The Functional Relevance of Diffusion Tensor Imaging in Patients with Degenerative Cervical Myelopathy.

Oreste de Divitiis,Domenico Solari,Gabriele Pasqua,Marcello Bartolo,Francesco Ricciardi,Teresa Somma,Paolo Cappabianca,Gualtiero Innocenzi,Luigi Pavone,Stefania d’Avanzo,Marco Ciavarro

doi:10.3390/jcm9061828

Abstract

(1) Background: In addition to conventional magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) has been investigated as a potential diagnostic and predictive tool for patients with degenerative cervical myelopathy (DCM). In this preliminary study, we evaluated the use of quantitative DTI in the clinical practice as a possible measure to correlate with upper limbs function. (2) Methods: A total of 11 patients were enrolled in this prospective observational study. Fractional anisotropy (FA) values was extracted from DTI data before and after surgery using a GE Signa 1.5 T MRI scanner. The Nine-Hole Peg Test and a digital dynamometer were used to measure dexterity and hand strength, respectively. (3) Results: We found a significant increase of FA values after surgery, in particular below the most compressed level (p = 0.044) as well as an improvement in postoperative dexterity and hand strength. Postoperative FA values moderately correlate with hand dexterity (r = 0.4272, R2 = 0.0735, p = 0.19 for the right hand; r = 0.2087, R2 = 0.2265, p = 0.53 for the left hand). (4) Conclusion: FA may be used as a marker of myelopathy and could represent a promising diagnostic value in patients affected by DCM. Surgical decompression can improve the clinical outcome of these patients, especially in terms of the control of finger-hand coordination and dexterity.

Highlights

Degenerative cervical myelopathy (DCM) is the most common non-traumatic spinal cord disorder in patients over 55 years old [1,2,3,4]: It is a progressive spinal cord disease characterized by degenerative changes of the bone, ligaments and intervertebral disc of cervical spine [5,6].DCM comprises a wide set of clinical features, including neck pain, motor and sensory deficits and bladder dysfunction [7,8]
Fractional anisotropy (FA) values was extracted from diffusion tensor imaging (DTI) data before and after surgery using a GE Signa 1.5 T magnetic resonance imaging (MRI) scanner
(4) Conclusion: FA may be used as a marker of myelopathy and could represent a promising diagnostic value in patients affected by DCM

Summary

Introduction

Degenerative cervical myelopathy (DCM) is the most common non-traumatic spinal cord disorder in patients over 55 years old [1,2,3,4]: It is a progressive spinal cord disease characterized by degenerative changes of the bone, ligaments and intervertebral disc of cervical spine [5,6].DCM comprises a wide set of clinical features, including neck pain, motor and sensory deficits and bladder dysfunction [7,8]. Peculiar loss of strength and hand dexterity (the so-called “clumsy hand” or “myelopathy hand”) is observed in patients with DCM. The occurrence of “myelopathy hand” has been demonstrated to be a crucial clinical sign to achieve an early suspicion of pyramidal tract damage [9,10,11]. Conventional T2-weighted magnetic resonance imaging (T2WI) is an integral part of DCM patient evaluation. T2WI shows an increased signal intensity in the compressed part of the spinal cord; this abnormal MR signal has low sensitivity for structural change of the cord in cervical myelopathy and it is not predictive of neurological function before and after surgical treatment [12,13,14,15,16,17]

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