Degenerativní cervikální myelopatie (DCM) je způsobena kompresí krční míchy stenózou krčního míšního kanálu. Relativní odolnost míšní tkáně k mechanické kompresi však může vést k nemyelopatické degenerativní kompresi krční míchy (NMDCCC). Rutinní MR techniky jsou schopny detekovat kompresi míchy, ale nejsou schopny spolehlivě odlišit nemyelopatickou kompresi a symptomatickou myelopatii. Pokročilé MR techniky, jako magneticko-rezonanční spektroskopie (MRS) a difúzí vážená MR (dMRI), představují nový nástroj pro zhodnocení subtilních změn mikrostruktury a biochemického složení míšní tkáně. Současně jsou však tyto techniky vzhledem k velikosti míchy a jejímu uložení v míšním kanálu technicky velmi náročné. Využití pokročilého 3T MR scanneru spolu s novými MR technikami u kohorty 50 zdravých dobrovolníků, 50 NMDCCC a 50 DCM pacientů zvýší citlivost MR v časné detekci kompresivních změn míšní tkáně a pomůže najít citlivé MR markery, které odliší DCM a NMDCCC. Korelace MR nálezů s tíží míšní komprese a klinické disability pomůže určit jejich relevanci při plánování chirurgické dekomprese.; Degenerative cervical myelopathy (DCM) is caused by compression due to cervical canal stenosis. The relative resilience of the spinal cord tissue to the mechanical compression leads to non-myelopathic degenerative cervical cord compression (NMDCCC). Routine MRI techniques could detect spinal cord compression, but not to distinguish DCM and NMDCCC. Advanced MR techniques, such as diffusion MRI and magnetic resonance spectroscopy, provide unique tools for assessing subtle changes in spinal cord microstructure and biochemical composition, respectively, but are prone to technical challenges due to small size and position of the spinal cord. The utilization of advanced 3T scanner along with novel MRI/MRS techniques in a cohort of 50 NMDCC, 50 DCM and 50 healthy individuals will increase the sensitivity for detection of spinal cord changes and will establish sensitive markers of spinal cord tissue alteration with potential to distinguish NMDCC and DCM subjects. MRI outcomes will be related to severity of compression and clinical measures to establish their relevance in surgical planning.

• MeSH
• biologické markery MeSH
• difuzní magnetická rezonance metody   MeSH
• komprese míchy diagnostické zobrazování   MeSH
• magnetická rezonanční spektroskopie metody   MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• neurologie
• radiologie, nukleární medicína a zobrazovací metody
• NLK Publikační typ
• závěrečné zprávy o řešení grantu AZV MZ ČR

BACKGROUND AND PURPOSE: Non-myelopathic degenerative cervical spinal cord compression (NMDC) frequently occurs throughout aging and may progress to potentially irreversible degenerative cervical myelopathy (DCM). Whereas standard clinical magnetic resonance imaging (MRI) and electrophysiological measures assess compression severity and neurological dysfunction, respectively, underlying microstructural deficits still have to be established in NMDC and DCM patients. The study aims to establish tract-specific diffusion MRI markers of electrophysiological deficits to predict the progression of asymptomatic NMDC to symptomatic DCM. METHODS: High-resolution 3 T diffusion MRI was acquired for 103 NMDC and 21 DCM patients compared to 60 healthy controls to reveal diffusion alterations and relationships between tract-specific diffusion metrics and corresponding electrophysiological measures and compression severity. Relationship between the degree of DCM disability, assessed by the modified Japanese Orthopaedic Association scale, and tract-specific microstructural changes in DCM patients was also explored. RESULTS: The study identified diffusion-derived abnormalities in the gray matter, dorsal and lateral tracts congruent with trans-synaptic degeneration and demyelination in chronic degenerative spinal cord compression with more profound alterations in DCM than NMDC. Diffusion metrics were affected in the C3-6 area as well as above the compression level at C3 with more profound rostral deficits in DCM than NMDC. Alterations in lateral motor and dorsal sensory tracts correlated with motor and sensory evoked potentials, respectively, whereas electromyography outcomes corresponded with gray matter microstructure. DCM disability corresponded with microstructure alteration in lateral columns. CONCLUSIONS: Outcomes imply the necessity of high-resolution tract-specific diffusion MRI for monitoring degenerative spinal pathology in longitudinal studies.

• MeSH
• difuzní magnetická rezonance MeSH
• komprese míchy * diagnostické zobrazování   MeSH
• krční obratle diagnostické zobrazování   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mícha diagnostické zobrazování   MeSH
• nemoci míchy * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

Diffusion magnetic resonance imaging (dMRI) proved promising in patients with non-myelopathic degenerative cervical cord compression (NMDCCC), i.e., without clinically manifested myelopathy. Aim of the study is to present a fast multi-shell HARDI-ZOOMit dMRI protocol and validate its usability to detect microstructural myelopathy in NMDCCC patients. In 7 young healthy volunteers, 13 age-comparable healthy controls, 18 patients with mild NMDCCC and 15 patients with severe NMDCCC, the protocol provided higher signal-to-noise ratio, enhanced visualization of white/gray matter structures in microstructural maps, improved dMRI metric reproducibility, preserved sensitivity (SE = 87.88%) and increased specificity (SP = 92.31%) of control-patient group differences when compared to DTI-RESOLVE protocol (SE = 87.88%, SP = 76.92%). Of the 56 tested microstructural parameters, HARDI-ZOOMit yielded significant patient-control differences in 19 parameters, whereas in DTI-RESOLVE data, differences were observed in 10 parameters, with mostly lower robustness. Novel marker the white-gray matter diffusivity gradient demonstrated the highest separation. HARDI-ZOOMit protocol detected larger number of crossing fibers (5-15% of voxels) with physiologically plausible orientations than DTI-RESOLVE protocol (0-8% of voxels). Crossings were detected in areas of dorsal horns and anterior white commissure. HARDI-ZOOMit protocol proved to be a sensitive and practical tool for clinical quantitative spinal cord imaging.

