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Comparison and Clinical Utility of Pre- and Postoperative Diffusion Tensor Imaging MRI Findings in Patients with Cervical Spondylotic Myelopathy

Year 2025, Volume: 7 Issue: 2, 399 - 405, 09.05.2025

Cevat Akıncı , Giyas Ayberk , İsmail Bozkurt , Karabekir Ercan , Abdullah Emre Taçyıldız

https://doi.org/10.37990/medr.1635845

Abstract

Aim: This study aimed to present the cervical diffusion tensor imaging (DTI) results in cervical spondylotic myelopathy (CSM) patients scheduled for operation and follow-up.
Material and Method: This clinical cohort type study was conducted between January 2016 and May 2016 in the neurosurgery clinic of a tertiary hospital. The study included 27 patients diagnosed with cervical spondylotic myelopathy. Surgical treatment was recommended to 15 patients and follow-up to the remaining. Cervical magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) scans were performed, and anteroposterior canal diameters, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) values were calculated.
Results: The mean age was 62.37±7.39, and 22.2% (n=6) were women. Hoffmann pathological reflex was detected in 11 (40.7%) patients. The preoperative and postoperative AP (4.18±0.85 vs. 6.66±1.00, p<0.001), ADC (1.49±0.16 vs. 1.30±0.11, p=0.001), and FA (0.36±0.04 vs. 0.43±0.04, p=0.001) values were significantly different. The FA values of patients scheduled for follow-up were significantly higher than those who were recommended surgery (0.43±0.04 vs. 0.37±0.04, p=0.001). A negative correlation was found between FA and ADC values in both preoperative (r=-0.618, p<0.001) and postoperative (r=-0.748, p=0.013) measurements.
Conclusion: DTI is a radiological tool that can aid in diagnosing CSM and identifying patients requiring surgery or follow-up. Due to its expected clinical benefits, we recommend a more widespread application of this method in patients with CSM.

Keywords

Diffusion tensor imaging spinal cord diseases myelopathy surgery

Ethical Statement

Ethical approval (No: 165–Date: 11.05.2016) was received from the Yıldırım Beyazit University Faculty of Medicine, Atatürk Training and Research Hospital Clinical Research Ethics Committee.

