Comparison of DTI Parameter Ratios for Early Diagnosis of Degenerative Cervical Myelopathy

Study DesignProspective study.ObjectiveTo assess the performance of diffusion tensor imaging (DTI) parameter ratios for early diagnosis by investigating their associations with clinical measures in patients with single-level degenerative cervical myelopathy (DCM).MethodsA total of 309 participants were enrolled in this study, including 176 patients in the DCM group and 133 healthy controls. Baseline variables were used for propensity score matching (PSM), yielding 103 matched pairs. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), and relative anisotropy (RA) values in white matter (WM) and gray matter (GM) were measured respectively. Clinical measures including Japanese Orthopedic Association (JOA) score, Visual Analog Scale (VAS), Nurick grade, and symptom duration were used. Cut-off values were determined using receiver operating characteristic (ROC) curve analysis. Stratified bootstrap resampling was used for internal validation. Area under the curve (AUC) was calculated. And the Youden index was used to identify optimal thresholds.ResultsIn healthy controls, FA, ADC, and RA ratios in all 3 WM regions and in GM showed no significant correlations with age. The RA ratio showed the strongest correlations with JOA (r = 0.896) and symptom duration (r = -0.760) (all P < 0.001). The RA ratio achieved the highest AUC (0.981; cut-off 0.844; sensitivity 98.07%; specificity 96.12%) and outperformed the FA ratio (AUC = 0.927) and ADC ratio (AUC = 0.939) by DeLong's test (P < 0.05).ConclusionThe RA ratio may serve as a complementary quantitative imaging marker to support clinical assessment in the diagnosis and prediction of DCM.