title: The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy.
abstract: OBJECTIVE
  We prospectively investigated whether high intramedullary SI and contrast [gadolinium-diethylene-triamine-pentaacetic acid (Gd-DTPA)] enhancement in magnetic resonance imaging (MRI) are associated with postoperative prognosis in cervical compressive myelopathy (CCM) patients.
  
  
  METHODS
  Seventy-four patients with ventral cord compression at one or two levels underwent anterior cervical discectomy and fusion (ACDF) for CCM between March 2006 and June 2009. The mean follow-up period was 39.7 months (range, 12.7-55.7 months). The cervical cord compression ratio and clinical outcomes were measured using Japanese Orthopedic Association (JOA) scores for cervical myelopathy. Patients were classified into three groups based on the SI change in T2WI, T1-weighted images (T1WI), and contrast (Gd-DTPA) enhancement.
  
  
  RESULTS
  The mean preoperative and postoperative JOA scores were 10.5 ± 2.9 and 15.0 ± 2.1 (P < 0.05), respectively. The mean recovery ratio of the JOA score was 70.9 ± 20.2%. There were statistically significant differences in postoperative JOA and recovery ratio among three groups. However, post-surgical neurological outcomes were not associated with age, symptom duration, preoperative JOA, and cord compression.
  
  
  CONCLUSIONS
  We found that intramedullary SI change is a poor prognostic factor and the intramedullary contrast (Gd-DTPA) enhancement on preoperative MRI should be viewed as the worst predictor of surgical outcomes in cervical myelopathy. Contrast (Gd-DTPA) enhancement and postoperative MRI are useful for identifying the prognosis of patients with poor neurological recovery.
authors.affiliation: Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 146-92, Dogok-Dong, Kangnam-gu, Kangnam, PO Box 1217, Seoul 135-720, Korea. ydnscho@yuhs.ac
authors.forename: Yong Eun
authors.initials: YE
authors.lastname: Cho
authors.forename: Jun Jae
authors.initials: JJ
authors.lastname: Shin
authors.forename: Keun Su
authors.initials: KS
authors.lastname: Kim
authors.forename: Dong Kyu
authors.initials: DK
authors.lastname: Chin
authors.forename: Sung Uk
authors.initials: SU
authors.lastname: Kuh
authors.forename: Ji Hae
authors.initials: JH
authors.lastname: Lee
authors.forename: Woo Ho
authors.initials: WH
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D017586:Diskectomy / Q000379:methods*; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D013117:Spinal Cord Compression / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D019786:Gadolinium DTPA