References

  • Tracy JA, Bartleson JD. Cervical spondylotic myelopathy. Neurologist. 2010;16:176-87.
  • Badhiwala JH, Ahuja CS, Akbar MA, et al. Degenerative cervical myelopathy—update and future directions. Nat Rev Neurol. 2020;16:108-24.
  • Al-Ryalat NT, Saleh SA, Mahafza WS, et al. Myelopathy associated with age-related cervical disc herniation: a retrospective review of magnetic resonance images. Ann Saudi Med. 2017;37:130-7.
  • Tsuchiya K, Katase S, Fujikawa S, et al. Diffusion-weighted MRI of the cervical spinal cord using a single-shot fast spin-echo technique: findings in normal subjects and in myelomalacia. Neuroradiol. 2003;45:90-4.
  • Baliyan V, Das CS, Sharma R, Gupta AK. Diffusion weighted imaging: technique and applications. World J Radiol. 2016;8:785-98.
  • Severino R, Nouri A, Tessitore E. Degenerative cervical myelopathy: how to identify the best responders to surgery?. J Clin Med. 2020;9:759.
  • Boucard CC, Hanekamp S, Ćurčić-Blake B, et al. Neurodegeneration beyond the primary visual pathways in a population with a high incidence of normal‐pressure glaucoma. Ophthalmic Physiol Opt. 2016;36:344-53.
  • Tohyama S, Walker MR, Sammartino F, et al. The utility of diffusion tensor imaging in neuromodulation: moving beyond conventional magnetic resonance imaging. Neuromodulation. 2020;23:427-35.
  • Demir A, Ries M, Moonen CTW, et al. Diffusion-weighted MR imaging with apparent diffusion coefficient and apparent diffusion tensor maps in cervical spondylotic myelopathy. Radiology. 2003;229:37-43.
  • Shabani S, Kaushal M, Budde MD, et al. Diffusion tensor imaging in cervical spondylotic myelopathy: a review. J Neurosurg Spine. 2020;33:65-72.
  • Kara B, Celik A, Karadereler S, et al. The role of DTI in early detection of cervical spondylotic myelopathy: a preliminary study with 3-T MRI. Neuroradiology. 2011;53:609-16.
  • Guan X, Fan G, Wu X, et al. Diffusion tensor imaging studies of cervical spondylotic myelopathy: a systemic review and meta-analysis. PloS One. 2015;10:e0117707.
  • Lindberg PG, Sanchez K, Ozcan F, et al. Correlation of force control with regional spinal DTI in patients with cervical spondylosis without signs of spinal cord injury on conventional MRI. Eur Radiol. 2016;26:733-42.
  • Mink JH, Gordon RE, Deutsch AL, The cervical spine: radiologist's perspective. Phys Med Rehabil Clin. 2003;14:493-548.
  • Suri A, Chabbara RPS, Mehta VS, et al. Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J. 2003;3:33-45.
  • Shabani S, Kaushal M, Budde M, et al. Comparison between quantitative measurements of diffusion tensor imaging and T2 signal intensity in a large series of cervical spondylotic myelopathy patients for assessment of disease severity and prognostication of recovery. J Neurosurg Spine. 2019;31:473-9.
  • Lee JW, Kim JH, Park JB, et al. Diffusion tensor imaging and fiber tractography in cervical compressive myelopathy: preliminary results. Skeletal Radiol. 2011;40:1543-51.
  • Ellingson BM, Ulmer JL, Kurpad SN, Schmit BD. Diffusion tensor MR imaging of the neurologically intact human spinal cord. AJNR Am J Neuroradiol. 2008;29:1279-84.
  • Hori M, Okubo T, Aoki S, et al. Line scan diffusion tensor MRI at low magnetic field strength: feasibility study of cervical spondylotic myelopathy in an early clinical stage. J Magn Reson Imaging. 2006;23:183-8.
  • Kitamura M, Maki S, Koda M, et al. Longitudinal diffusion tensor imaging of patients with degenerative cervical myelopathy following decompression surgery. J Clin Neurosci. 2020;74:194-8.
  • Wang K, Idowu O, Thompson CB, et al. Tract-specific diffusion tensor imaging in cervical spondylotic myelopathy before and after decompressive spinal surgery: preliminary results. Clin Neuroradiol. 2017;27:61-9.
  • Guan L, Chen X, Hai Y, et al. High‐resolution diffusion tensor imaging in cervical spondylotic myelopathy: a preliminary follow‐up study. NMR Biomed. 2017;30:e3769.
  • Jones JGA, Cen SY, Lebel RM, et al. Diffusion tensor imaging correlates with the clinical assessment of disease severity in cervical spondylotic myelopathy and predicts outcome following surgery. AJNR Am J Neuroradiol. 2013;34:471-8.
  • Chernysh AA, Loftus DH, Zheng B, et al. Utility of diffusion tensor imaging (DTI) for prognosis and management of cervical spondylotic myelopathy: a PRISMA review. World Neurosurg. 2024;190:88-98.
  • Fang Y, Li S, Wang J. et al. Diagnostic efficacy of tract-specific diffusion tensor imaging in cervical spondylotic myelopathy with electrophysiological examination validation. Eur Spine J. 2024;33:1230-44.
  • Wang X, Tian X, Zhang Y, et al. Predictive value of dynamic diffusion tensor imaging for surgical outcomes in patients with cervical spondylotic myelopathy. BMC Med Imaging, 2024;24:260.
  • Shao H, Liu Q, Saeed A, et al. Feasibility of diffusion tensor imaging in cervical spondylotic myelopathy using MUSE sequence. Spine J. 2024;24:1352-60.
  • Wen CY, Cui JL, Liu HS, et al. Is diffusion anisotropy a biomarker for disease severity and surgical prognosis of cervical spondylotic myelopathy?. Radiology. 2014;270:197-204.
  • Cui J-L, Li X, Chan T-Y, et al. Quantitative assessment of column-specific degeneration in cervical spondylotic myelopathy based on diffusion tensor tractography. Eur Spine J. 2015;24:41-7.
  • Budzik J.-F, Balbi V, Thuc VL, et al. Diffusion tensor imaging and fibre tracking in cervical spondylotic myelopathy. Euro Radiol. 2011;21:426-33.

