Investigation of perfusion impairment in degenerative cervical myelopathy beyond the site of cord compression

Scientific Reports, 2023 · DOI: 10.1038/s41598-023-49896-3 · Published: December 13, 2023

Spinal Cord Injury Neurology Medical Imaging

Simple Explanation

This study aimed to determine tissue-specific blood perfusion impairment of the cervical cord above the compression site in patients with degenerative cervical myelopathy (DCM) using intravoxel incoherent motion (IVIM) imaging. A quantitative MRI protocol, including structural and IVIM imaging, was conducted in healthy controls and patients. This study demonstrates tissue-specific cervical perfusion impairment rostral to the compression site in DCM patients.

Study Duration

June 2021 and December 2022

Participants

29 DCM patients and 30 healthy controls

Evidence Level

Not specified

Key Findings

1
Cord atrophy was observed in the WM (− 9.3%; p = 0.005) and GM (− 6.3%; p = 0.008) in patients compared to healthy controls above the stenosis level.
2
Blood velocity (BV) and blood flow (BF) indices were decreased in the ventral horns of the GM (BV: − 20.1%, p = 0.0009; BF: − 28.2%, p = 0.0008), in the ventral funiculi (BV: − 18.2%, p = 0.01; BF: − 21.5%, p = 0.04) and lateral funiculi (BV: − 8.5%, p = 0.03; BF: − 16.5%, p = 0.03) of the WM, across C1–C3 levels.
3
A decrease in microvascular volume fraction was associated with GM atrophy (R = 0.46, p = 0.02).

Research Summary

This study shows remote tissue-specific perfusion impairment in the cervical cord in DCM patients above the compression site (C1-C3 levels). Blood velocity and blood flow indices were reduced in the atrophied cervical grey and white matter above the level of compression. The current findings suggest that the hemodynamics and vasculature architecture are adversely affected far beyond the focal site of compression in DCM.

Practical Implications

Diagnostic Tool

IVIM indices are sensitive to remote perfusion changes in the cervical cord in DCM and may serve as neuroimaging biomarkers of hemodynamic impairment in future studies.

Understanding Disease Mechanisms

The association between perfusion impairment and cervical cord atrophy indicates that changes in hemodynamics caused by compression may contribute to the neurodegenerative processes in DCM.

Potential Therapeutic Targets

Future studies following DCM patients serially can shed light on the underlying mechanisms of remote vasculature reorganization occurring spontaneously and how this is influenced by spinal cord decompressive surgery.

Study Limitations

1
DCM patients were mildly clinically affected and had neurological outcome measures in the upper end of the clinical data range, leading to ceiling effect in the statistical analysis investigating correlation between IVIM indices and clinical parameters.
2
The statistical results have not been corrected for multiple comparisons.
3
The current acquisition time of the IVIM protocol hinders its translation to clinical routine and future research focusing on reduction of scan time (e.g., through optimization of the b-value distribution and number of repetitions) is warranted.

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