Diffusion tensor imaging in cervical spondylotic myelopathy: a review

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Degenerative spondylotic myelopathy is the most common cause of spinal dysfunction, as well as nontraumatic spastic paraparesis and quadriparesis. Although conventional MRI is the gold standard for radiographic evaluation of the spinal cord, it has limited application for determining prognosis and recovery. In the last decade, diffusion tensor imaging (DTI), which is based on the property of preferential diffusion of water molecules, has gained popularity in evaluating patients with cervical spondylotic myelopathy (CSM). The use of DTI allows for evaluation of microstructural changes in the spinal cord not otherwise detected on routine conventional MRI. In this review, the authors describe the application of DTI in CSM evaluation and its role as an imaging biomarker to predict disease severity and prognosis.

ABBREVIATIONS AD = axial diffusivity; ADC = apparent diffusion coefficient; CSM = cervical spondylotic myelopathy; DTI = diffusion tensor imaging; DWI = diffusion-weighted imaging; FA = fractional anisotropy; JOA = Japanese Orthopaedic Association; LMC = level of maximum cord compression; MD = mean diffusivity; mJOA = modified JOA; RD = radial diffusivity; ROI = region of interest; SNR = signal-to-noise ratio.
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Contributor Notes

Correspondence Shekar N. Kurpad: Medical College of Wisconsin, Milwaukee, WI. skurpad@mcw.edu.INCLUDE WHEN CITING Published online February 28, 2020; DOI: 10.3171/2019.12.SPINE191158.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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