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Accuracy of Diffusion Tensor Imaging for Diagnosing Cervical Spondylotic Myelopathy in Patients Showing Spinal Cord Compression.

Lee S, Lee YH, Chung TS, Jeong EK, Kim S, Yoo YH, Kim IS, Yoon CS, Suh JS, Park JH - Korean J Radiol (2015)

Bottom Line: The calculated performance of MD, FA, MD∩FA (considered positive when both the MD and FA results were positive), LD∩FA (considered positive when both the LD and FA results were positive), and RD∩FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard.Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD∩FA (p = 0.024) and MD and RD∩FA (p = 0.024).Fractional anisotropy combined with MD, RD, or LD is expected to be more useful than FA and MD for diagnosing CSM in patients who show deformed spinal cords without signal changes on MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.

ABSTRACT

Objective: To assess the performance of diffusion tensor imaging (DTI) for the diagnosis of cervical spondylotic myelopathy (CSM) in patients with deformed spinal cord but otherwise unremarkable conventional magnetic resonance imaging (MRI) findings.

Materials and methods: A total of 33 patients who underwent MRI of the cervical spine including DTI using two-dimensional single-shot interleaved multi-section inner volume diffusion-weighted echo-planar imaging and whose spinal cords were deformed but showed no signal changes on conventional MRI were the subjects of this study. Mean diffusivity (MD), longitudinal diffusivity (LD), radial diffusivity (RD), and fractional anisotropy (FA) were measured at the most stenotic level. The calculated performance of MD, FA, MD∩FA (considered positive when both the MD and FA results were positive), LD∩FA (considered positive when both the LD and FA results were positive), and RD∩FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard.

Results: The MD, LD, and RD cut-off values were 1.079 × 10(-3), 1.719 × 10(-3), and 0.749 × 10(-3) mm(2)/sec, respectively, and that of FA was 0.475. Sensitivity, specificity, positive predictive value and negative predictive value were: 100 (4/4), 44.8 (13/29), 20 (4/20), and 100 (13/13) for MD; 100 (4/4), 27.6 (8/29), 16 (4/25), and 100 (8/8) for FA; 100 (4/4), 58.6 (17/29), 25 (4/16), and 100 (17/17) for MD∩FA; 100 (4/4), 68.9 (20/29), 30.8 (4/13), and 100 (20/20) for LD∩FA; and 75 (3/4), 68.9 (20/29), 25 (3/12), and 95.2 (20/21) for RD∩FA in percentage value. Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD∩FA (p = 0.024) and MD and RD∩FA (p = 0.024).

Conclusion: Fractional anisotropy combined with MD, RD, or LD is expected to be more useful than FA and MD for diagnosing CSM in patients who show deformed spinal cords without signal changes on MRI.

No MeSH data available.


Related in: MedlinePlus

Cervical spondylotic myelopathy (CSM) detected using diffusion tensor imaging (DTI) parameters in patient whose T2-weighted image was designated as showing as grade 2 stenosis.Off-center sagittal T2-weighted image (A) of patient showed deformed spinal cord without definite signal change at C4-5 disc level, which was most stenotic level (arrow); thus, stenosis was designated as grade 2. DTI parameters were measured at that level on mid-sagittal gray-tone fractional anisotropy (FA) map (B). FA, mean diffusivity, longitudinal diffusivity, and radial diffusivity values of this patient were 0.349, 1.198 × 10-3 mm2/sec, 1.728 × 10-3 mm2/sec, and 0.933 × 10-3 mm2/sec, respectively. All values were compatible with diagnosis of CSM considering cut-off value of each parameter. Color-coded map (C) based on principal eigenvalues in sagittal plane revealed subtle dark color (arrow), suggesting changes in eigenvalues at most stenotic level. Blue coloring represents principal eigenvector aligned in head-foot direction.
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Figure 5: Cervical spondylotic myelopathy (CSM) detected using diffusion tensor imaging (DTI) parameters in patient whose T2-weighted image was designated as showing as grade 2 stenosis.Off-center sagittal T2-weighted image (A) of patient showed deformed spinal cord without definite signal change at C4-5 disc level, which was most stenotic level (arrow); thus, stenosis was designated as grade 2. DTI parameters were measured at that level on mid-sagittal gray-tone fractional anisotropy (FA) map (B). FA, mean diffusivity, longitudinal diffusivity, and radial diffusivity values of this patient were 0.349, 1.198 × 10-3 mm2/sec, 1.728 × 10-3 mm2/sec, and 0.933 × 10-3 mm2/sec, respectively. All values were compatible with diagnosis of CSM considering cut-off value of each parameter. Color-coded map (C) based on principal eigenvalues in sagittal plane revealed subtle dark color (arrow), suggesting changes in eigenvalues at most stenotic level. Blue coloring represents principal eigenvector aligned in head-foot direction.

