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Diffusion spinal imaging a feasible MRI alternative for cervical spondylotic myelopathy

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SAN DIEGO — In results of a pilot study of high-resolution diffusion tensor imaging, investigators from Salt Lake City reported that it provided more thorough information about the status of the spinal cord in patients with cervical spondylotic myelopathy than controls.

Alpesh Ashwin Patel

Diffusion tensor imaging (DTI), which is MR-based, essentially measures the magnitude of water diffusion in tissue.

The technique may help clinicians identify and treat these patients earlier in the disease process, which is critical, according to Alpesh Ashwin Patel, MD.

“Diffusion tensor imaging … has the potential to improve diagnostic information, as well as prognostic information,” Patel said, here, at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

Patel and colleagues compared 17 patients imaged with DTI who had what he described as moderate cervical spondylotic myelopathy, based on their Nurick scores and modified Japanese Orthopedic Association Scores, to 14 control patients who only underwent conventional T2 weighted MR imaging. The investigators found the high-resolution DTI was much more specific, among other advantages of the new modality.

In particular, DTI helped them identify axonal disruptions and demyelination, sometimes in patients with or without related signal changes in the spinal cord on MRI, according to the results.

“We do see a loss of normal axonal diffusion in the patients with myelopathy. This is consistent with demyelination or some degree of axonal dysfunction,” Patel said.

While a small sample size and other factors greatly limited the study and the high-resolution DTI results are not yet as readily interpretable as conventional MRI, “this is a work in progress,” he noted.

Reference:

• Patel AA, Daubs MD, Brodke DS, et al. High-resolution diffusion tensor imaging in cervical spondylotic myelopathy. Paper #21. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.

Disclosure: Alpesh receives royalties, is paid for speaking by and is a consultant to Amedica. He is on the speaker’s bureau for Biomet, Medtronic and Stryker.

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