Artikel
Diffusion tensor imaging is an alternative to CT-myelography for surgical planning in patients with multilevel cervical spondylotic myelopathy
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Autoren
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Sebastian Siller
- Klinikum der Ludwig-Maximilians-Universität - Campus Großhadern, Neurochirurgische Klinik, München, Deutschland
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Karsten Schöller
- Justus-Liebig-Universität Gießen, Neurochirurgische Klinik, Gießen, Deutschland
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Sebastian Siller
- Klinikum der Ludwig-Maximilians-Universität - Campus Großhadern, Neurochirurgische Klinik, München, Deutschland
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Christian Brem
- Klinikum der Ludwig-Maximilians-Universität - Campus Großhadern, Abteilung für Neuroradiologie, München, Deutschland
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Jürgen Lutz
- Klinikum Ingolstadt, Institut für Neuroradiologie, Ingolstadt, Deutschland
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Stefan Zausinger
- Klinikum der Ludwig-Maximilians-Universität - Campus Großhadern, Neurochirurgische Klinik, München, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Despite its invasiveness, computed-tomography myelography (CT-M) is still considered to be superior to conventional magnetic-resonance imaging (MRI) for preoperative evaluation of multilevel cervical spondylotic myelopathy (MCSM). We analyzed if diffusion-tensor imaging (DTI) could be a less-invasive alternative for this purpose.
Methods: In 20 patients with MCSM and indication for decompression of at least one cervical level, CT-M was carried out preoperatively to determine the extent of spinal canal / CSF space and cord compression (Naganawa score) for decision on the number of levels to be decompressed. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) as the main DTI indices were correlated with these parameters and with MRI-based increased signal-intensity (ISI); ROC-analysis was performed to determine the sensitivity to discriminate levels requiring decompression surgery. European-Myelopathy-Score (EMS) and neck/radicular Visual-Analogue-Scale (VAS-N/-R) were utilized for clinical evaluation.
Results: According to preoperative CT-M, 20 levels of maximum and 16 levels of relevant additional stenosis were defined and decompressed. Preoperative FA and particularly ADC showed a significant correlation with the CT-M Nagawana score but also with the ISI grade. Furthermore, both FA and ADC facilitated a good discrimination between stenotic and non-stenotic levels with cut-off-values being < 0.49 for FA and > 1.15x10-9 m2/s for ADC. FA and especially ADC revealed a considerably higher sensitivity (79% / 82%) in discriminating levels requiring decompression surgery compared to ISI (55%). EMS and VAS-N/-R were significantly improved at 14 months compared to preoperative values.
Conclusion: In MCSM patients, DTI parameters are highly sensitive to identify levels requiring surgical decompression and might therefore represent a less-invasive alternative to CT-M for surgical planning.
