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. 2018 May 15;43(10):675-680.
doi: 10.1097/BRS.0000000000002470.

Quantitative Magnetization Transfer MRI Measurements of the Anterior Spinal Cord Region are Associated With Clinical Outcomes in Cervical Spondylotic Myelopathy

Michael Brendan Cloney  1 , Zachary A Smith  1 , Kenneth A Weber 2nd  2 , Todd B Parrish  3
Affiliations

Quantitative Magnetization Transfer MRI Measurements of the Anterior Spinal Cord Region are Associated With Clinical Outcomes in Cervical Spondylotic Myelopathy

Michael Brendan Cloney et al. Spine (Phila Pa 1976). .

Abstract

Study design: A case-control study.

Objective: The aim of this study was to understand the role of magnetization transfer ratio (MTR) in identifying patients with clinically significant myelopathy and disability.

Summary of background data: MTR is a quantitative measure that correlates with myelin loss and neural tissue destruction in a variety of neurological diseases. However, the usefulness of MTR in patients with cervical spondylotic myelopathy (CSM) has not been examined.

Methods: We prospectively enrolled seven CSM patients and seven age-matched controls to undergo magnetic resonance imaging (MRI) of the cervical spine. Nurick, Neck Disability Index (NDI), and modified Japanese Orthopedic Association (mJOA) scores were collected for all patients. Clinical hyperreflexia was tested at the MCP joint, using a six-axis load cell. Reflex was simulated by quickly moving the joint from maximum flexion to maximum extension (300°/second). Anterior, lateral, and posterior cord MTR measurements were compared with clinical outcomes.

Results: Compared with controls, CSM patients had lower anterior cord MTR (38.29 vs. 29.97, Δ = -8.314, P = 0.0022), and equivalent posterior cord (P = 0.2896) and lateral cord (P = 0.3062) MTR. Higher Nurick scores were associated with lower anterior cord MTR (P = 0.0205), but not lateral cord (P = 0.5446) or posterior cord MTR (P = 0.1222). Lower mJOA was associated with lower anterior cord MTR (P = 0.0090), but not lateral cord (P = 0.4864) or posterior cord MTR (P = 0.4819). There was no association between NDI and MTR of the anterior (P = 0.4351), lateral (P = 0.7557), or posterior cord (P = 0.9171). There was a linear relationship between hyperreflexia and anterior cord MTR (slope = -117.3, R = 0.6598, P = 0.0379), but not lateral cord (P = 0.1906, R = 0.4511) or posterior cord (P = 0.2577, R = 0.3957) MTR.

Conclusion: Anterior cord MTR correlates with clinical outcomes as measured by mJOA index, Nurick score, and quantitative hyperreflexia, and could play a role in the preoperative assessment of CSM.

Level of evidence: 2.

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Figures

Figure 1.
Figure 1.
A) Example images with (MTC1) and without (MTC0) a magnetization transfer (MT) pulse and the corresponding MT ratio (MTR) image are shown. B) MTR metrics were extracted from the entire spinal cord (Blue) and from the anterior (Yellow), lateral (Orange), and posterior (Red) spinal cord regions. Images shown are from a healthy participant at the C5–6 intervertebral disc level.
Figure 2.
Figure 2.
Anterior cord MTR for CSM patients versus controls. Compared to controls, CSM patients had lower anterior cord MTR (38.29 v. 29.97, Δ = −8.314, p=0.0022).
Figure 3.
Figure 3.
The relationship between anterior cord MTR and Nurick scores. The mean Nurick score among CSM patients was 1.714 [1.263, 2.166] ± 0.488. Higher Nurick scores were associated with lower anterior cord MTR (p=0.0205).
Figure 4.
Figure 4.
The relationship between anterior cord MTR and mJOA scores. The mean mJOA score among CSM patients was 14.29 [12.46, 16.11] ± 1.976. Lower mJOA was associated with lower anterior cord MTR (p=0.0090).
Figure 5.
Figure 5.
Linear regression analysis comparing anterior cord MTR and quantitative hyperreflexia measurements. There is a linear relationship between hyperreflexia and anterior cord MTR (slope = −117.3, R = 0.6598, p = 0.0379).
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