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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

Correlation Between Individual MR Measurements and mJOA.A) Ratio of maximum fiber tract density at the site of compression to fiber tract density at C2 versus mJOA (R2= 0.5939, P<0.0001). B) Fractional anisotropy (FA) at the site of greatest stenosis versus mJOA (R2= 0.7034, P<0.0001). C) Mean diffusivity (MD) at the site of greatest stenosis versus mJOA (R2= 0.4739, P<0.0001). D) Cho/NAA ratio measured at C2 versus mJOA score (R2= 0.4649, P<0.0001).
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pone.0139451.g002: Correlation Between Individual MR Measurements and mJOA.A) Ratio of maximum fiber tract density at the site of compression to fiber tract density at C2 versus mJOA (R2= 0.5939, P<0.0001). B) Fractional anisotropy (FA) at the site of greatest stenosis versus mJOA (R2= 0.7034, P<0.0001). C) Mean diffusivity (MD) at the site of greatest stenosis versus mJOA (R2= 0.4739, P<0.0001). D) Cho/NAA ratio measured at C2 versus mJOA score (R2= 0.4649, P<0.0001).

Mentions: Results suggested no significant linear correlation between mJOA score and patient age (R2<0.001, P = 0.9698), vertebral body diameter at the site of compression (R2= 0.093, P = 0.1223), spinal cord diameter at the site of compression (R2= 0.042, P = 0.3055), Pavlov-Torg ratio (R2= 0.1004, P = 0.1073), Cho/Cr (R2= 0.034, P = 0.3573), NAA/Cr (R2= 0.079, P = 0.1560), or Myo-I/Cr (R2= 0.019, P = 0.4965). However, the ratio of maximum fiber tract density at the site of compression to fiber tract density at C2 (Fig 2AR2= 0.5939, P<0.0001), FA at the site of compression (Fig 2B; R2= 0.7034, P<0.0001), MD at the site of compression (Fig 2C; R2= 0.4739, P<0.0001), and Cho/NAA at C2 (Fig 2D; R2= 0.4649, P<0.0001) were all found to be correlated with mJOA after Bonferroni corrections for multiple comparisons.


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)

Correlation Between Individual MR Measurements and mJOA.A) Ratio of maximum fiber tract density at the site of compression to fiber tract density at C2 versus mJOA (R2= 0.5939, P<0.0001). B) Fractional anisotropy (FA) at the site of greatest stenosis versus mJOA (R2= 0.7034, P<0.0001). C) Mean diffusivity (MD) at the site of greatest stenosis versus mJOA (R2= 0.4739, P<0.0001). D) Cho/NAA ratio measured at C2 versus mJOA score (R2= 0.4649, P<0.0001).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4592013&req=5

pone.0139451.g002: Correlation Between Individual MR Measurements and mJOA.A) Ratio of maximum fiber tract density at the site of compression to fiber tract density at C2 versus mJOA (R2= 0.5939, P<0.0001). B) Fractional anisotropy (FA) at the site of greatest stenosis versus mJOA (R2= 0.7034, P<0.0001). C) Mean diffusivity (MD) at the site of greatest stenosis versus mJOA (R2= 0.4739, P<0.0001). D) Cho/NAA ratio measured at C2 versus mJOA score (R2= 0.4649, P<0.0001).
Mentions: Results suggested no significant linear correlation between mJOA score and patient age (R2<0.001, P = 0.9698), vertebral body diameter at the site of compression (R2= 0.093, P = 0.1223), spinal cord diameter at the site of compression (R2= 0.042, P = 0.3055), Pavlov-Torg ratio (R2= 0.1004, P = 0.1073), Cho/Cr (R2= 0.034, P = 0.3573), NAA/Cr (R2= 0.079, P = 0.1560), or Myo-I/Cr (R2= 0.019, P = 0.4965). However, the ratio of maximum fiber tract density at the site of compression to fiber tract density at C2 (Fig 2AR2= 0.5939, P<0.0001), FA at the site of compression (Fig 2B; R2= 0.7034, P<0.0001), MD at the site of compression (Fig 2C; R2= 0.4739, P<0.0001), and Cho/NAA at C2 (Fig 2D; R2= 0.4649, P<0.0001) were all found to be correlated with mJOA after Bonferroni corrections for multiple comparisons.

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