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Cervical compressive myelopathy: flow analysis of cerebrospinal fluid using phase-contrast magnetic resonance imaging

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Abstract

Purpose

To evaluate cerebrospinal fluid (CSF) flow in cervical compressive myelopathy (CCM), by both quantitative and qualitative analyses, using 3T cine phase-contrast magnetic resonance imaging (cine MRI).

Methods

From September, 2014 to June, 2015, we enrolled 45 subjects (18 women and 27 men, mean age, 61.7 ± 13.4 years) to undergo cervical cine MRI. The subjects were divided into three groups: no stenosis and cervical stenosis with and without intramedullary T2 hyperintensity. We measured maximal CSF velocity, and 12 CSF velocity waveforms were plotted per subject. Two readers independently assessed the CSF waveform shape (0 absent; 1 serrated; 2 bi-directional with small amplitude; and 3 normal bi-directional waveform) and the CSF motion pattern (0 absent; 1 interrupted; and 2 intact). The numbers of 12 waveform shapes were summed to yield a CSF waveform score. Linear mixed model and ROC curve analyses were used for statistical analyses.

Results

Maximal CSF velocity was significantly lower in CCM (marginal mean, 2.72 cm/s) than in stenosis without intramedullary T2 hyperintensity (3.27 cm/s, p = 0.027) and no stenosis (3.80 cm/s, p < 0.001). Bi-phasic CSF motion was lost in cervical stenosis. CSF waveform scores of 17 (area under curve (AUC), 0.797; p = 0.003) and 16.5 (AUC, 0.790; p = 0.004) could predict Japanese Orthopedic Association (JOA) score corresponding to CCM.

Conclusions

Maximal CSF velocity and CSF waveform score on cine MRI decreased in CCM and was correlated with the JOA score. Thus, both quantitative and qualitative analyses using cine MRI could effectively demonstrate CSF flow alterations in CCM.

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Acknowledgements

The authors thank the Medical Research Collaborating Center at Seoul National University Bundang Hospital for performing the statistical analyses. Funding was provided by National Research Foundation of Korea (Grant No. NRF-2013R1A1A2006851).

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Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 463-707, Republic of Korea

    Yun Jung Bae, Joon Woo Lee, Eugene Lee & Heung Sik Kang

  2. Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 463-707, Republic of Korea

    Jin S. Yeom

  3. Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 463-707, Republic of Korea

    Ki-Jeong Kim

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  1. Yun Jung Bae
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  2. Joon Woo Lee
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Correspondence to Joon Woo Lee.

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Bae, Y.J., Lee, J.W., Lee, E. et al. Cervical compressive myelopathy: flow analysis of cerebrospinal fluid using phase-contrast magnetic resonance imaging. Eur Spine J 26, 40–48 (2017). https://doi.org/10.1007/s00586-016-4874-9

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  • DOI: https://doi.org/10.1007/s00586-016-4874-9

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