Diffusion Tensor Imaging in Diagnosing and Evaluating Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis

Global Spine Journal, 2025 · DOI: 10.1177/21925682241263792 · Published: June 27, 2024

Neuroimaging Spinal Disorders Research Methodology & Design

Simple Explanation

Degenerative cervical myelopathy (DCM) is a common spinal cord disorder. This study explores how well diffusion tensor imaging (DTI) distinguishes DCM patients from healthy individuals and relates DTI measurements to symptom severity. The study included 57 studies in its meta-analysis. DTI parameter fractional anisotropy (FA) was lower in DCM patients, while apparent diffusion coefficient (ADC), mean diffusivity (MD), and radial diffusivity (RD) were higher. DTI's diagnostic potential lies in distinguishing healthy individuals from those with DCM. While ADC may not correlate with symptom severity, it might predict surgical outcomes, making it a valuable imaging biomarker for clearer management decisions in mild DCM.

Study Duration

Not specified

Participants

1503 DCM patients and 1141 healthy subjects

Evidence Level

Level 1: Systematic Review and Meta-Analysis

Key Findings

1
Fractional anisotropy (FA) values are significantly lower in DCM patients compared to healthy subjects at the maximal compression level.
2
Apparent diffusion coefficient (ADC) values are significantly higher in DCM patients compared to healthy controls.
3
Significant correlation of FA (r = .53, 95% CI: 0.40-0.65) at the maximal compression level with JOA/mJOA scores, indicating a relationship between FA and myelopathy severity.

Research Summary

This systematic review and meta-analysis evaluated the utility of diffusion tensor imaging (DTI) in diagnosing and assessing degenerative cervical myelopathy (DCM). It analyzed 57 studies involving over 1000 DCM patients. The study found that DTI parameters, particularly FA and ADC, showed promise in distinguishing DCM patients from healthy individuals. Lower FA and higher ADC values were consistently observed in DCM patients. A significant correlation was found between FA and myelopathy severity, as measured by JOA/mJOA scores. This suggests DTI can be used for assessing disease progression and treatment efficacy.

Practical Implications

Diagnostic Reliability

DTI parameters, particularly FA and ADC, can be used as reliable diagnostic tools for DCM.

Assessment of Disease Progression

DTI can be used to assess disease progression and treatment efficacy in DCM patients, especially through FA correlation with JOA/mJOA scores.

Surgical Decision-Making

ADC might predict surgical outcomes in mild DCM, aiding in deciding between conservative treatment and immediate surgery.

Study Limitations

1
The prevalent risk of bias, especially in patient selection and the absence of uniform diagnostic thresholds, is a critical concern.
2
The small sample sizes and the geographical concentration of studies, primarily in Asia, potentially limit the broader applicability and generalizability of our findings.
3
The variability in measuring DTI parameters across different cervical spine levels poses a significant challenge and complicates the interpretation of results across studies.

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