• MeSH
• biomedicínské inženýrství MeSH
• difuzní magnetická rezonance * MeSH
• dospělí MeSH
• komprese míchy diagnostické zobrazování   patologie   MeSH
• krční obratle patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci míchy diagnostické zobrazování   patologie   MeSH
• poměr signál - šum MeSH
• reprodukovatelnost výsledků MeSH
• senzitivita a specificita MeSH
• shluková analýza MeSH
• studie případů a kontrol MeSH
• zobrazování difuzních tenzorů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

• MeSH
• invazivní růst nádoru MeSH
• komprese míchy diagnostické zobrazování   etiologie   chirurgie   MeSH
• krční mícha patologie   MeSH
• lidé MeSH
• lokální recidiva nádoru * diagnóza   chirurgie   radioterapie   MeSH
• magnetická rezonanční tomografie MeSH
• melanom * diagnóza   chirurgie   patofyziologie   MeSH
• nádory míchy * diagnóza   chirurgie   patofyziologie   MeSH
• neurochirurgické výkony MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND AND PURPOSE: Diffusion tensor imaging (DTI) has previously been used as a biomarker of myelopathy in patients with degenerative cervical cord compression (DCCC). However, many factors may affect the diffusion properties of the spinal cord. This prospective study seeks to identify sources of variability in spinal cord DTI parameters in both DCCC patients and healthy subjects. METHODS: The study group included 130 patients with DCCC confirmed by magnetic resonance imaging and 71 control subjects without signs of DCCC. DTI data of the cervical spine were acquired in all subjects. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were measured at different levels of the spinal cord (SCLs). Statistical data analysis was then used to determine diffusion parameters in terms of age, sex, SCL, and spinal cord compression. RESULTS: Significant variations in FA and ADC values emerged when several spinal cord levels were mutually compared in the control group. FA values correlated significantly with age in the DCCC group and sex had a significant influence on ADC values in both groups. The two diffusion parameters in the DCCC group differed significantly between patients with clinical signs of mild-to-moderate myelopathy compared with asymptomatic patients, and correlated with measurements of spinal canal morphology. CONCLUSIONS: Diffusion parameters of the cervical spinal cord were thus shown to respond significantly to spinal cord compression, but were subject to interaction with several other factors including sex, age, and SCL. These findings may be important to the interpretation of DTI measurements in individual patients.

• MeSH
• komprese míchy diagnostické zobrazování   MeSH
• krční mícha diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• zobrazování difuzních tenzorů * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

STUDY DESIGN: Cross-sectional population-based observational study. OBJECTIVE: To estimate the prevalence of nonmyelopathic spondylotic cervical cord compression (NMSCCC) and cervical spondylotic myelopathy (CSM) in a population older than 40 years and to evaluate the magnetic resonance imaging (MRI) characteristics of these conditions. SUMMARY OF BACKGROUND DATA: The prevalence of neither NMSCCC nor CSM is known and there exists no commonly accepted quantitative MRI definition of cervical cord compression. METHODS: A group of 183 randomly recruited volunteers, 93 women, median age 66 years, range 40-80 years, underwent MRI examination of the cervical spine and spinal cord on a 1.5 T device using conventional sequences from disc levels C2/C3 to C6/C7. The imaging criterion for cervical cord compression was defined as a change in spinal cord contour at the level of an intervertebral disc on axial or sagittal MRI scan. RESULTS: MRI signs of cervical cord compression were found in 108 individuals (59.0%; 95% CI: 51.5%-66.2%); their numbers increased with age from 31.6% in the fifth decade to 66.8% in the eighth. Clinical signs of symptomatic CSM were found in two cases (1.1%), and 75 cases (41.0%) were without compression. An anteroposterior cervical canal diameter at the level of intervertebral disc (CDdisc) of less than 9.9 mm was associated with the highest probability of NMSCCC-odds ratio (OR) = 32.5, followed by a compression ratio of ≤0.5: OR = 11.1. CONCLUSION: The prevalence of NMSCCC in a population older than 40 years is higher than previously reported and increases with age. CDdisc and compression ratio had the highest capacity to discriminate between subjects with and without asymptomatic compression, and their cut-off values could be used to objectify criteria for cervical cord compression. LEVEL OF EVIDENCE: 2.

• MeSH
• dospělí MeSH
• komprese míchy komplikace   diagnostické zobrazování   epidemiologie   MeSH
• krční mícha diagnostické zobrazování   chirurgie   MeSH
• krční obratle patologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• páteřní kanál diagnostické zobrazování   MeSH
• prevalence MeSH
• průřezové studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spondylóza diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH