Can Qualitative Cervical Tractography Predict Clinical Findings as Effectively as It Aids Surgical Planning Today?

Aim: To investigate cervical spinal tractography (CST) and diffusion tensor imaging findings in patients with intramedullary cervical spinal cord (CSC) tumors and to evaluate the association between qualitative diffusion tensor tractography (DTT) findings and neurological examination findings (NEF).

Material and methods: Neuroradiology case records were retrospectively evaluated to identify patients with intramedullary CSC tumors who underwent cervical spinal DTT. Conventional magnetic resonance imaging (MRI) and DTT were performed using a 3.0-T MRI system. Demographic data, CST and clinical findings, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were recorded. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) were calculated.

Results: This study enrolled 31 patients (16 women and 15 men) with a mean age of 35.2 ± 15.6 years (range: 1-70 years). The mean FA and ADC were 0.34 ± 0.45 and 1.88 ± 0.89, respectively. Physical examination revealed hemihypesthesia (19.3%), hemiparesis (16.1%), and quadriparesis (3.2%). Completely normal neurological findings were observed in 61.3% of the patients. DTT revealed deviation (n=15), deformation (n=11), and interruption (n=5) of the fibers. No significant relationship was observed between NEF and DTT findings (p=0.127). The sensitivity, specificity, PPV, and NPV of DTT for CSC tracts were 100%, 0%, 38.7%, and 0%, respectively.

Conclusion: Although qualitative DTT of the CSC might be useful for planning and preservation of the fiber tracts during intramedullary tumor surgery, it did not exhibit significant association with clinical findings in this study. Qualitative DTT of CSC in patients with intramedullary tumors may not correlate well with NEF.