Podcast Episode 9: Imaging techniques
Episode 9 of the AO Spine RECODE-DCM Top 10 podcast series looks at the role of dynamic or novel imaging techniques and neurophysiology in the assessment of Degenerative Cervical Myelopathy. Ben Davies and Michelle Starkey are joined by Bizhan Aarabi, Rosie Hillman, and Shekar Kurpad.
Current evidence and reason for uncertainties
No guidelines identified.
Systematic reviews that need updating or extending
Martin AR, Aleksanderek I, Cohen-Adad J, Tarmohamed Z, Tetreault L, Smith N, Cadotte DW, Crawley A, Ginsberg H, Mikulis DJ, Fehlings MG. Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI. Neuroimage Clin. 2015 Dec 4;10:192-238.
Ellingson BM, Salamon N, Holly LT. Advances in MR imaging for cervical spondylotic myelopathy. Eur Spine J. 2015 Apr;24 Suppl 2:197-208.
Source of uncertainty
* This list shows the original survey submission(s) that informed the indicative uncertainties and the resulting priority question.
Why isn't Dynamic MRI with the neck positioned in flexion and then extension more common when research shows that intermittent and dynamic compression causes progression of DCM?
Are lateral dynamic cervical x-rays a necessity for evaluation of DCM?
Furthermore I would like to see some research about dynamic flexion and extension MRI in cervical myelopathy research
Does dynamic MRI scan help to detect early signs of myelopathy?
PLace of flexion / extension views. Use of plates
Do functional imaging studies provide earlier detection of DCM than static anatomical imaging studies?
Dynamic MRI: usefulness
In mild stages, what exam would be the more sensitive to assess the cord compression and the relationship with symptoms? Dynamic MRI, tractography? Others?
Is a neutral cervical MRI the best modality for diagnosing cervical myelopathy?
Flexion extension MRI meaning Dynamic MRI is it useful & when ?
Is dynamic cervical MRI a mandatory tool in diagnosing cervical myelopathy?
What is the role of dynamic cervical MR study (hyperflexion -hyperextansion) in the diagnosis of DCM
What is the value of functional MRI (flexion and extension) in diagnosis
Is there any chance to improve the diagnosis of DCM with functional imaging? (ie early detection of asymptomatic patients)
What additional value does dynamic (flexion / extension) MRI contribute over standard imaging in the selection of patients for surgery.
Are dynamic MRI scans valuable?
Role of dynamic mri.
What percentage of spinal surgeons rule out instability prior to undertaking fusion procedures in patients with DCM?
How effective is dynamic MRI in diagnosing dynamic cord compression in patients with no evidence of critical central canal stenosis on a standard MRI.
Is MRI tractocraphy useful in diagnosis of CSM?
I would like to see if 3 Tesla MRI or better, could make earlier diagnosis of cervical myelopathy
Could study of the spinal cord vasculature help in diagnose DCM?
What will be the paper of diffusion MRI
Is there any MRI sequences that could diagnosis microischemia in DCM that could lead to a early treatment?
Would contrast administration in MRI be beneficial in increasing the detection rate in the diagnosis of DCM What is the role of Diffusion studies in detecting DCM.
Further exploration of our concept of corticospinal reserve capacity as assessed by nTMS
What is the role of DTI in imaging DCM?
Can we improve the diagnostic accuracy of DCM by functional MRI fibertract visualisation in c-spine stenosis, with MRI proven obliteration of CSF space and deformed spinal cord but without visible T2 signs of myeloamalacy to delineate indications for decompressive surgery versus wait and see ?
Does the cervical myelopathy change connectivity with the motor cortex/ or spinothalamic pathways? ( fMRI study)
What is the role of DTI MRI in DCM?
Role of emerging advanced imaging
What is the role of DTI in diagnosing DCM?
Better sequence of MRI to detect the difference between oedema and infarct
Are there imaging technologies that will allow us to differentiate between active swelling in the cord vs. myelomalacia.
Can "functional" MRI help as a diagnostic tool in DCM examination?
Role of DTI imaging
1.Role of High CT Slices dan Ultrasound in diagnosis of Stenotic cervical diseases
Will diffuse tensor imaging predict DCM symptoms or natural history?
Does different MRI magnet strengths help in detecting/diagnosing DCM?
Is tractography of value?
Role of advanced MRI as diffusion tensor imaging.
The role of DTI in quntitating the extent of DCM
Can advanced imaging methods detect spinal cord pathological changes that underlie motor and sensory deficits CSM?
Which imaging techniques best identify spinal cord injury. Currently restricted to edematous changes.
What is the role of adjunct investigations - e.g. diffusion MRI?