Proton magnetic resonance spectroscopy of human cervical spondylosis at 3T

STUDY DESIGN: A single center magnetic resonance imaging and spectroscopic study involving twenty-one patients with advanced cervical spondylosis and eleven healthy controls. OBJECTIVE: We assessed the utility of MR spectroscopy to quantify biochemical changes within the spinal cord and serve as a potential biomarker in patients with cervical spondylosis with or without T2 hyperintensity within the cord. SETTING: Los Angeles, California, USA METHODS: Twenty-one patients with cervical spondylosis and eleven healthy controls were evaluated. Single voxel MR spectroscopy was performed in the cervical cord. Morphometry of the spinal canal space was measured. NAA, choline, myo-inositol, glutamine-glutamate complex and lactate metabolite concentration ratios with respect to total creatine were quantified using an LC model algorithm and compared between healthy controls and spondylosis patients. Correlation of MRS metabolites with mJOA score was also performed. RESULTS: The spinal canal space was significantly different between patients and controls (ANOVA, P<0.0001). Total choline-to creatine-ratio was significantly elevated in patients with spondylosis and T2-hyperintensity compared with healthy controls (ANOVA, P<0.01). A significantly higher choline-to-NAA ratio was observed in spondylosis patients compared with healthy controls (ANOVA, P<0.01). Slightly elevated glutamine-glutamate complex and myo-inositol was encountered in patients with stenosis without T2 hyperintensity. A linear correlation between Cho-NAA ratio and mJOA was also observed (P<0.01). CONCLUSION: MRS appears sensitive to biochemical changes occurring in advanced cervical spondylosis patients. The choline/NAA ratio was significantly correlated with the mJOA score, providing a potentially clinical useful radiographical biomarker for the management of advanced cervical spondylosis patients.