背景:退行性颈椎病(DCM)表现为脊髓功能障碍的主要原因,并且是非创伤性的,本质上是慢性和进行性的。减压手术通常用于停止进一步的残疾和神经功能障碍。当前围绕评估和预后潜力的诊断选择的局限性使得DCM在很大程度上仍然是临床诊断。
目的:概述当前诊断技术的局限性,提出了用于评估DCM脊髓完整性的新型定量MRI(qMRI)技术背后的证据,并提出了未来的方向。
方法:截至2021年11月发表的文章来自Medline,EMBASE和EBM使用关键搜索词:脊髓,脊柱,脖子,MRI,磁共振成像,qMRI,T1,T2,T2*,R2*,DTI,弥散张量成像,MT,磁化转移,SWI,磁敏感加权成像,大胆,血氧水平依赖性,功能磁共振成像,功能磁共振成像,功能性MRI,MRS,磁共振波谱学。
结果:共检索到2057篇文章,其中68篇文章用于分析。该搜索产生了2篇关于定量T1作图的文章,这些文章表明中重度DCM的脊髓T1值较高;43篇关于DTI的文章,表明分数各向异性和改良的日本骨科协会评分之间存在很强的相关性;15篇关于fMRI(BOLD)的文章,表明大脑中各种连接的功能连通性和激活量与手术后恢复的严重程度呈正相关;6篇关于MRS的文章,表明胆碱/N-乙酰天冬氨酸值得注意的是,大多数研究样本量较低,6个月内时间较短.
结论:需要更多的样本量和更长的时间范围的纵向研究来确定qMRI在DCM中的全部预后能力。
BACKGROUND: Degenerative cervical myelopathy (DCM) manifests as the primary cause of spinal cord dysfunction and is non-traumatic, chronic and progressive in nature. Decompressive surgery is typically utilised to halt further disability and neurological dysfunction. The limitations of current diagnostic options surrounding assessment and prognostic potential render DCM still largely a clinical diagnosis.
OBJECTIVE: To outline the limitations of current diagnostic techniques, present evidence behind novel quantitative MRI (qMRI) techniques for assessing spinal cord integrity in DCM and suggest future directions.
METHODS: Articles published up to November 2021 were retrieved from Medline, EMBASE and EBM using key search terms: spinal cord, spine, neck, MRI, magnetic resonance imaging, qMRI, T1, T2, T2*, R2*, DTI, diffusion tensor imaging, MT, magnetisation transfer, SWI, susceptibility weighted imaging, BOLD, blood oxygen level dependent, fMRI, functional magnetic resonance imaging, functional MRI, MRS, magnetic resonance spectroscopy.
RESULTS: A total of 2057 articles were retrieved with 68 articles included for analysis. The search yielded 2 articles on Quantitative T1 mapping which suggested higher T1 values in spinal cord of moderate-severe DCM; 43 articles on DTI which indicated a strong correlation of fractional anisotropy and modified Japanese Orthopaedic Association scores; 15 articles on fMRI (BOLD) which demonstrated positive correlation of functional connectivity and volume of activation of various connections in the brain with post-surgical recovery; 6 articles on MRS which suggested that Choline/N-acetylaspartate (Cho/NAA) ratio presents the best correlation with DCM severity; and 4 articles on MT which revealed a preliminary negative correlation of magnetisation transfer ratio with DCM severity. Notably, most studies were of low sample size with short timeframes within 6 months.
CONCLUSIONS: Further longitudinal studies with higher sample sizes and longer time horizons are necessary to determine the full prognostic capacity of qMRI in DCM.