析，或比较健康对照组和DCM患者。
我们的荟萃分析纳入了57项研究。在最大压迫（MC）水平，DCM患者的分数各向异性（FA）值较低，而DCM组的表观扩散系数（ADC）、平均扩散率（MD）和径向扩散率（RD）显著较高。此外，我们对DTI参数诊断效用的研究揭示了FA（分别为0.84、0.80、0.83）和ADC（分别为0.74、0.84、0.88）的高敏感性、特异性和曲线下面积值。此外，我们探讨了DTI参数与脊髓病严重程度之间的相关性，发现在MC水平FA（0.53，95%CI：0.40至0.65）与日本矫形外科学会/改良日本矫形外科学会（JOA/mJOA）评分之间存在显著相关性。
目前DCM的指南建议对轻度和重度病例均进行减压手术。然而，对于哪些轻度DCM患者可能从保守治疗而非立即手术中获益，它们缺乏明确的建议。ADC在此的作用可能至关重要，有可能区分健康个体和DCM。虽然它可能与症状严重程度无关，但它可能预测手术结果，使其成为一种有价值的成像生物标志物，有助于在轻度DCM中做出更清晰的管理决策。
