Role of DTI in cases of cervical spondylosis presented with compression myelopathy: Could it explain the clinical radiological mismatch?!

Introduction and aim of work: The work aimed to assess if Diffusion Tensor Imaging and Fiber Tractography (DTI) can explain the contradiction between the side of brachialgia in patients with cervical spondylosis and the side of cord compression by the cervical disc-osteophytes complex. Materials and methods: The study included 12 patients with cervical brachialgia presented with clinical Radiological mismatch. The Fraction Anisotrophy (FA) and Apparent Diffusion Coefficient (ADC) were measured at, above and below the disc level in addition to another measurement at the high cord away from compression; measurements were done on right and left side of the cord. Results: FA values were most reduced at and above the level of the disc on the side opposite to the disc protrusion in all patients concordant with the side of the clinical presentation. That was accompanied with increased levels of ADC. DTI showed sensitivity of 92%, specificity 87% and accuracy 89%. Conclusion: Accordingly, we could conclude that DTI with assessment of FA and ADC is a useful tool in the work up of patients with contradiction between the lateralization of brachialgia and the side of the cervical disc lesion, and this could explain the patient symptomatology.