Value of brain fMRI and spine DTI in predicting functional outcomes for patients with cervical spondylotic myelopathy / 中华物理医学与康复杂志

ABSTRACT

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 cervi-cal 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 acti-vation ( 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 oper-ating characteristic ( ROC) curve analyses were performed for the predictive ability with respect to surgical out-comes. 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 independ-ently associated with poor outcomes. Conclusions fMRI and DTI parameters may be more valuable than conven-tional MRI results for neurological assessment and prognosis with CSM patients. They can also provide references for making up rehabilitation plans.