Diagnostic efficacy of tract-specific diffusion tensor imaging in cervical spondylotic myelopathy with electrophysiological examination validation

Purpose: This study aimed to investigate the effectiveness of tract-specific diffusion tensor imaging (DTI) metrics in identifying the responsible segments for neurological dysfunction in cervical spondylotic myelopathy (CSM). Methods: The study encompassed nineteen patients in CSM group and ten healthy caregivers in control group. All participants underwent a comprehensive physical examination, MRI assessment, and DTI examination conducted by a senior chief physician. Intraoperative spinal cord electrophysiological examination was performed as the objective measure of spinal cord function during surgery for patients. MRI parameters including the aspect ratio, transverse ratio, T2 hyperintensities of the spinal cord and DTI metrics parameters such as axial diffusivity (AD), mean diffusivity (MD), radial diffusivity (RD), fractional anisotropy (FA) for both whole spinal cord column and dorsal column were collected. Receiver operating characteristic curves were constructed to evaluate the diagnostic efficacy of the parameters. The area under the curve (AUC), sensitivity, and specificity were calculated. Results: The AUC of DTI (Dorsal column) parameters was larger than the corresponding parameters of the DTI (Whole spinal cord). AD of DTI-Dorsal Column possessed the greatest efficacy (AUC=0.823, sensitivity=84.21%, specificity=77.32%) to determine the responsible segment, larger than AD of DTI-Whole spinal cord, aspect ratio and transverse ratio. Diagnostic efficacy of DTI and MRI parameters was influenced by cervical spine segment. Conclusions: AD from the DTI-Dorsal Column exhibited the most significant potential in identifying responsible segments. The diagnostic effectiveness of both DTI and MRI parameters was notably influenced by the specific cervical spine segment.