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Abstract：
OBJECTIVE: To investigate the brain mechanism of non-correspondence between imaging presentations and clinical symptoms in cervical spondylotic myelopathy (CSM) patients and to test the utility of brain imaging biomarkers for predicting prognosis of CSM.
METHODS: Forty patients with CSM (22 mild-moderate CSM, 18 severe CSM) and 25 healthy controls (HCs) were recruited for rs-fMRI and cervical spinal cord diffusion tensor imaging (DTI) scans. DTI at the spinal cord (level C2/3) with fractional anisotropy (FA) and degree centrality (DC) were recorded. Then one-way analysis of covariance (ANCOVA) was conducted to detect the group differences in the DC and FA values across the three groups. Pearson correlation analysis was then separately performed between JOA with FA and DC.
RESULTS: Among them, degree centrality value of left middle temporal gyrus exhibited a progressive increase in CSM groups compared with HCs, the DC value in severe CSM group was higher compared with mild-moderate CSM group. (P < 0.05), and the DC values of the right superior temporal gyrus and precuneus showed a decrease after increase. Among them, DC values in the area of precuneus in severe CSM group were significantly lower than those in mild-moderate CSM and HCs. (P < 0.05). The fractional anisotropy (FA) values of the level C2/3 showed a progressive decrease in different clinical stages, that severe CSM group was the lowest, significantly lower than those in mild-moderate CSM and HCs (P < 0.05). There was negative correlation between DC value of left middle temporal gyrus and JOA scores (P < 0.001), and the FA values of dorsal column in the level C2/3 positively correlated with the JOA scores (P < 0.001).
CONCLUSIONS: Structural and functional changes have taken place in the cervical spinal cord and brain of CSM patients. The Brain reorganization plays an important role in maintaining the symptoms and signs of CSM, aberrant DC values in the left middle temporal gyrus may be the possible mechanism of inconsistency between imaging findings and clinical symptoms. Degree centrality is a potentially useful prognostic functional biomarker in cervical spondylotic myelopathy.
METHODS: Forty patients with CSM (22 mild-moderate CSM, 18 severe CSM) and 25 healthy controls (HCs) were recruited for rs-fMRI and cervical spinal cord diffusion tensor imaging (DTI) scans. DTI at the spinal cord (level C2/3) with fractional anisotropy (FA) and degree centrality (DC) were recorded. Then one-way analysis of covariance (ANCOVA) was conducted to detect the group differences in the DC and FA values across the three groups. Pearson correlation analysis was then separately performed between JOA with FA and DC.
RESULTS: Among them, degree centrality value of left middle temporal gyrus exhibited a progressive increase in CSM groups compared with HCs, the DC value in severe CSM group was higher compared with mild-moderate CSM group. (P < 0.05), and the DC values of the right superior temporal gyrus and precuneus showed a decrease after increase. Among them, DC values in the area of precuneus in severe CSM group were significantly lower than those in mild-moderate CSM and HCs. (P < 0.05). The fractional anisotropy (FA) values of the level C2/3 showed a progressive decrease in different clinical stages, that severe CSM group was the lowest, significantly lower than those in mild-moderate CSM and HCs (P < 0.05). There was negative correlation between DC value of left middle temporal gyrus and JOA scores (P < 0.001), and the FA values of dorsal column in the level C2/3 positively correlated with the JOA scores (P < 0.001).
CONCLUSIONS: Structural and functional changes have taken place in the cervical spinal cord and brain of CSM patients. The Brain reorganization plays an important role in maintaining the symptoms and signs of CSM, aberrant DC values in the left middle temporal gyrus may be the possible mechanism of inconsistency between imaging findings and clinical symptoms. Degree centrality is a potentially useful prognostic functional biomarker in cervical spondylotic myelopathy.
摘要：
目的：探讨脊髓型颈椎病（CSM）患者影像学表现与临床症状不一致的脑机制，并检验脑影像学生物标志物在预测CSM预后中的作用。
方法：40例CSM患者（22例轻-中度CSM，招募18名严重CSM）和25名健康对照（HC）进行rs-fMRI和颈脊髓扩散张量成像（DTI）扫描。记录具有分数各向异性（FA）和度中心性（DC）的脊髓DTI（C2/3级）。然后进行单向协方差分析(ANCOVA)以检测三组间DC和FA值的组间差异。然后分别在JOA与FA和DC之间进行Pearson相关性分析。
结果：其中，与HCs相比，CSM组左颞中回的度中心性值呈进行性增加，重度CSM组的DC值高于轻-中度CSM组。(P<0.05),右侧颞上回和前回的DC值在增加后呈下降趋势。其中,重度CSM组前肌区域的DC值显着低于轻度-中度CSM和HC。(P<0.05)。水平C2/3的分数各向异性（FA）值在不同的临床分期显示出逐渐降低，严重的CSM组最低，显著低于轻-中度CSM和HCs(P<0.05)。左颞中回DC值与JOA评分呈负相关(P<0.001),C2/3水平的背柱FA值与JOA评分呈正相关(P<0.001)。
结论：CSM患者的颈脊髓和大脑发生了结构和功能变化。大脑重组在维持CSM的症状和体征中起着重要作用，左颞中回DC值的异常可能是影像学表现与临床症状不一致的可能机制。度中心性是脊髓型颈椎病潜在有用的预后功能生物标志物。
方法：40例CSM患者（22例轻-中度CSM，招募18名严重CSM）和25名健康对照（HC）进行rs-fMRI和颈脊髓扩散张量成像（DTI）扫描。记录具有分数各向异性（FA）和度中心性（DC）的脊髓DTI（C2/3级）。然后进行单向协方差分析(ANCOVA)以检测三组间DC和FA值的组间差异。然后分别在JOA与FA和DC之间进行Pearson相关性分析。
结果：其中，与HCs相比，CSM组左颞中回的度中心性值呈进行性增加，重度CSM组的DC值高于轻-中度CSM组。(P<0.05),右侧颞上回和前回的DC值在增加后呈下降趋势。其中,重度CSM组前肌区域的DC值显着低于轻度-中度CSM和HC。(P<0.05)。水平C2/3的分数各向异性（FA）值在不同的临床分期显示出逐渐降低，严重的CSM组最低，显著低于轻-中度CSM和HCs(P<0.05)。左颞中回DC值与JOA评分呈负相关(P<0.001),C2/3水平的背柱FA值与JOA评分呈正相关(P<0.001)。
结论：CSM患者的颈脊髓和大脑发生了结构和功能变化。大脑重组在维持CSM的症状和体征中起着重要作用，左颞中回DC值的异常可能是影像学表现与临床症状不一致的可能机制。度中心性是脊髓型颈椎病潜在有用的预后功能生物标志物。