Year 2025, Volume: 7 Issue: 2, 399 - 405, 09.05.2025

Cevat Akıncı , Giyas Ayberk , İsmail Bozkurt , Karabekir Ercan , Abdullah Emre Taçyıldız

https://doi.org/10.37990/medr.1635845

Abstract

References

  • Tracy JA, Bartleson JD. Cervical spondylotic myelopathy. Neurologist. 2010;16:176-87.
  • Badhiwala JH, Ahuja CS, Akbar MA, et al. Degenerative cervical myelopathy—update and future directions. Nat Rev Neurol. 2020;16:108-24.
  • Al-Ryalat NT, Saleh SA, Mahafza WS, et al. Myelopathy associated with age-related cervical disc herniation: a retrospective review of magnetic resonance images. Ann Saudi Med. 2017;37:130-7.
  • Tsuchiya K, Katase S, Fujikawa S, et al. Diffusion-weighted MRI of the cervical spinal cord using a single-shot fast spin-echo technique: findings in normal subjects and in myelomalacia. Neuroradiol. 2003;45:90-4.
  • Baliyan V, Das CS, Sharma R, Gupta AK. Diffusion weighted imaging: technique and applications. World J Radiol. 2016;8:785-98.
  • Severino R, Nouri A, Tessitore E. Degenerative cervical myelopathy: how to identify the best responders to surgery?. J Clin Med. 2020;9:759.
  • Boucard CC, Hanekamp S, Ćurčić-Blake B, et al. Neurodegeneration beyond the primary visual pathways in a population with a high incidence of normal‐pressure glaucoma. Ophthalmic Physiol Opt. 2016;36:344-53.
  • Tohyama S, Walker MR, Sammartino F, et al. The utility of diffusion tensor imaging in neuromodulation: moving beyond conventional magnetic resonance imaging. Neuromodulation. 2020;23:427-35.
  • Demir A, Ries M, Moonen CTW, et al. Diffusion-weighted MR imaging with apparent diffusion coefficient and apparent diffusion tensor maps in cervical spondylotic myelopathy. Radiology. 2003;229:37-43.
  • Shabani S, Kaushal M, Budde MD, et al. Diffusion tensor imaging in cervical spondylotic myelopathy: a review. J Neurosurg Spine. 2020;33:65-72.
  • Kara B, Celik A, Karadereler S, et al. The role of DTI in early detection of cervical spondylotic myelopathy: a preliminary study with 3-T MRI. Neuroradiology. 2011;53:609-16.
  • Guan X, Fan G, Wu X, et al. Diffusion tensor imaging studies of cervical spondylotic myelopathy: a systemic review and meta-analysis. PloS One. 2015;10:e0117707.
  • Lindberg PG, Sanchez K, Ozcan F, et al. Correlation of force control with regional spinal DTI in patients with cervical spondylosis without signs of spinal cord injury on conventional MRI. Eur Radiol. 2016;26:733-42.
  • Mink JH, Gordon RE, Deutsch AL, The cervical spine: radiologist's perspective. Phys Med Rehabil Clin. 2003;14:493-548.
  • Suri A, Chabbara RPS, Mehta VS, et al. Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J. 2003;3:33-45.
  • Shabani S, Kaushal M, Budde M, et al. Comparison between quantitative measurements of diffusion tensor imaging and T2 signal intensity in a large series of cervical spondylotic myelopathy patients for assessment of disease severity and prognostication of recovery. J Neurosurg Spine. 2019;31:473-9.
  • Lee JW, Kim JH, Park JB, et al. Diffusion tensor imaging and fiber tractography in cervical compressive myelopathy: preliminary results. Skeletal Radiol. 2011;40:1543-51.
  • Ellingson BM, Ulmer JL, Kurpad SN, Schmit BD. Diffusion tensor MR imaging of the neurologically intact human spinal cord. AJNR Am J Neuroradiol. 2008;29:1279-84.
  • Hori M, Okubo T, Aoki S, et al. Line scan diffusion tensor MRI at low magnetic field strength: feasibility study of cervical spondylotic myelopathy in an early clinical stage. J Magn Reson Imaging. 2006;23:183-8.
  • Kitamura M, Maki S, Koda M, et al. Longitudinal diffusion tensor imaging of patients with degenerative cervical myelopathy following decompression surgery. J Clin Neurosci. 2020;74:194-8.
  • Wang K, Idowu O, Thompson CB, et al. Tract-specific diffusion tensor imaging in cervical spondylotic myelopathy before and after decompressive spinal surgery: preliminary results. Clin Neuroradiol. 2017;27:61-9.
  • Guan L, Chen X, Hai Y, et al. High‐resolution diffusion tensor imaging in cervical spondylotic myelopathy: a preliminary follow‐up study. NMR Biomed. 2017;30:e3769.
  • Jones JGA, Cen SY, Lebel RM, et al. Diffusion tensor imaging correlates with the clinical assessment of disease severity in cervical spondylotic myelopathy and predicts outcome following surgery. AJNR Am J Neuroradiol. 2013;34:471-8.
  • Chernysh AA, Loftus DH, Zheng B, et al. Utility of diffusion tensor imaging (DTI) for prognosis and management of cervical spondylotic myelopathy: a PRISMA review. World Neurosurg. 2024;190:88-98.
  • Fang Y, Li S, Wang J. et al. Diagnostic efficacy of tract-specific diffusion tensor imaging in cervical spondylotic myelopathy with electrophysiological examination validation. Eur Spine J. 2024;33:1230-44.
  • Wang X, Tian X, Zhang Y, et al. Predictive value of dynamic diffusion tensor imaging for surgical outcomes in patients with cervical spondylotic myelopathy. BMC Med Imaging, 2024;24:260.
  • Shao H, Liu Q, Saeed A, et al. Feasibility of diffusion tensor imaging in cervical spondylotic myelopathy using MUSE sequence. Spine J. 2024;24:1352-60.
  • Wen CY, Cui JL, Liu HS, et al. Is diffusion anisotropy a biomarker for disease severity and surgical prognosis of cervical spondylotic myelopathy?. Radiology. 2014;270:197-204.
  • Cui J-L, Li X, Chan T-Y, et al. Quantitative assessment of column-specific degeneration in cervical spondylotic myelopathy based on diffusion tensor tractography. Eur Spine J. 2015;24:41-7.
  • Budzik J.-F, Balbi V, Thuc VL, et al. Diffusion tensor imaging and fibre tracking in cervical spondylotic myelopathy. Euro Radiol. 2011;21:426-33.
There are 30 citations in total.

