Abstract
A meta-analysis was conducted to assess alterations in measures of diffusion tensor imaging (DTI) in the patients of cervical spondylotic myelopathy (CSM), exploring the potential role of DTI as a diagnosis biomarker. A systematic search of all related studies written in English was conducted using PubMed, Web of Science, EMBASE, CINAHL, and Cochrane comparing CSM patients with healthy controls. Key details for each study regarding participants, imaging techniques, and results were extracted. DTI measurements, such as fractional anisotropy (FA), apparent diffusion coefficient (ADC), and mean diffusivity (MD) were pooled to calculate the effect size (ES) by fixed or random effects meta-analysis. 14 studies involving 479 CSM patients and 278 controls were identified. Meta-analysis of the most compressed levels (MCL) of CSM patients demonstrated that FA was significantly reduced (ES -1.52, 95% CI -1.87 to -1.16, P < 0.001) and ADC was significantly increased (ES 1.09, 95% CI 0.89 to 1.28, P < 0.001). In addition, a notable ES was found for lowered FA at C2-C3 for CSM vs. controls (ES -0.83, 95% CI -1.09 to -0.570, P < 0.001). Meta-regression analysis revealed that male ratio of CSM patients had a significant effect on reduction of FA at MCL (P = 0.03). The meta-analysis of DTI studies of CSM patients clearly demonstrated a significant FA reduction and ADC increase compared with healthy subjects. This result supports the use of DTI parameters in differentiating CSM patients from health subjects. Future researches are required to investigate the diagnosis performance of DTI in cervical spondylotic myelopathy.
Highlights
Cervical spondylotic myelopathy (CSM) is a common disease caused by chronic compression of the spinal cord secondary to spondylosis or disc degeneration [1]
The search terms used in the systemic screening were "cervical spondylotic myelopathy", "cervical pain", "cervical spinal cord", which were combined with the terms "diffusion tensor imaging", "fractional anisotropy" and "apparent diffusion coefficient"
To the best of our knowledge, this is the first meta-analysis of diffusion tensor imaging (DTI) studies between CSM patients and healthy subjects
Summary
Cervical spondylotic myelopathy (CSM) is a common disease caused by chronic compression of the spinal cord secondary to spondylosis or disc degeneration [1]. It is the most common form of spinal cord dysfunction and the leading cause of spinal cord injury in individuals older than 55 years [2]. T2-weighted MR image [3]. T2-weighted imaging alone, has low sensitivity for detecting the subtle structural damage of the cord in myelopathy, especially in patients with chronic onset of symptoms [4,5,6]. It is difficult to evaluate the condition of the compressed spinal cord with such imaging modalities
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