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Sheila N F Liberato de Matos1,2, Giovanna Ladeia-Rocha3, José Abraão Carneiro Neto1

  • 1Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador.

Annals of Clinical and Translational Neurology
|March 9, 2022
PubMed
Summary
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Diffusion tensor imaging (DTI) and thoracic index measurements show promise for diagnosing Human T-lymphotropic virus type 1-associated myelopathy (HAM). These advanced techniques offer greater diagnostic insight than conventional MRI alone for HTLV-1 carriers and HAM patients.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Diagnosis of Human T-lymphotropic virus type 1-associated myelopathy (HAM) relies on Magnetic Resonance Imaging (MRI) to exclude other conditions, but its sensitivity for HAM is limited, with spinal cord atrophy seen in only 30% of patients.
  • Diffusion Tensor Imaging (DTI) offers potential for detecting microstructural white matter damage in the spinal cord, which may be crucial for early HAM diagnosis.
  • Conventional MRI parameters have shown limited utility in definitively diagnosing HAM, necessitating the exploration of advanced imaging techniques.

Purpose of the Study:

  • To quantitatively assess spinal cord damage in HTLV-1-infected individuals using DTI.
  • To evaluate the utility of conventional MRI parameters alongside DTI in diagnosing HAM.
  • To determine the diagnostic accuracy of DTI-derived metrics (Fractional Anisotropy - FA, Mean Diffusivity - MD) and the thoracic index in differentiating HAM patients.

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Main Methods:

  • A cross-sectional study included 33 HTLV-1 carriers, 28 patients with definite HAM, and 11 healthy subjects (HS).
  • Region-of-interest (ROI)-based FA and MD measurements were performed in the thoracic and lumbar spinal cord.
  • The thoracic index was calculated, and Receiver Operating Characteristic (ROC) curve analysis was used to determine optimal diagnostic cutoffs for FA, MD, and the thoracic index.

Main Results:

  • Spinal cord atrophy was present in 53.6% of definite HAM patients.
  • ROC analysis demonstrated high diagnostic accuracy for FA (0.824), MD (0.839), and thoracic index (0.838) in the thoracic spinal cord.
  • Definite HAM patients exhibited significantly lower FA and higher MD values compared to HTLV-1 carriers and HS at the T5 vertebral level (p < 0.01).

Conclusions:

  • DTI analysis of the spinal cord, specifically FA and MD metrics, provides valuable quantitative information about white matter integrity.
  • The thoracic index, derived from conventional MRI, also shows significant diagnostic potential for HAM.
  • Combined with conventional MRI, DTI and thoracic index determination offer complementary insights that can aid in the diagnosis of HAM.