Signal intensity ratio on magnetic resonance imaging as a prognostic factor in patients with cervical compressive myelopathy.
Patients with intramedullary signal intensity (SI) changes have a poor prognosis after surgical decompression in cervical compressive myelopathy (CCM); however, some patients show no clear relationship between the SI and postsurgical prognosis. This discrepancy may be because no comprehensive and proper quantitative evaluation exists to assess SI on magnetic resonance imaging (MRI). The purpose of this study was prospectively to evaluate the correlation between the clinical features, neurological outcome of patients with CCM, and the quantitative assessment of SI changes preoperatively and postoperatively, and the correlation with SI severity.A total of 112 patients with CCM at 1 or 2 levels underwent anterior cervical discectomy and fusion. We quantitatively analyzed MR signal changes on T1-weighted MR images (T1WI), gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) contrast-enhanced T1WI, and T2-weighted MR images (T2WI) using the signal intensity ratio (SIR). We evaluated the correlations between various variables and neurological outcome using the Japanese Orthopedic Association (JOA) scale, and the severity of SI change by grade (i.e., grade 0 ["none"], grade 1 ["light"], and grade 2 ["bright on T2WI"]).Significant differences between the 3 grades existed in symptom duration, preoperative JOA score, SIR on T2WI, and JOA recovery ratio. The JOA recovery ratio was negatively correlated with symptom duration and the SIR on T2WI, and positively correlated with the preoperative JOA score and cord compression ratio, but not with the SIR on T1WI and contrast-enhanced T1WI. On the postoperative 12-month follow-up MRI, the JOA recovery ratio and SIR on T2WI of the SI reversal patients were better than those of the nonreversal patients. On multiple regression analysis, the SIR on T2WI was the main significant prognostic factor of surgical outcome.The grading system on T2WI provided reliable predictive information for neurological outcome. Quantitative alterations in the SI on preoperative and postoperative T2WI, but not T1WI or contrast-enhanced T1WI, reflected the clinical features, surgical outcomes, and the correlation with SI severity. The patients with a longer duration of symptoms, lower cord compression ratio, severe myelopathy, intense signal change (i.e., grade 2) on the spinal cord, and an SIR greater than 1.55 had a poor recovery after a surgical operation.
aDepartment of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine bDepartment of Neurosurgery, Yonsei University College of Medicine cDepartment of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Tae Hyun
TH
Kim
Yoon
Y
Ha
Jun Jae
JJ
Shin
Yong Eun
YE
Cho
Ji Hae
JH
Lee
Woo Ho
WH
Cho
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D003287:Contrast Media / Q000008:administration & dosage; D017586:Diskectomy / Q000379:methods; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013117:Spinal Cord Compression / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome
D003287:Contrast Media; D019786:Gadolinium DTPA
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