Farah Kaissar, Mchinda Samira, Pini Laurianne, Baucher Guillaume, Roche Pierre- Hugues, Fuentes Stéphane, Callot Virginie
Aix-Marseille University, CNRS, CRMBM, Marseille, France.
APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France.
Eur Spine J. 2025 Feb;34(2):731-740. doi: 10.1007/s00586-025-08652-z. Epub 2025 Jan 9.
Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord (SC) dysfunction. In routine clinical practice, SC changes are well depicted using conventional MRI, especially T2-weighted imaging. However, this modality usually fails to provide satisfactory clinico-radiological correlations. In this context we assessed the potential value of quantitative changes measured with a T1 MP2RAGE sequence.
18 patients diagnosed with chronic onset of DCM and 17 healthy controls (HC) were enrolled in the study. Clinical presentation was assessed using the modified Japanese Orthopaedic Association (mJOA) scale. Sagittal cervical SC T2-w 3D SPACE imaging and T1 MP2RAGE mapping were performed at baseline and 3-months postoperatively. Data were processed using Matlab and the SC Toolbox.
mJOA score increased from 13.3 ± 2.1 preoperatively to 14.4 ± 1.9 at follow-up (p = 0.027). Site of maximum compression (Cmax) was at C3-C4 cervical levels in 4 patients, C4-C5 in 8 patients, C5-C6 in 5 patients and C6-C7 in 1 patient. SC compression was multi-level in 7 patients and single-level in 11 patients. T2-w hyperintensity was present in 15 patients. Mean SC T1 values in the whole SC in the DCM group at baseline showed significant difference as compared to mean SC T1 values in HC group (962.2 ± 62 vs. 924.9 ± 34 ms, respectively (p < 0.0001)) but no differences could be observed between baseline and 3-month follow-up (962.4 ± 59 ms (p = 0.86)). Z-scores at baseline were - 0.05 ± 1 for mild, 1.2 ± 1.9 for moderate and 2.5 ± 1.2 for severe. Mean baseline and 3-month follow-up SC T1 values were weakly but significantly correlated to preoperative (R = 0.33 (p = 0.013) and postoperative mJOA (R = 0.29 (p = 0.024). Baseline T1 value at C2 level was significantly correlated with mJOA at 3-month follow-up (p = 0.048).
T1-MP2RAGE mapping in patients with DCM demonstrated both focal and diffuse cervical SC alteration. It could thus be a biomarker for patients with DCM managed surgically.
退行性颈椎脊髓病（DCM）是脊髓（SC）功能障碍最常见的原因。在常规临床实践中，使用传统MRI，尤其是T2加权成像，可以很好地显示脊髓变化。然而，这种方式通常无法提供令人满意的临床与影像学相关性。在此背景下，我们评估了用T1 MP2RAGE序列测量的定量变化的潜在价值。
本研究纳入了18例诊断为慢性起病的DCM患者和17名健康对照者（HC）。使用改良日本骨科协会（mJOA）量表评估临床表现。在基线和术后3个月进行颈椎脊髓矢状位T2-w 3D SPACE成像和T1 MP2RAGE映射。数据使用Matlab和脊髓工具箱进行处理。
mJOA评分从术前的13.3±2.1提高到随访时的14.4±1.9（p = 0.027）。最大压迫部位（Cmax）在4例患者中位于C3-C4颈椎水平，8例患者中位于C4-C5，5例患者中位于C5-C6，1例患者中位于C6-C7。7例患者脊髓压迫为多节段，11例患者为单节段。15例患者存在T2-w高信号。DCM组基线时整个脊髓的平均T1值与HC组相比有显著差异（分别为962.2±62与924.9±34 ms，p < 0.0001），但在基线和3个月随访之间未观察到差异（962.4±59 ms，p = 0.86）。轻度患者基线时的Z评分为-0.05±1，中度患者为1.2±1.9，重度患者为2.5±1.2。基线和3个月随访时脊髓的平均T1值与术前（R = 0.33，p = 0.013）和术后mJOA（R = 0.29，p = 0.024）呈弱但显著的相关性。C2水平的基线T1值与3个月随访时的mJOA显著相关（p = 0.048）。
DCM患者的T1-MP2RAGE映射显示了颈椎脊髓的局灶性和弥漫性改变。因此，它可能是接受手术治疗的DCM患者的一种生物标志物。
