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. 2025 Jan;15(1):267-283.
doi: 10.1177/21925682241263792. Epub 2024 Jun 14.

Diffusion Tensor Imaging in Diagnosing and Evaluating Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis

Mohammad Mohammadi  1 , Faramarz Roohollahi  2   3 , Farzin Farahbakhsh  4 , Aynaz Mohammadi  1 , Elham Mortazavi Mamaghani  1 , Samuel Berchi Kankam  5   6 , Azin Moarrefdezfouli  4 , Afshar Ghamari Khameneh  7 , Mohamad Mahdi Mahmoudi  8 , Davit Baghdasaryan  9 , Allan R Martin  10 , James Harrop  11 , Vafa Rahimi-Movaghar  4   12   13   14   15
Affiliations

Diffusion Tensor Imaging in Diagnosing and Evaluating Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis

Mohammad Mohammadi et al. Global Spine J. 2025 Jan.

Abstract

Study design: Systematic review.

Objective: Degenerative cervical myelopathy (DCM) is a common spinal cord disorder necessitating surgery. We aim to explore how effectively diffusion tensor imaging (DTI) can distinguish DCM from healthy individuals and assess the relationship between DTI metrics and symptom severity.

Methods: We included studies with adult DCM patients who had not undergone decompressive surgery and implemented correlation analyses between DTI parameters and severity, or compared healthy controls and DCM patients.

Results: 57 studies were included in our meta-analysis. At the maximal compression (MC) level, fractional anisotropy (FA) exhibited lower values in DCM patients, while apparent diffusion coefficient (ADC), mean diffusivity (MD), and radial diffusivity (RD) were notably higher in the DCM group. Moreover, our investigation into the diagnostic utility of DTI parameters disclosed high sensitivity, specificity, and area under the curve values for FA (.84, .80, .83 respectively) and ADC (.74, .84, .88 respectively). Additionally, we explored the correlation between DTI parameters and myelopathy severity, revealing a significant correlation of FA (.53, 95% CI:0.40 to .65) at MC level with JOA/mJOA scores.

Conclusion: Current guidelines for DCM suggest decompressive surgery for both mild and severe cases. However, they lack clear recommendations on which mild DCM patients might benefit from conservative treatment vs immediate surgery. ADC's role here could be pivotal, potentially differentiating between healthy individuals and DCM. While it may not correlate with symptom severity, it might predict surgical outcomes, making it a valuable imaging biomarker for clearer management decisions in mild DCM.

Keywords: degenerative cervical myelopathy; diagnosis; diffusion tensor imaging; meta-analysis.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow chart for this review.
Figure 2.
Figure 2.
Meta-analysis for comparison of FA between DCM and healthy subjects. (A) Mean differences in FA at maximum compression level, grouped by age. (B) Mean differences in mean FA of all levels, grouped by age.
Figure 3.
Figure 3.
Meta-analysis for comparison of ADC between DCM and healthy subjects. (A) Mean differences in ADC at maximum compression level, grouped by age. (B) Mean differences in mean ADC of all levels, grouped by age.
Figure 4.
Figure 4.
Meta-analysis for comparison of MD, AD and RD between DCM and healthy subjects. (A) Mean differences in MD at maximum compression level, grouped by age. (B) Mean differences in mean AD of all levels, grouped by age. (C) Mean differences in RD at maximum compression level, grouped by age. (D) Mean differences in mean RD of all levels, grouped by age.
Figure 5.
Figure 5.
Meta-analysis for comparison of DTI parameters of different levels between DCM and healthy subjects. (A) Mean differences in FA, grouped by level of DTI assessment. (B) Mean differences in ADC, grouped by level of DTI assessment. (C) Mean differences in MD, grouped by level of DTI assessment. (D) Mean differences in AD, grouped by level of DTI assessment. (E) Mean differences in RD, grouped by level of DTI assessment.
Figure 6.
Figure 6.
Meta-analysis for Correlation of DTI Parameters with Myelopathy Severity Based on JOA or mJOA at maximum compression level. (A) Correlation of FA with Myelopathy Severity (JOA or mJOA) at maximum compression level. (B) Correlation of ADC with Myelopathy Severity (JOA or mJOA) at maximum compression level. (C) Correlation of MD with Myelopathy Severity (JOA or mJOA) at maximum compression level. (D) Correlation of RD with Myelopathy Severity (JOA or mJOA) at maximum compression level.
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