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

Ellingson BM, Salamon N, Hardy AJ, Holly LT - PLoS ONE (2015)

Bottom Line: Parameters that did not add value to model performance were removed, then an optimized multiparametric model was established to predict mJOA.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, United States of America; Department of Biomedical Physics, David Geffen School of Medicine, University of California-Los Angeles, United States of America; Department of Bioengineering, Henri Samueli School of Engineering and Applied Sciences, University of California-Los Angeles, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California-Los Angeles, United States of America.

ABSTRACT

Purpose: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus

Anatomic, Diffusion, and Spectroscopic MR Measurements in Cervical Spondylosis.A) A patient with mild impairment (mJOA = 17) showing slightly elevated fiber tract density, relatively normal FA and MD, and a dominant NAA peak. B) A patient with moderate impairment (mJOA = 14) showing focally high fiber tract density, lower FA and higher MD, along with emergence of a Cho metabolites. C) A patient with severe impairment (mJOA = 8) showing elevated T2 hyperintensity on T2-weighted images, high fiber tract density indicative of compressed fibers extending rostral-caudal from the site of compression, lower FA and higher MD at the site of greatest stenosis, and dominant Cho peak in the MR spectra. Red box at C2 indicates the voxel used for MR spectroscopic measurement. Red arrow shows area of compression.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4592013&req=5

pone.0139451.g001: Anatomic, Diffusion, and Spectroscopic MR Measurements in Cervical Spondylosis.A) A patient with mild impairment (mJOA = 17) showing slightly elevated fiber tract density, relatively normal FA and MD, and a dominant NAA peak. B) A patient with moderate impairment (mJOA = 14) showing focally high fiber tract density, lower FA and higher MD, along with emergence of a Cho metabolites. C) A patient with severe impairment (mJOA = 8) showing elevated T2 hyperintensity on T2-weighted images, high fiber tract density indicative of compressed fibers extending rostral-caudal from the site of compression, lower FA and higher MD at the site of greatest stenosis, and dominant Cho peak in the MR spectra. Red box at C2 indicates the voxel used for MR spectroscopic measurement. Red arrow shows area of compression.

Mentions: Patients with increasing neurological dysfunction appeared to have higher degrees of compression, T2 hyperintensity, lowered diffusion anisotropy, focally higher fiber tract density, and abnormal metabolic signatures compared with patients demonstrating stenosis without substantial neurological impairment (Fig 1; S1 Data). In particular, patients with a mild impairment (Fig 1A), defined as having mJOA scores between 15 and 17, tended to show only slightly increased fiber tract density in the area of compression, relatively high FA and low MD within the cord in the area of highest compression, and a dominant NAA peak with little Cho observed. In patients with moderate impairment (Fig 1B), or mJOA ranging from 12 to 14, focally higher fiber tract density was observed at the site of compression often extending rostral-caudal, lowered FA and slightly elevated MD was observed at the site of compression, and elevated Cho and lowered NAA levels were often noted. In patients with severe impairment (Fig 1C) exhibiting mJOA lower than 12, focally elevated fiber tract density was noted with significantly lower FA and higher MD present at the site of compression, along with a dominant Cho peak on MRS at the C2 level.


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

Ellingson BM, Salamon N, Hardy AJ, Holly LT - PLoS ONE (2015)

Anatomic, Diffusion, and Spectroscopic MR Measurements in Cervical Spondylosis.A) A patient with mild impairment (mJOA = 17) showing slightly elevated fiber tract density, relatively normal FA and MD, and a dominant NAA peak. B) A patient with moderate impairment (mJOA = 14) showing focally high fiber tract density, lower FA and higher MD, along with emergence of a Cho metabolites. C) A patient with severe impairment (mJOA = 8) showing elevated T2 hyperintensity on T2-weighted images, high fiber tract density indicative of compressed fibers extending rostral-caudal from the site of compression, lower FA and higher MD at the site of greatest stenosis, and dominant Cho peak in the MR spectra. Red box at C2 indicates the voxel used for MR spectroscopic measurement. Red arrow shows area of compression.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592013&req=5

pone.0139451.g001: Anatomic, Diffusion, and Spectroscopic MR Measurements in Cervical Spondylosis.A) A patient with mild impairment (mJOA = 17) showing slightly elevated fiber tract density, relatively normal FA and MD, and a dominant NAA peak. B) A patient with moderate impairment (mJOA = 14) showing focally high fiber tract density, lower FA and higher MD, along with emergence of a Cho metabolites. C) A patient with severe impairment (mJOA = 8) showing elevated T2 hyperintensity on T2-weighted images, high fiber tract density indicative of compressed fibers extending rostral-caudal from the site of compression, lower FA and higher MD at the site of greatest stenosis, and dominant Cho peak in the MR spectra. Red box at C2 indicates the voxel used for MR spectroscopic measurement. Red arrow shows area of compression.
Mentions: Patients with increasing neurological dysfunction appeared to have higher degrees of compression, T2 hyperintensity, lowered diffusion anisotropy, focally higher fiber tract density, and abnormal metabolic signatures compared with patients demonstrating stenosis without substantial neurological impairment (Fig 1; S1 Data). In particular, patients with a mild impairment (Fig 1A), defined as having mJOA scores between 15 and 17, tended to show only slightly increased fiber tract density in the area of compression, relatively high FA and low MD within the cord in the area of highest compression, and a dominant NAA peak with little Cho observed. In patients with moderate impairment (Fig 1B), or mJOA ranging from 12 to 14, focally higher fiber tract density was observed at the site of compression often extending rostral-caudal, lowered FA and slightly elevated MD was observed at the site of compression, and elevated Cho and lowered NAA levels were often noted. In patients with severe impairment (Fig 1C) exhibiting mJOA lower than 12, focally elevated fiber tract density was noted with significantly lower FA and higher MD present at the site of compression, along with a dominant Cho peak on MRS at the C2 level.

Bottom Line: Parameters that did not add value to model performance were removed, then an optimized multiparametric model was established to predict mJOA.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, United States of America; Department of Biomedical Physics, David Geffen School of Medicine, University of California-Los Angeles, United States of America; Department of Bioengineering, Henri Samueli School of Engineering and Applied Sciences, University of California-Los Angeles, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California-Los Angeles, United States of America.

ABSTRACT

Purpose: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus