title: Accuracy of Diffusion Tensor Imaging for Diagnosing Cervical Spondylotic Myelopathy in Patients Showing Spinal Cord Compression.
abstract: OBJECTIVE
  To assess the performance of diffusion tensor imaging (DTI) for the diagnosis of cervical spondylotic myelopathy (CSM) in patients with deformed spinal cord but otherwise unremarkable conventional magnetic resonance imaging (MRI) findings.
  
  
  METHODS
  A total of 33 patients who underwent MRI of the cervical spine including DTI using two-dimensional single-shot interleaved multi-section inner volume diffusion-weighted echo-planar imaging and whose spinal cords were deformed but showed no signal changes on conventional MRI were the subjects of this study. Mean diffusivity (MD), longitudinal diffusivity (LD), radial diffusivity (RD), and fractional anisotropy (FA) were measured at the most stenotic level. The calculated performance of MD, FA, MD∩FA (considered positive when both the MD and FA results were positive), LD∩FA (considered positive when both the LD and FA results were positive), and RD∩FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard.
  
  
  RESULTS
  The MD, LD, and RD cut-off values were 1.079 × 10(-3), 1.719 × 10(-3), and 0.749 × 10(-3) mm(2)/sec, respectively, and that of FA was 0.475. Sensitivity, specificity, positive predictive value and negative predictive value were: 100 (4/4), 44.8 (13/29), 20 (4/20), and 100 (13/13) for MD; 100 (4/4), 27.6 (8/29), 16 (4/25), and 100 (8/8) for FA; 100 (4/4), 58.6 (17/29), 25 (4/16), and 100 (17/17) for MD∩FA; 100 (4/4), 68.9 (20/29), 30.8 (4/13), and 100 (20/20) for LD∩FA; and 75 (3/4), 68.9 (20/29), 25 (3/12), and 95.2 (20/21) for RD∩FA in percentage value. Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD∩FA (p = 0.024) and MD and RD∩FA (p = 0.024).
  
  
  CONCLUSIONS
  Fractional anisotropy combined with MD, RD, or LD is expected to be more useful than FA and MD for diagnosing CSM in patients who show deformed spinal cords without signal changes on MRI.
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
authors.forename: Seungbo
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
authors.forename: Young Han
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
authors.forename: Tae-Sub
authors.initials: TS
authors.lastname: Chung
authors.affiliation: Department of Radiology, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT 84112, USA.
authors.forename: Eun-Kee
authors.initials: EK
authors.lastname: Jeong
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
authors.forename: Sungjun
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
authors.forename: Yeon Hwa
authors.initials: YH
authors.lastname: Yoo
authors.affiliation: Siemens Healthcare, Seoul 03737, Korea.
authors.forename: In Seong
authors.initials: IS
authors.lastname: Kim
authors.affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
authors.forename: Choon-Sik
authors.initials: CS
authors.lastname: Yoon
authors.affiliation: Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
authors.forename: Jin-Suck
authors.initials: JS
authors.lastname: Suh
authors.affiliation: Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D056324:Diffusion Tensor Imaging; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D011859:Radiography; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology
keywords: Cervical spondylotic myelopathy; Diffusion tensor imaging; Fractional anisotropy; Longitudinal diffusivity; MRI; Mean diffusivity; Radial diffusivity