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Spinal cord perfusion is associated with microstructural damage in cervical spondylotic myelopathy patients who underwent cervical laminoplasty

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A Commentary to this article was published on 16 November 2023

Abstract

Objectives

To investigate the association between spinal cord perfusion and microstructural damage in CSM patients who underwent cervical laminoplasty using MR dynamic susceptibility contrast (DSC), diffusion tensor imaging (DTI), and neurite orientation dispersion and density imaging (NODDI) techniques.

Methods

A follow-up cohort study was conducted with 53 consecutively recruited CSM patients who had undergone cervical laminoplasty 12–14 months after the surgery from April 2016 to December 2016. Twenty-one aged-matched healthy volunteers were recruited as controls. For each patient, decompressed spinal cord levels were imaged on a 3.0-T MRI scanner by diffusion and DSC sequences to quantify the degrees of microstructural damage and perfusion conditions, respectively. The diffusion data were analyzed by DTI and NODDI models to produce diffusion metrics. Classic indicator dilution model was used to quantify the DSC metrics. Mann–Whitney U test was performed for comparison of diffusion metrics between patients and healthy controls. Pearson correlation was used to explore the associations between the metrics of spinal cord perfusion and microstructural damage.

Results

DTI metrics, neurite density, and isotropic volume fraction had significant differences between postoperative patients and healthy controls. Pearson correlation test showed that SCBV was significantly positively correlated with RD, MD, and ODI, and negatively correlated with FA and NDI. SCBF was found to be significantly positively correlated with RD and MD, and negatively correlated with FA.

Conclusions

Increased spinal cord perfusion quantified by DSC is associated with microstructural damage assessed by diffusion MRI in CSM patients who underwent cervical laminoplasty.

Clinical relevance statement

This study found that the spinal cord perfusion is associated with microstructural damage in postoperative cervical spondylotic myelopathy patients, indicating that high perfusion may play a role in the pathophysiological process of cervical spondylotic myelopathy and deserves more attention.

Key Points

• Spinal cord microstructural damage can be persistent despite the compression had been relieved 12–14 months after the cervical laminoplasty in cervical spondylotic myelopathy (CSM) patients.

• Spinal cord perfusion is associated with microstructural damage in CSM patients after the cervical laminoplasty.

• Inflammation in the decompressed spinal cord may be a cause of increased perfusion and is associated with microstructural damage during the recovery period of CSM.

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Abbreviations

AD:

Axial diffusivity

CSM:

Cervical spondylotic myelopathy

DSC:

Dynamic susceptibility contrast

DTI:

Diffusion tensor imaging

FA:

Fractional anisotropy

MD:

Mean diffusivity

MTT:

Mean transit time

NDI:

Neurite density index

NODDI:

Neurite orientation dispersion and density imaging

ODI:

Orientation dispersion index

RD:

Radial diffusivity

SCBF:

Spinal cord blood flow

SCBV:

Spinal cord blood volume

Viso:

Isotropic volume fraction

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Acknowledgements

We thank Guangqi Li from the Center for Biomedical Imaging Research in Tsinghua University (Beijing, China) for his contribution to the figures and response for revision.

Funding

This study has received funding by the National Key Research and Development Program of China (2017YFC0108700), the National Natural Science Foundation of China (61571258), the National Natural Science Foundation of China (11871459), Tsinghua University Initiative Scientific Research Program (20161080166), Capital’s Funds for Health Improvement and Research (CFH2020-2–1121), Beijing JST Research Funding (ZR-201912), and Beijing Jishuitan Hospital Elite Young Scholar Programme (XKGG202103).

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Author notes

  1. Co-first authors Chunyao Wang and Xiao Han contributed equally to this manuscript.

  2. Co-corresponding authors Huijun Chen and Wei Tian contributed equally to this manuscript.

Authors and Affiliations

  1. Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China

    Chunyao Wang, Sisi Li, Hua Guo & Huijun Chen

  2. Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China

    Xiao Han, Jinchao Wang & Wei Tian

  3. Beijing Research Institute of Traumatology and Orthopaedics, Beijing, China

    Xiao Han

  4. Center for Magnetic Resonance Research, Radiology, Medical School of the University of Minnesota, Minnesota, USA

    Xiaodong Ma

  5. Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China

    Wen Jiang

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Correspondence to Wei Tian or Huijun Chen.

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The scientific guarantor of this publication is Huijun Chen (corresponding author).

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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Some study subjects or cohorts have been previously reported in

[10] Ma X, Han X, Jiang W, et al A Follow-up Study of Postoperative DCM Patients Using Diffusion MRI with DTI and NODDI[J]. Spine, 2018:1.

[11] Jiang W, Han X, Guo H, et al Usefulness of conventional magnetic resonance imaging, diffusion tensor imaging and neurite orientation dispersion and density imaging in evaluating postoperative function in patients with cervical spondylotic myelopathy[J]. Journal of Orthopaedic Translation, 2018, 15:59–69.

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Wang, C., Han, X., Ma, X. et al. Spinal cord perfusion is associated with microstructural damage in cervical spondylotic myelopathy patients who underwent cervical laminoplasty. Eur Radiol 34, 1349–1357 (2024). https://doi.org/10.1007/s00330-023-10011-9

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