Details

Primary Language English
Subjects Brain and Nerve Surgery (Neurosurgery), Radiology and Organ Imaging
Journal Section Original Articles
Authors

Cevat Akıncı 0000-0002-4606-6115

Giyas Ayberk 0000-0002-9258-4001

İsmail Bozkurt 0000-0002-6719-5522

Karabekir Ercan 0000-0002-4812-3371

Abdullah Emre Taçyıldız 0000-0001-5806-243X

Publication Date May 9, 2025
Submission Date February 8, 2025
Acceptance Date March 28, 2025
Published in Issue Year 2025 Volume: 7 Issue: 2

Cite

AMA Akıncı C, Ayberk G, Bozkurt İ, Ercan K, Taçyıldız AE. Comparison and Clinical Utility of Pre- and Postoperative Diffusion Tensor Imaging MRI Findings in Patients with Cervical Spondylotic Myelopathy. Med Records. May 2025;7(2):399-405. doi:10.37990/medr.1635845
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Chief Editors

Assoc. Prof. Zülal Öner
İzmir Bakırçay University, Department of Anatomy, İzmir, Türkiye

Assoc. Prof. Deniz Şenol
Düzce University, Department of Anatomy, Düzce, Türkiye

Editors
Assoc. Prof. Serkan Öner
İzmir Bakırçay University, Department of Radiology, İzmir, Türkiye
 
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