1.Using T2 weighted magnetic resonance imaging and diffusion tensor imaging to predict functional outcomes for patients with cervical spondyiotic myelopathy
Canghai SHEN ; Baoshan XU ; Qiang YANG ; Xiaoguang ZHANG ; Xiaofeng LI ; Qi LI ; Xinlong MA
Chinese Journal of Physical Medicine and Rehabilitation 2017;39(7):492-497
Objective To explore the value of quantitative T2 weighted magnetic resonance imaging (T2WI) and diffusion tensor imaging (DTI) parameters for predicting functional outcomes after surgery for cervical spondylotic myelopathy (CSM).Methods One hundred and forty CSM patients received T2WI and DTI before surgery at Tianjin Hospital between April 2014 and April 2016.They were then given systematic rehabilitation treatment after the surgery.The Japanese Orthopaedics Association (JOA) scoring system was applied to evaluate their neurological function before and after the surgery.According to the JOA recovery rate at 1-year follow-up,the patients were divided into a good recovery group (recovery rate≥ 50%) and a poor recovery group (recovery rate <50%).Maximum spinal cord compression (MSCC),signal change ratio (SCR),transverse area (TA),apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were compared between the two groups.Receiver operating characteristics (ROC) curves were used to measure the prognostic ability and determine the best cut-off value for each variable.The independent predictors of a poor recovery were estimated using univariate and multivariate analysis.Results ROC analysis showed that the area under the ROC curve (AUC) of MSCC was 0.593.For SCR it was 0.682.For the TA it was 0.706.For the ADC it was 0.719 and for FA it was 0.749.The respective cut-off values were 44% compression,1.561,0.46 cm2,1.339×10-3 mm2/s and 0.386.FA had the largest AUC,followed by ADC,TA,SCR and MSCC.MSCC and SCR had low discrimination power (AUC<0.7) in predicting a poor recovery,whereas TA,ADC and FA had moderate discrimination power (AUC 0.7-0.9).Logistic multivariate regression showed that a low JOA score,TA≤0.46 cm2 or FA≤0.386 were independent risk factors for a poor recovery.A predicting model built according to the results of the logistic regression analysis gave an AUC of 0.87,significantly better than that of the JOA score.With a cut-off value of 0.36,the sensitivity and specificity were 80% and 77% respectively.Conclusions Combining T2WI and DTI parameters with the JOA score may better predict the recovery of patients with CSM.The values can also provide references for making up rehabilitation plans.
2. The effect of peri-operative hyperbaric oxygen therapy on the recovery of neurologic function of patients with cervical spondylotic myelopathy: A diffusion tensor imaging study
Canghai SHEN ; Yongjian FENG ; Yancheng SONG ; Gang LIU ; Zhiwei LIU ; Haiyang DAI
Chinese Journal of Physical Medicine and Rehabilitation 2019;41(11):833-837
Objective:
To observe the clinical effect of hyperbaric oxygen therapy on cervical spondylotic myelopathy (CSM) in the peri-operative period, and to explore its neural mechanism.
Methods:
Eighty patients who underwent surgical decompression for CSM were randomly divided into a hyperbaric oxygen group (
3. Value of brain fMRI and spine DTI in predicting functional outcomes for patients with cervical spondylotic myelopathy
Yancheng SONG ; Liqing KANG ; Canghai SHEN ; Lan FU ; Fenghai LIU ; Yongjian FENG
Chinese Journal of Physical Medicine and Rehabilitation 2019;41(9):651-656
Objective:
To explore the correlations relating functional MRI (fMRI) and diffusion tensor imaging (DTI) parameters with pre-operative neurological status and post-operative outcomes for patients with cervical spondylotic myelopathy (CSM).
Methods:
Eighty-seven CSM patients treated with surgical decompression and 38 healthy counterparts were enrolled as the CSM and control groups respectively. DTI and fMRI of the cervical spine were performed while the subjects performed a finger-tapping task with their right hands before the operation and 6 months later. The control group was evaluated only when they were enrolled. All of the patients were given systematic rehabilitation treatment after the surgery. The Japanese Orthopaedic Association (JOA) scoring system for CSM was used to evaluate neurological status, and a JOA recovery rate <50% was defined as a poor recovery.
Results:
Compared with the healthy controls, the pre-operative patients showed significantly higher volume of activation (VOA) in the left precentral gyrus (PrCG), but that had decreased significantly 6 months after the surgery. Before the surgery, the patients′ fractional isotropy (FA) was significantly less than that of the controls, but it had increased significantly 6 months after the operation. There was no difference in VOA in the left postcentral gyrus (PoCG) between the CSM patients and the controls before the surgery. The VOA ratio (PrCG/PoCG), VOA-PrCG, VOA-PoCG and FA were significantly correlated with both the JOA scores and recovery rates. Receiver operating characteristic (ROC) curve analyses were performed for the predictive ability with respect to surgical outcomes. The largest area under the ROC curve was observed for the VOA ratio (0.805), followed by FA (0.740), and the VOA-PrCG (0.715). The fMRI and DTI showed better potential for predicting functional outcomes than with standard MRI parameters. Multivariate logistic regression revealed that the VOA ratio and FA were independently associated with poor outcomes.
Conclusions
fMRI and DTI parameters may be more valuable than conventional MRI results for neurological assessment and prognosis with CSM patients. They can also provide references for making up rehabilitation plans.