Spinal cord structure-function relationships in degenerative cervical myelopathy

摘要：退行性脊髓型颈椎病(DCM)是引起脊髓功能障碍的最常见原因。 老年人是残疾和生活质量受损的重要原因。常规核磁共振成像，用于 手术计划没有区分不可逆转的脊髓损伤，而且经常与临床不符 考试。扩张型心肌炎的常规临床评估依赖于主观症状评分，缺乏客观性。 可量化的功能衡量标准。这两个现行的实践标准都没有克服这种脱节 弥漫性心肌病的放射学和临床功能之间的关系，两者都不是手术结果的有力预测因素。至 为了克服弥散张量成像(DTI)缺乏病理特异性的缺点，我们发展了滤波扩散成像 加权成像(FDWI)，增强轴突损伤的检测。我们开发了多金属压制复合式 频谱弥散加权成像(MSI-DWI)评价手术后脊髓微结构 脊椎内固定器。为了更好地确定这些新的成像方法的功能相关性，我们 演示评估DCM患者细微感觉运动功能障碍的技术。这个项目的长期目标是 将先进的多参数脊髓MRI纳入扩张型颈椎病的常规临床评估，以提高疗效 手术结果的诊断和预测。该项目的总体目标是确定 脊髓微结构和功能的量化可以消除DCM和DCM的临床和放射学资料的歧义 改善扩张型心肌病手术后预后的预测。第一个目标将确定多参数磁共振成像 轴突损伤(Fdwi)和脱髓鞘(磁化转移[MT]成像)的测量可以优于 常规MRI用于结构与功能的相关性。为了达到第二个目标，我们将使用定量测试 运动、感觉和平衡功能，以客观跟踪手术后的功能恢复并确定这些 测量结果优于标准症状评分。第三个目标是使用术后MSI-DWI来检测 脊髓减压后微结构改变与量化功能的关系 做手术。总而言之，这些目标的成功完成将促进 多参数脊髓磁共振对扩张型心肌病脊髓完整性的诊断、预测和监测。

ABSTRACT: Degenerative cervical myelopathy (DCM) is the commonest cause of spinal cord dysfunction in older adults and an important cause of disability and impaired quality of life. Conventional MRI, which is used for surgical planning, does not distinguish irreversible spinal cord damage and is frequently inconsistent with clinical examination. Routine clinical assessment for DCM relies on subjective symptom scores, and lacks objective quantifiable measures of function. Neither of these current standards of practice overcome the disassociation between radiology and clinical function in DCM, and neither are strong predictors of surgical outcome. To overcome the lack of pathological specificity of diffusion tensor imaging (DTI), we developed filtered diffusion weighted imaging (fDWI), which enhances detection of axonal injury. We developed metal-suppression multi- spectral diffusion weighted imaging (MSI-DWI) to assess post-surgical spinal cord microstructure in the presence of spinal instrumentation. To better identify the functional correlates of these novel imaging approaches, we demonstrate techniques to assess subtle sensorimotor dysfunction in DCM. The long term goal of this project is to incorporate advanced multi-parametric spinal cord MRI in the routine clinical assessment of DCM to improve diagnosis and prognostication of surgical outcome. The overall objective of this project is to determine if quantification of spinal cord microstructure and function can disambiguate clinico-radiologic data in DCM and improve prognostication of outcome after surgery for DCM. The first aim will determine if multi-parametric MRI measures of axonal injury (fDWI) and demyelination (magnetization transfer [MT] imaging) can outperform conventional MRI for structure-function correlations. To achieve the second aim, we will use quantitative tests of motor, sensory and balance function to objectively track functional recovery after surgery and determine if these measures are superior to standard symptom scores. The third aim will use post-surgical MSI-DWI to detect microstructural changes in the decompressed spinal cord that are associated with quantitative function after surgery. Together, the successful completion of these aims will advance the clinical translational of multiparametric spinal cord MRI for diagnosis, prognostication and monitoring of spinal cord integrity in DCM.