Diffusion tensor imaging predicts functional impairment in mild-to-moderate cervical spondylotic myelopathy.
Diffusion tensor imaging predicts functional impairment in mild-to-moderate cervical spondylotic myelopathy.
复制标题
扩散张量成像可以预测轻度至中度颈椎脊髓病的功能障碍。
DOI：
10.1016/j.spinee.2014.02.027
复制
发表时间：
2014-11-01
期刊：
影响因子：
--
通讯作者：
Holly LT
中科院分区：
文献类型：
--
作者：
Ellingson BM;Salamon N;Grinstead JW;Holly LT
MRI是评估颈脊髓的标准成像方式；然而，脊髓型颈椎病（CSM）患者脊髓的MRI评估并没有显示出与手术或药物干预后神经功能或预后的一致关联。因此，需要一种敏感的成像生物标志物来预测晚期颈椎病患者的功能损害。本研究的目的是将弥散张量成像（DTI）作为颈椎病患者显微结构完整性和功能损伤的成像生物标志物。非随机、单机构研究。48例有或无脊髓信号改变的颈椎病患者行脊髓DTI并进行功能评估。通过mJOA评分测量神经功能这项研究得到了美国国立卫生研究院的支持，不存在明显的利益冲突。采用放大epi技术和二维空间选择性射频激励脉冲进行DTI测量。在压缩点对分数各向异性（FA）、平均扩散系数（MD）、径向和轴向扩散系数（RD和AD）、轴向扩散各向异性ψ（定义为AD-MD）和主特征向量取向的标准差进行了评价。结果表明，脊柱最高受压水平的平均FA、tADC、ψ和主特征向量方向标准差与修正日本骨科协会（mJOA）评分呈线性相关。受试者-操作者特征（Receiver-operator characteristic， ROC）分析表明，FA和ψ对轻度至中度狭窄患者具有较高的敏感性和特异性。本研究的结果支持DTI作为预测颈椎病患者功能损害的生物标志物的潜在应用。
MRI is the standard imaging modality for the assessment of the cervical spinal cord; however, MRI assessment of the spinal cord in cervical spondylotic myelopathy (CSM) patients has not demonstrated a consistent association with neurological function or outcome after surgical or medical intervention. Thus, there is a need for sensitive imaging biomarkers that can predict functional impairment in patients with advanced cervical spondylosis. The purpose of this study was to implement diffusion tensor imaging (DTI) as an imaging biomarker for microstructural integrity and functional impairment in patients with cervical spondylosis. Non-randomized, single institution study. Forty-eight cervical spondylosis patients with or without spinal cord signal change underwent DTI of the spinal cord along with functional assessment. Functional measures of neurological function via mJOA score This study was supported by the NIH and there are no perceived conflicts of interest. A zoomed-EPI technique and 2D spatially selective RF excitation pulse were used for DTI measurement. Fractional anisotropy (FA), mean diffusivity (MD), radial and axial diffusion coefficient (RD and AD), axial diffusion anisotropy, ψ, defined as AD-MD, and the standard deviation of primary eigenvector orientation were evaluated at the site of compression. Results suggest average FA, tADC, ψ, and standard deviation of primary eigenvector orientation at the spinal level of highest compression were linearly correlated with modified Japanese Orthopedic Association (mJOA) score. Receiver-operator characteristic (ROC) analysis suggested FA and ψ could identify stenosis patients with mild to moderate symptoms with a relatively high sensitivity and specificity. The results of this study support the potential use of DTI as a biomarker for predicting functional impairment in patients with cervical spondylosis.
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