# PREDICTIVE VALUE OF DIFFUSION MRI IN CERVICAL SPONDYLOTIC MYELOPATHY

> **NIH NIH R01** · WASHINGTON UNIVERSITY · 2021 · $454,514

## Abstract

Project Abstract
Degenerative cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord injury (SCI)
representing a significant public health problem. A major shortcoming limiting efforts to improve the treatment
of patients with CSM is the lack of quantifiable metrics on which to base clinical decisions. Advanced MRI
techniques, such as diffusion tensor imaging (DTI) have shown promise in this area. DTI measures the
magnitude, anisotropy, and directionality of water displacement in tissue and provides quantifiable measures of
directional diffusivity along white matter tracts. While DTI provides a valuable tool to assess white matter
integrity, unfortunately, we have found current DTI techniques are flawed because diffusion properties derived
using DTI lose specificity and sensitivity with increasing pathological and anatomical complexity. Thus the
prediction of long-term outcome using DTI remains uncertain. To overcome factors confounding DTI analysis,
we developed diffusion basis spectrum imaging (DBSI), to more accurately delineate white matter injury,
allowing differentiation and quantification of axonal injury/loss, demyelination, and inflammation in the setting
of spinal cord compression. DBSI quantifies edema/tissue loss in addition to axon/myelin injury, providing
improved imaging biomarkers that more accurately predict a patient's clinical course, response to therapy, and
long-term prognosis. The long-term objective of this proposal is to establish and validate non-invasive imaging
biomarkers that are predictors of clinical course and therapeutic response to surgical decompression in
patients with CSM. The first aim will assess whether spinal cord DBSI pathological metrics reflect neurological
impairments and predict long-term neurologic outcomes following decompressive spinal surgery in patients
with CSM. This aim will test the hypothesis that clinical manifestations of spinal cord compression in mild CSM
are predominantly a reflection of edema and inflammation, with a lower incidence of true axonal loss; In
contrast the high variability of functional recovery observed in moderate CSM patients is attributable to a
greater risk for permanent axonal loss caused by spinal cord compression. The second aim of this proposal,
will refine DBSI modeling for assessing effects of blood flow deficits on spinal cord pathology and improving
the accuracy of axonal loss quantification in CSM. This aim will test the hypothesis that the effect of spinal cord
blood flow on CSM pathology may be assessed by including Intra-Voxel-Incoherent-Motion (IVIM) in DBSI
modeling; the accuracy of DBSI-derived axon volume may be improved by including intra-axonal diffusion
component in DBSI modeling.
The identification and validation of such non-invasive DBSI biomarkers will provide guidance on clinical
management, long-term prognosis, and family counseling. The validation of a non-invasive biomarker for
predicting functional recovery in the surgic...

## Key facts

- **NIH application ID:** 10213841
- **Project number:** 5R01NS047592-14
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Wilson Z Ray
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $454,514
- **Award type:** 5
- **Project period:** 2005-04-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10213841

## Citation

> US National Institutes of Health, RePORTER application 10213841, PREDICTIVE VALUE OF DIFFUSION MRI IN CERVICAL SPONDYLOTIC MYELOPATHY (5R01NS047592-14). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10213841. Licensed CC0.

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