Clinical and Research MRI Techniques for Assessing Spinal Cord Integrity in Degenerative Cervical Myelopathy-A Scoping Review

Brandon He; Kyle Sheldrick; Abhirup Das; Ashish Diwan

doi:10.3390/biomedicines10102621

Clinical and Research MRI Techniques for Assessing Spinal Cord Integrity in Degenerative Cervical Myelopathy-A Scoping Review

Biomedicines. 2022 Oct 18;10(10):2621. doi: 10.3390/biomedicines10102621.

Authors

Brandon He^{1

2}, Kyle Sheldrick^{1

2}, Abhirup Das^{1

2}, Ashish Diwan^{1

3}

Affiliations

¹ Spine Labs, St. George & Sutherland Clinical School, UNSW Faculty of Medicine, Kogarah, NSW 2217, Australia.
² Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia.
³ Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Kogarah, NSW 2217, Australia.

Abstract

Background: Degenerative cervical myelopathy (DCM) manifests as the primary cause of spinal cord dysfunction and is non-traumatic, chronic and progressive in nature. Decompressive surgery is typically utilised to halt further disability and neurological dysfunction. The limitations of current diagnostic options surrounding assessment and prognostic potential render DCM still largely a clinical diagnosis.

Aims: To outline the limitations of current diagnostic techniques, present evidence behind novel quantitative MRI (qMRI) techniques for assessing spinal cord integrity in DCM and suggest future directions.

Method: Articles published up to November 2021 were retrieved from Medline, EMBASE and EBM using key search terms: spinal cord, spine, neck, MRI, magnetic resonance imaging, qMRI, T1, T2, T2*, R2*, DTI, diffusion tensor imaging, MT, magnetisation transfer, SWI, susceptibility weighted imaging, BOLD, blood oxygen level dependent, fMRI, functional magnetic resonance imaging, functional MRI, MRS, magnetic resonance spectroscopy.

Results: A total of 2057 articles were retrieved with 68 articles included for analysis. The search yielded 2 articles on Quantitative T1 mapping which suggested higher T1 values in spinal cord of moderate-severe DCM; 43 articles on DTI which indicated a strong correlation of fractional anisotropy and modified Japanese Orthopaedic Association scores; 15 articles on fMRI (BOLD) which demonstrated positive correlation of functional connectivity and volume of activation of various connections in the brain with post-surgical recovery; 6 articles on MRS which suggested that Choline/N-acetylaspartate (Cho/NAA) ratio presents the best correlation with DCM severity; and 4 articles on MT which revealed a preliminary negative correlation of magnetisation transfer ratio with DCM severity. Notably, most studies were of low sample size with short timeframes within 6 months.

Conclusions: Further longitudinal studies with higher sample sizes and longer time horizons are necessary to determine the full prognostic capacity of qMRI in DCM.

Keywords: cervical spine; cervical spondylotic myelopathy (CSM); degenerative cervical myelopathy (DCM); quantitative MRI; spinal cord compression.

Publication types

Review

Grants and funding

K.S. is supported by an Australian Government Research Training Program Scholarship, Spine Labs is supported by unrestricted research and education grants by Nuvasive Australia and Baxter Australia, A.Das is supported by internal funds from Spine Service.