title: Evaluation of DTI Parameter Ratios and Diffusion Tensor Tractography Grading in the Diagnosis and Prognosis Prediction of Cervical Spondylotic Myelopathy.
abstract: METHODS
  Prospective cohort.
  
  
  OBJECTIVE
  To explore the correlations between diffusion tensor imaging (DTI) ratios and diffusion tensor tractography (DTT) grading with clinical symptoms and outcomes of cervical spondylotic myelopathy (CSM).
  
  
  BACKGROUND
  In addition to magnetic resonance imaging (MRI) and computed tomography, DTI may be useful in understanding pathophysiology of spinal cord in earlier stages of the CSM but it may be confounded by age and cervical level, and previous studies had small sample sizes.
  
  
  METHODS
  Controls (n = 36) and patients with CSM (n = 93) underwent magnetic resonance imaging (MRI) and DTI at the Changhai Hospital of Shanghai between September 2011 and March 2013. Apparent diffusion coefficient (ADC), fractional anisotropy (FA) of white matter (WM), and central grey matter (GM) were assessed. Patients were divided into three MRI grades: no abnormal signals; increased T2WI; and increased T2WI and low T1WI. DTT images were divided into three grades: no abnormal signals; abnormal local signal cord and disordered fiber tracts; and distortion of the spinal cord and interrupted fiber tracts.
  
  
  RESULTS
  FA and ADC both correlated with age in all three bilateral WM funiculi and GM, whereas FA and ADC ratios only showed correlation with age in the ventral funiculus (VF) and central GM. Differences were observed in ADC ratios and FA ratios from different Japanese Orthopedic Association (JOA) score subgroups and JOA recovery subgroups. For the three WM funiculi and GM, correlations between DTI ratios, JOA scores, and JOA recovery rates were consistently higher than those between DTI values, JOA scores, and JOA recovery rates (all P < 0.05). MRI grading was correlated with the JOA scores (r = -0.674, P < 0.001) but not JOA recovery rates (r = -0.197, P = 0.058), whereas DTT grading was correlated with both JOA scores (r = -0.813, P < 0.001) and JOA recovery rate (r = -0.429, P < 0.001).
  
  
  CONCLUSIONS
  DTI parameter ratios seemed to be less influenced by age than raw DTI results and could be more valuable than absolute DTI parameters for the evaluation of CSM. DTT grading is more valuable than MRI grading for diagnosis and prognostic prediction in CSM patients.
  
  
  METHODS
  3.
authors.affiliation: Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Wang
authors.affiliation: Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Orthopedics Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China.
authors.forename: Qingxin
authors.initials: Q
authors.lastname: Song
authors.affiliation: Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China.
authors.forename: Canglong
authors.initials: C
authors.lastname: Hou
authors.affiliation: Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China.
authors.forename: Yixing
authors.initials: Y
authors.lastname: Tang
authors.affiliation: Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China.
authors.forename: Shiyue
authors.initials: S
authors.lastname: Chen
authors.affiliation: Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Bian
authors.affiliation: Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Hao
authors.affiliation: Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Hongxing
authors.initials: H
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology; D056324:Diffusion Tensor Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000473:pathology; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D055009:Spondylosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D055815:Young Adult