Spinal cord structure-function relationships in degenerative cervical myelopathy

摘要：退行性颈脊髓病（DCM）是脊髓功能障碍的最常见原因， 老年人和残疾和生活质量受损的一个重要原因。常规MRI，用于 手术计划，不区分不可逆的脊髓损伤，往往是不符合临床 考试DCM的常规临床评估依赖于主观症状评分， 可量化的功能测量。这些现行的实践标准都没有克服这种分离 DCM的放射学和临床功能之间的关系，两者都不是手术结果的强有力预测因素。到 为了克服弥散张量成像（DTI）缺乏病理特异性的缺点，我们开发了滤波弥散成像技术， 加权成像（fDWI），其增强了轴突损伤的检测。我们开发了金属抑制多- 频谱扩散加权成像（MSI-DWI），以评估手术后脊髓显微结构， 脊柱器械为了更好地识别这些新成像方法的功能相关性，我们 展示了评估DCM中微妙感觉运动功能障碍的技术。该项目的长期目标是 将先进的多参数脊髓MRI纳入DCM的常规临床评估中， 诊断和手术结果的统计。本项目的总体目标是确定， 脊髓显微结构和功能的定量可以消除DCM的临床放射学数据的歧义， 改善扩张型心肌病手术后结果预测。第一个目标将确定多参数MRI是否 轴索损伤（fDWI）和脱髓鞘（磁化传递[MT]成像）的测量可以优于 常规MRI用于结构-功能相关性。为了实现第二个目标，我们将使用定量测试， 运动、感觉和平衡功能，以客观地跟踪手术后的功能恢复，并确定这些功能是否 测量上级标准症状评分。第三个目标将使用术后MSI-DWI检测 减压后脊髓中与定量功能相关的显微结构变化， 手术总之，这些目标的成功完成将推动 多参数脊髓MRI用于诊断、鉴别和监测DCM的脊髓完整性。

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.