• Yoichi Aota, Tetsu Niwa, Masaaki Uesugi, Takayuki Yamashita, Tomio Inoue, and Tomoyuki Saito.
• Department of Orthopaedic Surgery, Yokohama City University, Kanagawa Prefecture, Japan. yaota@fukuhp.yokohamacu.ac.jp
• Spine. 2008 Apr 1; 33 (7): 814-20.

Study DesignA retrospective evaluation of diffusion-weighted imaging, apparent diffusion coefficient (ADC) maps, and T2-weighted images in patients with cervical compression myelopathy.ObjectiveTo correlate high signal intensity on ADC maps and T2-weighted images to neurologic severity and radiologic spinal cord compression.Summary Of Background DataPrevious studies indicated that the ADC map was more sensitive in detection of cervical compressive myelopathy than T2-weighted imaging. The relationship to neurologic severity has not been previously published.MethodsIn 100 patients with or without cervical compressive myelopathy, the magnetic resonance appearance of the spinal cord on ADC maps and T2-weighted images was evaluated independently by 2 readers. On the basis of the presence or absence of abnormality, patients were categorized into 4 groups by type of intramedullary change. The degree of canal compression and the Japanese Orthopedic Association (JOA) score for cervical myelopathy were compared among the 4 types.ResultsThe type I group consisted of 32 patients without signal change on either ADC maps or T2-weighted images. The type II group had 33 patients with high signal intensity only on the ADC map. The type III group contained 28 patients with high signal intensity on both the ADC map and the T2-weighted images. The type IV group comprised 7 patients with high signal intensity only on T2-weighted images. The degree of canal compression and the JOA scores were significantly different among the 4 groups (P < 0.005). Most type III (25 of 28) and type IV (7 of 7) patients had severe cord compression. Average JOA scores in each type were (I) 16.0, (II) 14.7, (III) 11.7, and (IV) 8.7.ConclusionADC maps demonstrated internal changes in the early stages of chronic spinal cord compression, but had limitations for the detection of intramedullary changes in late-stage myelopathy.

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