The Contribution of Diffusion Tensor Imaging to Quantitative Assessment on Multilevel Cervical Spondylotic Myelopathy

Abstract

Background/aims: This study aimed at assessing the feasibility of diffusion tensor imaging (DTI) in multilevel cervical spondylotic myelopathy (MCSM) and quantifying the association between DTI parameters and neuronal status as a whole.

Methods: Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were obtained from 32 patients with MCSM and 21 healthy volunteers at each level. The extent of cervical cord compression was evaluated by maximum spinal cord compression (MSCC). The DTI parameters were correlated with myelopathy severity based on modified Japanese Orthopedic Association (mJOA) score in comparison with anatomic morphological and signal changes on MRI.

Results: There were significant differences in the DTI values between the patients and those in the control group (p < 0.001). The general mean FA values correlated with mJOA scores strongly (r = 0.507, p = 0.003), even more than MSCC (r = -0.361, p = 0.042); however, such an association was not detected between ADC values and clinical findings (p > 0.05).

Conclusion: DTI shows a higher potential to quantitatively evaluate the whole neurological deficits of patients with MCSM. It helps us better understand the minor pathological changes within the spinal cord at an earlier stage than abnormal signal changes on MRI.