Application of Diffusion Tensor Imaging and Tractography in Predicting Postoperative Upper Extremity Motor Recovery in Acute Cervical Spinal Cord Injury.

Abstract

This study aimed to evaluate the predictive value of diffusion tensor imaging (DTI) parameters and diffusion tensor tractography in assessing upper limb motor function recovery following surgical intervention in patients with acute cervical spinal cord injury (CSCI). This prospective study enrolled 36 postoperative CSCI patients (experimental group) and 36 matched healthy controls group. All participants underwent DTI to compare fractional anisotropy (FA) and apparent diffusion coefficient differences. The experimental group was assessed using American Spinal Injury Association motor scores and the modified Barthel Index scores preoperatively and at 3-month follow-up. DTI parameters were analyzed for their correlation with upper limb motor recovery and predictive value. Preoperatively, the experimental group exhibited significantly different FA and apparent diffusion coefficient values in both spinal cord regions compared to the healthy controls group (P<0.001). At 3-month follow-up, the experimental group demonstrated significant improvements in DTI parameters, upper limb American Spinal Injury Association motor scores, and modified Barthel Index scores compared to preoperative values (P<0.001). Significant positive correlations were observed between preoperative DTI parameters and upper limb motor function recovery (P<0.05). Receiver operating characteristic curve analysis revealed that preoperative FA values at the injury site (area under the curve [AUC]=0.800), distal region FA values (AUC=0.736), and fiber tract ratios (AUC=0.864) all showed significant predictive value for upper limb motor recovery. FA values and fiber tract ratios serve as significant prognostic indicators for upper limb motor function recovery in CSCI patients following surgical treatment.