Prediction of the efficacy of surgical intervention in patients with cervical myelopathy by using diffusion tensor 3T-magnetic resonance imaging parameters.
BACKGROUND
The clinical significance of diffusion tensor (DT) magnetic resonance imaging (MRI) parameters was analyzed to predict postoperative functional recovery in patients with cervical myelopathy.


METHODS
Sixteen patients with cervical myelopathy caused by cervical spondylosis, disk herniation or ossification of the posterior longitudinal ligament who underwent surgical intervention in our institute were enrolled in this retrospective study. There were 7 men and 9 women, with a mean age of 62.8 years. Clinical assessment was done before surgery and at least 3 months after surgery. All patients underwent whole-body 3.0-Tesla MRI before surgery. DT images (DTIs) were obtained using a single-shot fast spin-echo-based sequence. Mean values of mean diffusivity (MD) and fractional anisotropy (FA) at 6 disk levels of the cervical spine were measured using manual setting of regions of interest. The MD and FA values at the most compressed part were analyzed. Absolute MD and FA values at the most compressed spinal level in patients were transformed into the normalized values with a z-score analysis.


RESULTS
MD-z may decrease with the severity of cervical myelopathy. Receiver operating characteristic analysis of MD-z and FA-z suggested that both MD-z and FA-z have clinical validity for predicting the efficacy of surgical intervention, but MD-z was considered to be the most appropriate value to predict the efficacy of surgery.


CONCLUSIONS
DTIs may be a promising modality to predict functional recovery after surgery. MD changes may reflect spinal cord condition and its reversibility.
Department of Neurosurgery, Osaka City University, Graduate School of Medicine, Osaka, Japan.
Hironori
H
Arima
Department of Diagnostic and Interventional Radiology, Osaka City University, Graduate School of Medicine, Osaka, Japan.
Shinichi
S
Sakamoto
Department of Neurosurgery, Osaka City University, Graduate School of Medicine, Osaka, Japan.
Kentaro
K
Naito
Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan.
Toru
T
Yamagata
Department of Neurosurgery, Osaka City University, Graduate School of Medicine, Osaka, Japan.
Takehiro
T
Uda
Department of Neurosurgery, Osaka City University, Graduate School of Medicine, Osaka, Japan.
Kenji
K
Ohata
Department of Neurosurgery, Osaka City University, Graduate School of Medicine, Osaka, Japan.
Toshihiro
T
Takami
Cervical myelopathy; diffusion tensor parameters; fractional anisotropy; functional recovery; mean diffusivity