Altered perfusion of the sensorimotor cortex in patients with cervical spondylotic myelopathy: an arterial spin labeling study

OBJECTIVE: Advanced magnetic resonance imaging studies have shown functional plasticity or reorganization and metabolite alterations of N-acetyl aspartate in the sensorimotor cortex (SMC), a hallmark region and key brain network, in patients with cervical spondylotic myelopathy (CSM). However, the nature of perfusion in the SMC and the relationship between regional cerebral blood flow (CBF), motor function scores, and structural damage of the cervical cord in patients with CSM are not fully understood. MATERIALS AND METHODS: All right-handed participants underwent pseudo-continuous arterial spin labeling pulse sequence scanning, and CBF was then calculated and compared between CSM and healthy groups. Clinical and structural associations were assessed in the SMC. Receiver operating characteristic (ROC) and leave-one-out cross-validation analyses were used to estimate the sensitivity and specificity of the significantly altered CBF in the SMC to distinguish myelopathy-related impairment. RESULTS: A total of 18 pairs of CSM patients and well-matched healthy subjects were included in the analyses. Compared with healthy subjects, CSM patients exhibited significantly decreased CBF in the left premotor ventral/precentral operculum (PMv/PrCO) and the bilateral dorsal anterior cingulate cortex (dACC); and increased CBF in the left paracentral lobule (PCL), the right PCL/supplementary motor area (PCL/SMA), and the right postcentral gyrus (PoCG; Gaussian random field correction at P<0.01). In the CSM group, the CBF values in the right PoCG were negatively correlated with Japanese Orthopaedic Association scores, and the CBF values in several regions were negatively correlated with Neck Disability Index scores. Finally, the ROC analysis revealed that significantly increased CBF in the left PCL, the right PCL/SMA, and the right PoCG discriminated patients with myelopathy-related impairment from healthy subjects. CONCLUSION: Regional CBF was reduced in operculum-integrated (PMv/PrCO) and motor control (dACC) regions but increased in sensory (PoCG) and motor-sensory processing (PCL/SMA) regions in patients with CSM.