Prognostic Value of DTI and fMRI of Cervical Myelopathy
Prognostic Value of DTI and fMRI of Cervical Myelopathy
Cervical myelopathy (CM) is one of the most common degenerative spinal cord disorders
 affecting older people. The progression of CM is insidious and the neurological decline can
 vary between patients. Surgical decompression is considered the most effective way to treat
 CM, however, it is not free from risk and the surgical outcome is not always satisfactory.
 The expected outcome of surgical intervention for CM remains a difficulty. There is a
 pressing need for a reliable and quantitative approach to predict surgical outcomes of CM and
 the precise prognosis. Previous studies have suggested a number of prognostic factors, such
 as age, duration of symptoms, pre-operative neurological status and abnormal MRI, but their
 prognostic value remains controversial. Recently, diffusion tensor imaging (DTI) and fMRI
 have been proposed as a promising tool for predicting the surgical prognosis of CM. In
 previous study, the protocol was successfully established for DTI microstructural
 characterization and resting state fMRI of the cervical spinal cord. This study is to
 evaluate the value of DTI and fMRI in predicting the outcome of surgical treatment. The
 ultimate goal is to establish a clinical protocol for quantitative DTI and fMRI analysis that
 could give accurate prognosis for surgical intervention to CM.
Cervical myelopathy (CM) is the most common cause of spinal cord dysfunction in the elderly.
 Symptoms often develop insidiously and are characterized by neck stiffness, arm pain,
 numbness in the hands, and weakness of the hands and legs. The causes of this myelopathy are
 many, such as spinal canal narrowing, osteophytes, herniated discs and hypertrophy of the
 ligamentum flavum. Although the clinical signs and symptoms of CM are well documented in the
 literature, a precise localization of the maximum level of compression is sometimes difficult
 in the elderly patients where multiple levels of the cervical spine are degenerated. Also the
 lack of understanding of the pathophysiology and pathomechanism of CM has significantly
 hampered the development of a rational approach to the surgical treatment of such condition.

 The diagnosis is made based on clinical signs and symptoms with the help of conventional MRI
 imaging which demonstrates the levels of anatomical stenosis. Surgical decompression of the
 cervical spine is the most common form of treatment. Magnetic resonance imaging (MRI) has
 been used widely in the evaluation of patients with CM. The commonly applied MR techniques
 include spin echo sequence, both conventional spin echo and fast/turbo spin echo for T1 and
 T2 information; gradient echo sequences, which generate T2 images; STIR (short tau inversion
 recovery) images; fat suppressed T1 images; gadolinium enhanced images applied to either
 routine T1WIs or fat suppressed T1WIs; MR spinal angiography; and cerebrospinal fluid flow
 (CSF) studies (either magnitude or phase contrast). However, conventional MRI mainly concerns
 anatomical information about CM, with less pathophysiological information. BOLD-fMRI is able
 to present the activated neuronal volume decreased in CM patients along with an increase in
 neuronal activities. diffusion tensor imaging (DTI) permits the detection of tissue-water
 molecular diffusion at microscopic dimensions. Previous studies have demonstrated the
 feasibility of DTI in evaluating microstructural changes in the myelopathic cervical cord.
 The prognostic values of spinal cord DTI in CM have been addressed in several previous
 studies. In recent years, combination of DTI and fMRI has been proposed to be an accurate
 prognostic tool for surgical management of CM.

 Cervical myelopathy (CM) is caused by degenerative stenosis of the cervical spine with
 progressive compression on the spinal cord resulting in loss of sensory and motor functions
 in the upper and lower limbs. Surgical decompression of the cervical spine is the most common
 form of treatment.

 The objective of this project is to evaluate the value of DTI and fMRI in predicting the
 outcome of surgical treatment.
Inclusion Criteria:

 -  The inclusion criteria are a clinical diagnosis of CM including the signs of
 corticospinal lesions together with the appropriate radiographic findings.

 Exclusion Criteria:

 -  Patients with acute spinal cord injuries, prior spinal intervention, with shrapnel or
 other metal or electronic implants in their bodies (such as pacemakers, aneurysm
 clips, surgical devices, metallic tattoos on the head, etc.), with claustrophobia and
 pregnant women will be excluded.