Diffusion Tensor Imaging Correlates with the Clinical Assessment of Disease Severity in Cervical Spondylotic Myelopathy and Predicts Outcome following Surgery
Diffusion Tensor Imaging Correlates with the Clinical Assessment of Disease Severity in Cervical Spondylotic Myelopathy and Predicts Outcome following Surgery
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DOI：
10.3174/ajnr.a3199
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发表时间：
2013-02-01
影响因子：
3.5
通讯作者：
Law, M.
中科院分区：
文献类型：
--
作者：
Jones, J. G. A.;Cen, S. Y.;Law, M.
本文对30例颈椎病型颈椎病患者的DTI表现与临床严重程度的关系进行了研究。低分数各向异性与初始临床评估相关，高FA患者表现出更好的预后。T2信号强度与功能状态相关，但不能预测预后，而狭窄程度与所有临床参数缺乏相关性。因此，DTI可能是评估这些患者疾病严重程度的有用诊断工具，其对术后预后的预测价值可能改善手术决策。背景和目的:CSM是一种常见的神经系统疾病,最终导致进步的残疾和麻痹没有适当的治疗。成像在CSM的评估中起着重要作用，并随着最近技术的进步而发展。我们试图系统地探讨CSM临床疾病严重程度与DTI之间的关系，并探讨DTI在手术决策模型中的潜在应用。材料与方法：前瞻性收集30例CSM患者的磁共振成像研究和临床评价。Spearman相关性用于研究诊断时临床疾病严重程度与FA之间的关系。临床评估采用mJOA、Nurick、Short Form-36和NDI评分。15例CSM患者随后接受了减压手术；对该队列应用Spearman相关和logistic回归研究基线DTI测量与术后预后之间的关系。评估常规影像学（脊髓T2信号强度和狭窄程度）与DTI的比较。结果：在诊断时，FA与基线mJOA （r = 0.62, P < 0.01）和Nurick评分（r = -0.46, P = 0.01）有很强的相关性。术后NDI评分改善所显示的功能恢复与术前DTI FA值升高相关（r = -0.61, P = 0.04）。与FA较低的CSM患者相比，FA过高的严重CSM患者术后mJOA评分更高（P = .08）。T2信号强度与基线时的功能状态相关，但不能预测术后结果；狭窄程度与临床参数无显著相关性。结论：DTI可能是评估CSM疾病严重程度的有用诊断工具。DTI对术后预后的预测价值可以改善手术决策，促进医疗保健结果的研究。
The relationship between DTI findings and clinical severity of cervical myelopathy due to spondylosis was studied in 30 patients. Low fractional anisotropy correlated with initial clinical assessments and patients with high FA showed better outcome. T2 signal intensity was associated with functional status but did not predict outcome whereas degree of stenosis lacked correlation with all clinical parameters. Thus, DTI may be a useful diagnostic tool for assessing disease severity in these patients and its predictive value regarding postoperative outcome may improve surgical decision making.BACKGROUND AND PURPOSE: CSM is a common neurologic disease that results in progressive disability and eventual paralysis without appropriate treatment. Imaging plays a significant role in the evaluation of CSM and has evolved with recent technical advances. We sought to systematically explore the relationship between clinical disease severity and DTI in CSM, and to investigate the potential use of DTI in surgical decision-making models.MATERIALS AND METHODS: MR imaging studies and clinical assessments were prospectively collected on 30 patients with CSM. Spearman correlations were used to investigate associations between clinical disease severity and FA at the time of diagnosis. Clinical assessment was performed using mJOA, Nurick, Short Form-36, and NDI scores. Fifteen patients with CSM subsequently underwent decompressive surgery; Spearman correlation and logistic regression were applied to this cohort to study the relationship between baseline DTI measurements and postoperative outcome. Conventional imaging (spinal cord T2 signal intensity and degree of stenosis) was evaluated for comparison with DTI.RESULTS: At diagnosis, FA demonstrated a strong correlation with baseline mJOA (r = 0.62, P < .01) and Nurick (r = -0.46, P = .01) scores. After surgery, recovery of function demonstrated by improvement in NDI score was associated with higher FA values on preoperative DTI (r = -0.61, P = .04). Severely affected patients with CSM with disproportionately high FA tended to achieve greater mJOA scores after surgery compared with subjects with lower FA (P = .08). T2 signal intensity was associated with functional status at baseline but did not predict postoperative outcome; degree of stenosis lacked any significant correlation with clinical parameters.CONCLUSIONS: DTI may be a useful diagnostic tool for assessing disease severity in CSM. The predictive value of DTI regarding postoperative outcome may improve surgical decision-making and facilitate health care outcomes research.