Tract-Specific Diffusion Tensor Imaging Reveals Laterality of Neurological Symptoms in Patients with Cervical Compression Myelopathy.
BACKGROUND
Patients with cervical compression myelopathy (CCM) generally present bilateral neurological symptoms in their extremities. However, a substantial portion of patients with CCM exhibit laterality of neurological symptoms. The aim of this study was to assess the correlation between intrinsic structural damage and laterality of symptoms using spinal cord diffusion tensor imaging (DTI) of the corticospinal tract.


METHODS
We enrolled 10 healthy volunteers and 40 patients with CCM in this study. We evaluated motor function using the American Spinal Injury Association (ASIA) motor score for left and right extremities. For DTI acquisitions, a 3.0-T magnetic resonance imaging system with diffusion-weighted spin-echo sequence was used. Regions-of-interest in the lateral column tracts were determined. We determined the correlations between fractional anisotropy (FA) and ASIA motor scores. An FA asymmetry index was calculated using left and right regions-of-interest.


RESULTS
Four patients exhibited laterality of symptoms in their extremities, for which left and right ASIA scores correlated moderately with FA in the left and right lateral columns, respectively (left: ρ = 0.64, P < 0.001; right: ρ = 0.67, P < 0.001). The area under the receiver-operator characteristic curve showed that the FA asymmetry index indicated laterality of symptoms.


CONCLUSIONS
Using tract-specific DTI, we demonstrated that microstructural damages in the left and right corticospinal tracts correlated with corresponding neurological symptoms in the ipsilateral side and the FA asymmetry index could indicate laterality in neurological symptoms of patients with CCM.
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan. Electronic address: makisatoshi@hotmail.com.
Satoshi
S
Maki
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
Masao
M
Koda
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
Junya
J
Saito
Clinical Research Center, Chiba University Hospital, Chiba City, Chiba, Japan.
Sho
S
Takahashi
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
Taigo
T
Inada
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
Koshiro
K
Kamiya
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
Mitsutoshi
M
Ota
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
Yasushi
Y
Iijima
Department of Radiology, Chiba University Hospital, Chiba City, Chiba, Japan.
Yoshitada
Y
Masuda
Department of Radiology, Chiba University Hospital, Chiba City, Chiba, Japan.
Koji
K
Matsumoto
Department of Radiology, Chiba University Hospital, Chiba City, Chiba, Japan.
Masatoshi
M
Kojima
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
Kazuhisa
K
Takahashi
Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba City, Chiba, Japan.
Takayuki
T
Obata
Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaragi, Japan.
Masashi
M
Yamazaki
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan.
Takeo
T
Furuya
D000328:Adult; D000368:Aged; D016880:Anisotropy; D001176:Arthrogryposis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002572:Cervical Plexus; D003658:Decision Making, Computer-Assisted; D056324:Diffusion Tensor Imaging; D005121:Extremities / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D015417:Hereditary Sensory and Motor Neuropathy / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D013116:Spinal Cord / Q000000981:diagnostic imaging; D018709:Statistics, Nonparametric
Asymmetry index; Cervical compression myelopathy; Diffusion tensor imaging; Laterality; Spinal cord