Prediction of Neurological Impairment in Cervical Spondylotic Myelopathy using a Combination of Diffusion MRI and Proton MR Spectroscopy

Anatomic, Diffusion, and Spectroscopic MR Measurements in Cervical Spondylosis.

A) A patient with mild impairment (mJOA = 17) showing slightly elevated fiber tract density, relatively normal FA and MD, and a dominant NAA peak. B) A patient with moderate impairment (mJOA = 14) showing focally high fiber tract density, lower FA and higher MD, along with emergence of a Cho metabolites. C) A patient with severe impairment (mJOA = 8) showing elevated T2 hyperintensity on T2-weighted images, high fiber tract density indicative of compressed fibers extending rostral-caudal from the site of compression, lower FA and higher MD at the site of greatest stenosis, and dominant Cho peak in the MR spectra. Red box at C2 indicates the voxel used for MR spectroscopic measurement. Red arrow shows area of compression.