Mentions: Thirty-three patients who showed compressed spinal cords without signal changes on T2WI were included in a subgroup to assess the diagnostic performance of the DTI parameters and their combinations. Among them, four patients had CSM (Fig. 5), and the remaining 29 patients did not. The ideal MD, LD, RD, and FA cut-off values in this subgroup were: > 1.079 × 10-3 mm2/sec, > 1.719 × 10-3 mm2/sec, > 0.749 × 10-3 mm2/sec and ≤ 0.475, respectively. The sensitivity, specificity, PPV, and NPV of MD, FA, MD∩FA, LD∩FA, and RD∩FA are summarized in Table 1. Specificity was significantly different (p < 0.001) among the DTI parameters and their combinations in multiple comparisons, indicating that at least one of the comparisons was significant, whereas sensitivity (p = 0.317), PPV (p = 0.328), and NPV (p = 0.210) were not significantly different. Significant differences were observed between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD∩FA (p = 0.024), and MD and RD∩FA (p = 0.024) in a post-hoc analysis of specificity between the parameters and their combinations. No significant differences were observed in the other comparisons.


Accuracy of Diffusion Tensor Imaging for Diagnosing Cervical Spondylotic Myelopathy in Patients Showing Spinal Cord Compression.

Lee S, Lee YH, Chung TS, Jeong EK, Kim S, Yoo YH, Kim IS, Yoon CS, Suh JS, Park JH - Korean J Radiol (2015)

Cervical spondylotic myelopathy (CSM) detected using diffusion tensor imaging (DTI) parameters in patient whose T2-weighted image was designated as showing as grade 2 stenosis.Off-center sagittal T2-weighted image (A) of patient showed deformed spinal cord without definite signal change at C4-5 disc level, which was most stenotic level (arrow); thus, stenosis was designated as grade 2. DTI parameters were measured at that level on mid-sagittal gray-tone fractional anisotropy (FA) map (B). FA, mean diffusivity, longitudinal diffusivity, and radial diffusivity values of this patient were 0.349, 1.198 × 10-3 mm2/sec, 1.728 × 10-3 mm2/sec, and 0.933 × 10-3 mm2/sec, respectively. All values were compatible with diagnosis of CSM considering cut-off value of each parameter. Color-coded map (C) based on principal eigenvalues in sagittal plane revealed subtle dark color (arrow), suggesting changes in eigenvalues at most stenotic level. Blue coloring represents principal eigenvector aligned in head-foot direction.
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Related In: Results  -  Collection

