Abstract
Diffusion magnetic resonance imaging (dMRI) proved promising in patients with non-myelopathic degenerative cervical cord compression (NMDCCC), i.e., without clinically manifested myelopathy. Aim of the study is to present a fast multi-shell HARDI-ZOOMit dMRI protocol and validate its usability to detect microstructural myelopathy in NMDCCC patients. In 7 young healthy volunteers, 13 age-comparable healthy controls, 18 patients with mild NMDCCC and 15 patients with severe NMDCCC, the protocol provided higher signal-to-noise ratio, enhanced visualization of white/gray matter structures in microstructural maps, improved dMRI metric reproducibility, preserved sensitivity (SE = 87.88%) and increased specificity (SP = 92.31%) of control-patient group differences when compared to DTI-RESOLVE protocol (SE = 87.88%, SP = 76.92%). Of the 56 tested microstructural parameters, HARDI-ZOOMit yielded significant patient-control differences in 19 parameters, whereas in DTI-RESOLVE data, differences were observed in 10 parameters, with mostly lower robustness. Novel marker the white-gray matter diffusivity gradient demonstrated the highest separation. HARDI-ZOOMit protocol detected larger number of crossing fibers (5–15% of voxels) with physiologically plausible orientations than DTI-RESOLVE protocol (0–8% of voxels). Crossings were detected in areas of dorsal horns and anterior white commissure. HARDI-ZOOMit protocol proved to be a sensitive and practical tool for clinical quantitative spinal cord imaging.
Highlights
Diffusion magnetic resonance imaging proved promising in patients with non-myelopathic degenerative cervical cord compression (NMDCCC), i.e., without clinically manifested myelopathy
The study sample consisted of a cohort of 33 NMDCCC patients (14 females, 56.7 ± 6.4 year ), 13 age-comparable healthy controls (9 females, age 51.9 ± 9.4 year ), and seven young healthy volunteers (3 females, age 27.4 ± 1.7 year ; acquired twice for reproducibility evaluations)
The radiological measurements, i.e. cross-sectional area (CSA) and compression ratio (CR), sub-divided the cohort of 33 NMDCCC patients to sub-group of 18 patients with mild NMDCCC (7 females, age 55.6 ± 6.1 year ) and sub-group of 15 patients with severe NMDCCC (7 females, 58.1 ± 6.8 year )
Summary
Diffusion magnetic resonance imaging (dMRI) proved promising in patients with non-myelopathic degenerative cervical cord compression (NMDCCC), i.e., without clinically manifested myelopathy. Aim of the study is to present a fast multi-shell HARDI-ZOOMit dMRI protocol and validate its usability to detect microstructural myelopathy in NMDCCC patients. DTI detected microstructural SC injury[19], and microstructural abnormality in patients with non-myelopathic degenerative cervical cord compression (NMDCCC) prior to development of subsequently expected neurological myelopathic symptoms and signs, i.e. DCM manifestation[20]. There is an urgent need to confirm the previous findings and to develop and validate a dMRI protocol that is fast, reliable, clinically feasible, and yet possesses the ability to detect microstructural cervical cord injury in the NMDCCC stage with high sensitivity (SE) and specificity (SP). Increasing angular resolution within current protocols would make them too long for clinical scanning
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