Journal Article

Prediction of Neurological Impairment in Cervical Spondylotic Myelopathy using a Combination of Diffusion MRI and Proton MR Spectroscopy

Salamon, Noriko, Hardy, Anthony J., Holly, Langston T., Ellingson, Benjamin M.

2015

Overview

In the present study we investigated a combination of diffusion tensor imaging (DTI) and magnetic resonance spectroscopic (MRS) biomarkers in order to predict neurological impairment in patients with cervical spondylosis. Twenty-seven patients with cervical spondylosis were evaluated. DTI and single voxel MRS were performed in the cervical cord. N-acetylaspartate (NAA) and choline (Cho) metabolite concentration ratios with respect to creatine were quantified, as well as the ratio of choline to NAA. The modified mJOA scale was used as a measure of neurologic deficit. Linear regression was performed between DTI and MRS parameters and mJOA scores. Significant predictors from linear regression were used in a multiple linear regression model in order to improve prediction of mJOA. Parameters that did not add value to model performance were removed, then an optimized multiparametric model was established to predict mJOA. Significant correlations were observed between the Torg-Pavlov ratio and FA (R2 = 0.2021, P = 0.019); DTI fiber tract density and FA, MD, Cho/NAA (R2 = 0.3412, P = 0.0014; R2 = 0.2112, P = 0.016; and R2 = 0.2352, P = 0.010 respectively); along with FA and Cho/NAA (R2 = 0.1695, P = 0.033). DTI fiber tract density, MD and FA at the site of compression, along with Cho/NAA at C2, were significantly correlated with mJOA score (R2 = 0.05939, P < 0.0001; R2 = 0.4739, P < 0.0001; R2 = 0.7034, P < 0.0001; R2 = 0.4649, P < 0.0001). A combination biomarker consisting of DTI fiber tract density, MD, and Cho/NAA showed the best prediction of mJOA (R2 = 0.8274, P<0.0001), with post-hoc tests suggesting fiber tract density, MD, and Cho/NAA were all significant contributors to predicting mJOA (P = 0.00053, P = 0.00085, and P = 0.0019, respectively). A linear combination of DTI and MRS measurements within the cervical spinal cord may be useful for accurately predicting neurological deficits in patients with cervical spondylosis. Additional studies may be necessary to validate these observations.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Aged / Aging - pathology / Aspartic Acid - analogs & derivatives / Aspartic Acid - analysis / Biomarkers / Care and treatment / Central nervous system diseases / Choline / Choline - analysis / Compression / Correlation analysis / Creatine / Creatinine - analysis / Density / Diagnosis / Diffusion / Diffusion Tensor Imaging / Female / Gait Disorders, Neurologic - etiology / Gait Disorders, Neurologic - pathology / Humans / Impairment / Linear Models / Magnetic resonance / Magnetic resonance imaging / Magnetic resonance spectroscopy / Male / Medicine / Metabolism / Metabolites / Middle Aged / N-Acetylaspartate / Neck pain / Neck Pain - etiology / Neck Pain - pathology / Nerve Fibers - pathology / Nervous system diseases / Neurobiology / Neurological complications / Neurological diseases / Neurosciences / Neurosurgery / NMR / Nuclear magnetic resonance / Older people / Parameters / Paresthesia - etiology / Paresthesia - pathology / Patients / Predictions / Prospective Studies / Proton Magnetic Resonance Spectroscopy / Regression models / Risk factors / Spectroscopy / Spectrum analysis / Spinal cord / Spinal Cord - pathology / Spinal Cord Compression - etiology / Spinal Cord Compression - pathology / Spinal cord injuries / Spinal osteophytosis / Spinal Stenosis - complications / Spinal Stenosis - pathology / Spondylosis / Spondylosis - complications / Spondylosis - pathology / Young Adult