Diffusion Tensor Imaging Based On 3D Slicer For Early Cervical Spondylotic Myelopathy Evaluation Of Anterior And Lateral White Matter Fibers In Patients

Objective:To investigate the clinical evaluation of the values of each parameter measured by diffusion tensor imaging DTI in patients with early stages of cervical spondylotic myelopathy CSM(no high signal in T2WI),anterior and lateral cords of white matter fibers with the application of 3D slicer software.Methods:A retrospective study was conducted to analyze the clinical data of 88 patients with early CSM(Grade 1 and Grade 2 according to the internationally accepted imaging standards for cervical spinal stenosis)collected from our Hospital from March 2021 to November 2022.The control group was 26 healthy volunteers(grade 0)examined during the same period.DTI scanning was performed on all patients,and 3D slicer software was used to measure the maximum compression segment of cervical spinal cord and the anterior and lateral cords of white matter fibers at C1 and 2 segments in the experimental group,while C1,2,C2,3,C3,4,C4,5,C5,6,C6 in the control group.Parameter values of the corresponding parts of cervical pulp white matter fibers in 7segments,and the ratio of them to C1 and 2 segments was calculated.Analysis and comparison between experimental group and control group anterior and lateral anisotropy fraction of white matter fiber(fractional anisotropy FA),mean diffusion MD,axial diffusion coefficient(axial diffusion AD)and radial diffusion coefficient(radial diffusion diffusion RD)to explore the diagnostic value of FA,MD,AD,RD and their ratio of DTI parameters on the anterior and lateral cord of white matter fibers in patients with early CSM,and the correlation and diagnostic value with JOA score.Results:Among the patients with CSM,5 had single-segment spinal cord compression and83 had multi-segment spinal cord compression(3 in C2,3,55 in C3,4,73 in C4,5,81 in C5,6,and 66 in C6,7),and none had spinal cord degeneration(no T2 WI high signal).The degree of spinal stenosis was mild(Grade 1)in 185 cases and moderate(Grade 2)in 93 cases.The differences in the DTI parameters between the control group were statistically significant(P<0.05),and it was found that the cervical medullary FA and AD values in the control group were highest at the C1,2 level and tended to decrease from C1,2 to C6,7 segments(P<0.05),and the MD and RD values were lowest at C1,2segments and tended to increase from C1,2 to C6,7 segments(P<0.05).The differences between the experimental and control groups were statistically significant(P<0.05)for each parameter of DTI,and in the experimental group,there was a statistically significant difference in the values of each parameter of DTI between Grade 1 and 2(P<0.05),and the combined model of MD and RD values predicted CSM better,where the combined model had the highest predictive efficacy(sensitivity 98.8%,specificity96.2%)and significant diagnostic efficacy(P < 0.05).The differences between the experimental and control groups were statistically significant(P<0.05)in the values of the parameters of the anterior and lateral white matter fibers and their ratios;the differences between the two groups were statistically significant(P<0.05).In the ROC curves of DTI parameters in patients with mild JOA scores in the lateral and anterior cords of white matter fibers versus those with non-mild scores,the joint model AUC values of MD values and RD values were larger and the sensitivity of the corresponding parameters was higher.Conclusions:1.More accurate and fine quantitative measurement of each parameter of the DTI sequence by 3D slicer software can provide quantitative indicators for the diagnosis of diseases,thus clarifying the early diagnosis of patients.2.The measurement results of MD value and RD value of the anterior and lateral cords of white matter fibers at the injured site in early CSM patients have relatively high reliability for the identification of symptoms,and the sensitivity and specificity of MD value and RD value are high,which is of great significance for evaluating the subtle changes of the anterior and lateral cords of white matter fibers in early CSM patients,so as to improve the early diagnosis rate.Thus,it can guide the selection of clinical treatment according to the degree and function of spinal cord injury.3.In the ROC curve of DTI parameters of patients with mild and non-mild JOA scores in lateral and anterior white matter fibers,the combined model of MD value and RD value was highly sensitive,which could better reflect the changes of nerve fibers and improve the diagnostic efficiency of diseases.