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Figure 5: Cervical spondylotic myelopathy (CSM) detected using diffusion tensor imaging (DTI) parameters in patient whose T2-weighted image was designated as showing as grade 2 stenosis.Off-center sagittal T2-weighted image (A) of patient showed deformed spinal cord without definite signal change at C4-5 disc level, which was most stenotic level (arrow); thus, stenosis was designated as grade 2. DTI parameters were measured at that level on mid-sagittal gray-tone fractional anisotropy (FA) map (B). FA, mean diffusivity, longitudinal diffusivity, and radial diffusivity values of this patient were 0.349, 1.198 × 10-3 mm2/sec, 1.728 × 10-3 mm2/sec, and 0.933 × 10-3 mm2/sec, respectively. All values were compatible with diagnosis of CSM considering cut-off value of each parameter. Color-coded map (C) based on principal eigenvalues in sagittal plane revealed subtle dark color (arrow), suggesting changes in eigenvalues at most stenotic level. Blue coloring represents principal eigenvector aligned in head-foot direction.
Mentions: Thirty-three patients who showed compressed spinal cords without signal changes on T2WI were included in a subgroup to assess the diagnostic performance of the DTI parameters and their combinations. Among them, four patients had CSM (Fig. 5), and the remaining 29 patients did not. The ideal MD, LD, RD, and FA cut-off values in this subgroup were: > 1.079 × 10-3 mm2/sec, > 1.719 × 10-3 mm2/sec, > 0.749 × 10-3 mm2/sec and ≤ 0.475, respectively. The sensitivity, specificity, PPV, and NPV of MD, FA, MD∩FA, LD∩FA, and RD∩FA are summarized in Table 1. Specificity was significantly different (p < 0.001) among the DTI parameters and their combinations in multiple comparisons, indicating that at least one of the comparisons was significant, whereas sensitivity (p = 0.317), PPV (p = 0.328), and NPV (p = 0.210) were not significantly different. Significant differences were observed between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD∩FA (p = 0.024), and MD and RD∩FA (p = 0.024) in a post-hoc analysis of specificity between the parameters and their combinations. No significant differences were observed in the other comparisons.

Bottom Line: The calculated performance of MD, FA, MD∩FA (considered positive when both the MD and FA results were positive), LD∩FA (considered positive when both the LD and FA results were positive), and RD∩FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard.Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD∩FA (p = 0.024) and MD and RD∩FA (p = 0.024).Fractional anisotropy combined with MD, RD, or LD is expected to be more useful than FA and MD for diagnosing CSM in patients who show deformed spinal cords without signal changes on MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.

ABSTRACT

Objective: To assess the performance of diffusion tensor imaging (DTI) for the diagnosis of cervical spondylotic myelopathy (CSM) in patients with deformed spinal cord but otherwise unremarkable conventional magnetic resonance imaging (MRI) findings.

Materials and methods: A total of 33 patients who underwent MRI of the cervical spine including DTI using two-dimensional single-shot interleaved multi-section inner volume diffusion-weighted echo-planar imaging and whose spinal cords were deformed but showed no signal changes on conventional MRI were the subjects of this study. Mean diffusivity (MD), longitudinal diffusivity (LD), radial diffusivity (RD), and fractional anisotropy (FA) were measured at the most stenotic level. The calculated performance of MD, FA, MD∩FA (considered positive when both the MD and FA results were positive), LD∩FA (considered positive when both the LD and FA results were positive), and RD∩FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard.

Results: The MD, LD, and RD cut-off values were 1.079 × 10(-3), 1.719 × 10(-3), and 0.749 × 10(-3) mm(2)/sec, respectively, and that of FA was 0.475. Sensitivity, specificity, positive predictive value and negative predictive value were: 100 (4/4), 44.8 (13/29), 20 (4/20), and 100 (13/13) for MD; 100 (4/4), 27.6 (8/29), 16 (4/25), and 100 (8/8) for FA; 100 (4/4), 58.6 (17/29), 25 (4/16), and 100 (17/17) for MD∩FA; 100 (4/4), 68.9 (20/29), 30.8 (4/13), and 100 (20/20) for LD∩FA; and 75 (3/4), 68.9 (20/29), 25 (3/12), and 95.2 (20/21) for RD∩FA in percentage value. Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD∩FA (p = 0.024) and MD and RD∩FA (p = 0.024).

Conclusion: Fractional anisotropy combined with MD, RD, or LD is expected to be more useful than FA and MD for diagnosing CSM in patients who show deformed spinal cords without signal changes on MRI.

No MeSH data available.


Related in: MedlinePlus