Diffusion Tensor Imaging in Diagnosing and Evaluating Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis.

STUDY DESIGN: Systematic review. OBJECTIVE: Degenerative cervical myelopathy (DCM) is a common spinal cord disorder necessitating surgery. We aim to explore how effectively diffusion tensor imaging (DTI) can distinguish DCM from healthy individuals and assess the relationship between DTI metrics and symptom severity. METHODS: We included studies with adult DCM patients who had not undergone decompressive surgery and implemented correlation analyses between DTI parameters and severity, or compared healthy controls and DCM patients. RESULTS: 57 studies were included in our meta-analysis. At the maximal compression (MC) level, fractional anisotropy (FA) exhibited lower values in DCM patients, while apparent diffusion coefficient (ADC), mean diffusivity (MD), and radial diffusivity (RD) were notably higher in the DCM group. Moreover, our investigation into the diagnostic utility of DTI parameters disclosed high sensitivity, specificity, and area under the curve values for FA (.84, .80, .83 respectively) and ADC (.74, .84, .88 respectively). Additionally, we explored the correlation between DTI parameters and myelopathy severity, revealing a significant correlation of FA (.53, 95% CI:0.40 to .65) at MC level with JOA/mJOA scores. CONCLUSION: Current guidelines for DCM suggest decompressive surgery for both mild and severe cases. However, they lack clear recommendations on which mild DCM patients might benefit from conservative treatment vs immediate surgery. ADC's role here could be pivotal, potentially differentiating between healthy individuals and DCM. While it may not correlate with symptom severity, it might predict surgical outcomes, making it a valuable imaging biomarker for clearer management decisions in mild DCM.

Correlation Between Pre-Operative Diffusion Tensor Imaging Indices and Post-Operative Outcome in Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis.

STUDY DESIGN: Systematic review. OBJECTIVES: The correlation between pre-operative diffusion tensor imaging (DTI) metrics and post-operative clinical outcomes in patients with degenerative cervical myelopathy (DCM) has been widely investigated with different studies reporting varied findings. We conducted a systematic review to determine the association between DTI metric and clinical outcomes after surgery. METHODS: We identified relevant articles that investigated the relationship between pre-operative DTI indices and post-operative outcome in DCM patients by searching PubMed/MEDLINE, Web of Science, Scopus, and EMBASE from inception until October 2023. In addition, quantitative synthesis and meta-analyses were performed. RESULTS: FA was significantly correlated with postoperative JOA or mJOA across all age and follow up subgroups, changes observed in JOA or mJOA from preoperative to postoperative stages (Δ JOA or Δ mJOA) in subgroups aged 65 and above and in those with a follow-up period of 6 months or more, as well as recovery rate in all studies pooled together and also in the under-65 age bracket. Additionally, a significant correlation was demonstrated between recovery rate and ADC across all age groups. No other significant correlations were discovered between DTI parameters (MD, AD, and ADC) and post-operative outcomes. CONCLUSION: DTI is a quantitative noninvasive evaluation tool that correlates with severity of DCM. However, the current evidence is still elusive regarding whether DTI metric is a validated tool for predicting the degree of post-operative recovery, which could potentially be useful in patient selection for surgery.

Possibility of Exciton Bose-Einstein Condensation in CdSe Nanoplatelets.

The quasi-two-dimensional exciton subsystem in CdSe nanoplatelets is considered. It is theoretically shown that Bose-Einstein condensation (BEC) of excitons is possible at a nonzero temperature in the approximation of an ideal Bose gas and in the presence of an "energy gap" between the ground and the first excited states of the two-dimensional exciton center of inertia of the translational motion. The condensation temperature (Tc) increases with the width of the "gap" between the ground and the first excited levels of size quantization. It is shown that when the screening effect of free electrons and holes on bound excitons is considered, the BEC temperature of the exciton subsystem increases as compared to the case where this effect is absent. The energy spectrum of the exciton condensate in a CdSe nanoplate is calculated within the framework of the weakly nonideal Bose gas approximation, considering the specifics of two-dimensional Born scattering.

Exciton States and Optical Absorption in CdSe and PbS Nanoplatelets.

The exciton states and their influence on the optical absorption spectrum of CdSe and PbS nanoplatelets (NPLs) are considered theoretically in this paper. The problem is discussed in cases of strong, intermediate, and weak size quantization regimes of charge carrier motion in NPLs. For each size quantization regime, the corresponding potential that adequately describes the electron-hole interaction in this mode of space quantization of charge carriers is chosen. The single-particle energy spectra and corresponding wave functions for strong intermediate and weak size quantization regimes have been revealed. The dependence of material parameters on the number of monolayers in the sample has been considered. The related selection rules and the dependence of the absorption coefficient on the frequency and polarization direction of the incident light wave were obtained. The interband transition threshold energy dependencies were obtained for each size quantization regime. The effect of dielectric coefficient mismatch and different models of electron-hole interaction potentials have been studied in CdSe and PbS NPLs. It is also shown that with an increase in the linear dimensions of the structure, the threshold frequency of absorption decreases. The binding energies and absorption coefficient results for NPL with different thicknesses agree with the experimental data. The values of the absorption exciton peaks measured experimentally are close to our calculated values for CdSe and PbS samples.

Real-Time Ultrasound Doppler Enhances Precision in Image-Guided Approaches to the Cerebellopontine Angle.

OBJECTIVE: To evaluate efficacy and reliability of intraoperative Doppler sonography in localizing the transverse and sigmoid sinuses during lateral suboccipital craniotomy. METHODS: A 16-Mhz intraoperative micro-Doppler ultrasound (16Mhz, Multi-Dop pro, Compumedics, Singen, Germany) was applied to detect the medial border of the sigmoid sinus and the inferior border of the transverse sinus in 25 patients. Micro-Doppler measurements were compared with magnetic resonance- and computed tomography-based image guidance (Kolibri, Brainlab, Munich, Germany). Visual detectability of the sinuses with the operating microscope was also documented. RESULTS: Inadvertent incision of the transverse or sigmoid sinuses did not occur in any patient when the 2 localizing methods have been used in combination. The mean mismatch of image-guided system and micro-Doppler was 2.64 mm (range, 0-6 mm; standard deviation, 1.55 mm). With the microscope the transverse sinus was invisible in 7 patients, the sigmoid sinus was visually undetectable in 1 case. The micro-Doppler indicated blood flow outside the visible borders of the sinuses in 5 patients. CONCLUSIONS: A combination of image-guidance and micro-Doppler enhances the accuracy in localizing the margins of the transverse and sigmoid sinuses using the retrosigmoid approach, thus preventing inadvertent injury. The method could potentially be applied during other craniotomies involving the exposure of a venous sinus.