Diffusion Basis Spectrum Imaging Provides Insights Into Cervical Spondylotic Myelopathy Pathology. Issue 1 (25th January 2023)

• Record Type: Journal Article
• Authors: Zhang, Justin K.; Jayasekera, Dinal; Song, Chunyu; Greenberg, Jacob K.; Javeed, Saad; Dibble, Christopher F.; Blum, Jacob; Sun, Peng; Song, Sheng-Kwei; Ray, Wilson Z.
• Is Part Of: Neurosurgery. Volume 92:Issue 1(2023)
• Page Start: 102
• Page End: 109
• Publication Date: 2023-01-25
• Subjects: MRI -- Diffusion-weighted MRI -- Diffusion tensor imaging -- Diffusion basis spectrum imaging -- Cervical spondylotic myelopathy; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/neu.0000000000002183
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: Diffusion basis spectrum imaging (DBSI) is a noninvasive quantitative imaging modality that may improve understanding of cervical spondylotic myelopathy (CSM) pathology through detailed evaluations of spinal cord microstructural compartments. OBJECTIVE: To determine the utility of DBSI as a biomarker of CSM disease severity. METHODS: A single-center prospective cohort study enrolled 50 patients with CSM and 20 controls from 2018 to 2020. All patients underwent clinical evaluation and diffusion-weighted MRI, followed by diffusion tensor imaging and DBSI analyses. Diffusion-weighted MRI metrics assessed white matter integrity by fractional anisotropy, axial diffusivity, radial diffusivity, and fiber fraction. In addition, DBSI further evaluates extra-axonal changes by isotropic restricted and nonrestricted fraction. Including an intra-axonal diffusion compartment, DBSI improves estimations of axonal injury through intra-axonal axial diffusivity. Patients were categorized into mild, moderate, and severe CSM using modified Japanese Orthopedic Association classifications. Imaging parameters were compared among patient groups using independent samples t tests and ANOVA. RESULTS: Twenty controls, 27 mild (modified Japanese Orthopedic Association 15-17), 12 moderate (12-14), and 11 severe (0-11) patients with CSM were enrolled. Diffusion tensor imaging and DBSI fractional anisotropy, axial diffusivity, and radial diffusivity were significantly different between control and patients with CSM ( P < .05). DBSI fiber fraction, restricted fraction, and nonrestricted fraction were significantly different between groups ( P < .01). DBSI intra-axonal axial diffusivity was lower in mild compared with moderate (mean difference [95% CI]: 1.1 [0.3-2.1], P < .01) and severe (1.9 [1.3-2.4], P < .001) CSM. CONCLUSION: DBSI offers granular data on white matter tract integrity in CSM that provide novel insights into disease pathology, supporting its potential utility as a biomarker of CSM disease progression. Abstract :