title: Diffusion tensor imaging predicts functional impairment in mild-to-moderate cervical spondylotic myelopathy.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) is the standard imaging modality for the assessment of cervical spinal cord; however, MRI assessment of the spinal cord in cervical spondylotic myelopathy patients has not demonstrated a consistent association with neurologic function or outcome after surgical or medical intervention. Thus, there is a need for sensitive imaging biomarkers that can predict functional impairment in patients with advanced cervical spondylosis.
  
  
  OBJECTIVE
  To implement diffusion tensor imaging (DTI) as an imaging biomarker for microstructural integrity and functional impairment in patients with cervical spondylosis.
  
  
  METHODS
  Nonrandomized, single institution study.
  
  
  METHODS
  Forty-eight cervical spondylosis patients with or without spinal cord signal change underwent DTI of the spinal cord along with functional assessment.
  
  
  METHODS
  Functional measures of neurologic function via modified Japanese Orthopedic Association (mJOA) score.
  
  
  METHODS
  A zoomed-echoplanar imaging technique and two-dimensional spatially selective radiofrequency excitation pulse were used for DTI measurement. Fractional anisotropy (FA), mean diffusivity (MD), radial and axial diffusion (AD) coefficient, AD anisotropy, ψ, defined as AD-MD, and the standard deviation (SD) of primary eigenvector orientation were evaluated at the site of compression.
  
  
  RESULTS
  Results suggest average FA, transverse apparent diffusion coefficient, ψ, and SD of primary eigenvector orientation at the spinal level of highest compression were linearly correlated with mJOA score. Receiver-operator characteristic analysis suggested FA and ψ could identify stenosis patients with mild-to-moderate symptoms with a relatively high sensitivity and specificity.
  
  
  CONCLUSIONS
  The results of this study support the potential use of DTI as a biomarker for predicting functional impairment in patients with cervical spondylosis.
authors.affiliation: Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA 90024, USA; Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA 90024, USA; Department of Bioengineering, School of Engineering, University of California Los Angeles, 420 Westwood Plaza, 5121 Engineering V, Los Angeles, CA 90095, USA. Electronic address: ellingsb@gmail.com.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Ellingson
authors.affiliation: Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA 90024, USA.
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.affiliation: Siemens Healthcare, 5030 NE 115th Ave, Portland OR 97208, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Grinstead
authors.affiliation: Department of Neurosurgery and Orthopaedics, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA 90024, USA.
authors.forename: Langston T
authors.initials: LT
authors.lastname: Holly
mesh_terms: D000328:Adult; D000368:Aged; D016880:Anisotropy; D015415:Biomarkers; D066193:Cervical Cord; D002574:Cervical Vertebrae / Q000473:pathology / Q000503:physiopathology*; D056324:Diffusion Tensor Imaging; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D055009:Spondylosis / Q000473:pathology / Q000503:physiopathology*
chemical_list: D015415:Biomarkers
keywords: Biomarker; CSM; Cervical spondylotic myelopathy; DTI; Diffusion tensor imaging; Spinal cord; Stenosis; mJOA