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Diffusion-weighted MR Imaging with Apparent Diffusion Coefficient and Apparent Diffusion Tensor Maps in Cervical Spondylotic Myelopathy¹

¹ From the Departments of Neuroradiology (A.D., J.M.C., V.D.), Spinal Orthopedics (J.M.V.), Rheumatology (J.D.), and Functional Neurologic Laboratory (P.A.), CHU-Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux, France; and Department of Magnetic Resonance of Biologic Systems, CNRS/Université Bordeaux, France (M.R., C.T.W.M.). Received May 30, 2002; revision requested July 18; final revision received December 31; accepted February 7, 2003. Address correspondence to V.D. (e-mail: vincent.dousset@chu-bordeaux.fr).

PURPOSE: To evaluate diffusion-weighted magnetic resonance (MR) imaging in patients with cervical spondylosis and/or myelopathy.

MATERIALS AND METHODS: A multishot echo-planar imaging sequence with calculation of apparent diffusion coefficient (ADC) and apparent diffusion tensor (ADT) was applied in 36 patients with symptomatic cervical spondylosis. Diffusion-weighted images read by two neuroradiologists were compared with T2-weighted fast spin-echo images read independently by three neuroradiologists with regard to clinical status (n = 36). MR findings in a selected subgroup of 20 patients whose clinical status was confirmed by electrophysiologic examination also were compared. Sensitivity, specificity, positive predictive value, and negative predictive value of both T2-weighted imaging and diffusion-weighted imaging (ADC and ADT) were calculated and compared.

RESULTS: Patients with myelopathy had abnormal ADC (17 of 21) and ADT (15 of 19) maps with increased ADC and ADT values and decreased anisotropy. For the detection of myelopathy, diffusion-weighted ADC maps had a sensitivity of 80% (17 of 21), while T2-weighted images had a sensitivity of 61% (13 of 21). The negative predictive value was 63% (seven of 11) and 60% (12 of 20) for ADC maps and T2-weighted images, respectively. Conversely, the specificity of diffusion-weighted images (53%; seven of 13) was lower than that of T2-weighted images (92%; 12 of 13). In patients with myelopathy confirmed at electrophysiologic examination, the sensitivity of diffusion-weighted images increased to 92% (12 of 13) and the negative predictive value increased to 75% (three of four), while T2-weighted images had a 53% (seven of 13) sensitivity and a 50% (six of 12) negative predictive value.

CONCLUSION: Diffusion weighting improved the sensitivity of imaging in cervical spondylotic myelopathy.

© RSNA, 2003

Index terms: Magnetic resonance (MR), diffusion tensor, 34.12144 • Spinal cord, compression, 341.77 • Spinal cord, diseases, 341.79

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