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fMRI May Help Resolve Incompatibility between Clinical and Conventional MRI Findings

Introduction When assessing patients with cervical myelopathy, it is not uncommon to find patients with localizing signs that may not be entirely compatible with the 2D images seen on conventional MRI. Dynamic MRI films may add information, but with fMRI, specifically diffusion tensor imaging (DTI), more information regarding the microstructure of the tracts may be gleaned. Thus, this helps ensure that the diagnosis of cervical myelopathy is accurate and that the operation will be over the correct level(s). Materials and Methods A prospective case series in consecutive patients with cervical myelopathy was reviewed. The parameters looked at included multilevel compression, sidedness of compression, and detailed neurological assessment. T2-weighted (T2W) magnetic resonance imaging (MRI) and DTI were used to compare against a reference, the neurological findings. “Level diagnosis” and sidedness compatibility were then assessed. Results Weighted orientation entropy-based DTI analysis provided a closer match to the “level diagnosis.” Detailed DTI analysis also enabled reconciliation of neurological findings compared with conventional MRI. This was compared using simple anterior–posterior compression and high signal intensity (when available) as a means to identify level and determine clinical compatibility. Conclusion DTI has the potential of becoming a new standard for examining patients with cervical myelopathy, both in identifying diagnostic compatibility and the level most contributory to the neurological deficit. Further studies are required to further establish actual clinical usefulness of this modality.