Tag: signal intensity

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Does the Presence of Preoperative Myelomalacia Impact Outcomes Following ACDF?

Spine 2025;50:1539–1546

This retrospective cohort study examines whether preoperative cervical myelomalacia on MRI influences patient-reported outcomes after anterior cervical discectomy and fusion (ACDF) in 518 adults. Results show similar modified JOA (mJOA) recovery between groups, with myelomalacia not independently predicting worse mJOA up to one year postoperatively.

Secondary findings reveal myelomalacia patients had lower baseline pain/disability and less frequent NDI MCID achievement, but multivariable analysis attributed those differences to baseline scores, smoking, and demographics rather than myelomalacia itself. Multilevel myelomalacia correlated with worse baseline mJOA but did not independently affect long-term improvement.

• Preoperative Myelomalacia: Presence of myelomalacia on MRI before anterior cervical discectomy and fusion (ACDF) in patients with mild-moderate myelopathy does not predict worse postoperative mJOA scores or overall patient-reported outcomes at any time point up to one year after surgery.

• Functional Outcomes: Both patients with and without preoperative myelomalacia achieve similar improvements in functional outcomes (mJOA), with no significant difference in the likelihood of reaching the minimum clinically important difference (MCID) for mJOA.

• Neck Disability Index (NDI): Patients with myelomalacia less commonly achieve MCID for NDI at one year, but this is attributable to less severe baseline symptoms and higher rates of current smoking, not the presence of myelomalacia itself.

• Multilevel Myelomalacia: Patients with two or more levels of myelomalacia have worse preoperative mJOA scores but show greater short-term improvement, resulting in similar one-year outcomes compared to single-level myelomalacia; preoperative severity, not the extent of myelomalacia, predicts improvement.

• Baseline Differences: Patients with myelomalacia tend to have lower baseline pain and disability, possibly due to earlier surgical intervention prompted by MRI findings rather than symptom severity.

• Other Patient-Reported Outcomes: Myelomalacia patients may have better physical component scores (SF-12 PCS) and lower neck pain (VAS neck) at one year, but these differences are small and likely reflect baseline characteristics rather than effects of myelomalacia.

• Prognostic Value: Myelomalacia seen on MRI should not be used as a binary prognostic indicator for surgical outcomes in mild-moderate myelopathy; clinical decision-making should consider baseline function and other patient factors.

• Research Implications: Further studies are needed to clarify the impact of myelomalacia severity, chronicity, and timing on outcomes, especially in patients with more severe myelopathy or more extensive cord signal changes

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Pineal cyst: results of long-term MRI surveillance and analysis of growth and shrinkage rates

J Neurosurg 138:113–119, 2023

OBJECTIVE Pineal cyst (PC) is a relatively common true cyst in the pineal gland. Its long-term natural course remains ill defined. This study aims to evaluate the long-term natural history of PC and examine MRI risk factors for cyst growth and shrinkage to help better define which patients might benefit from surgical intervention.

METHODS The records and MRI of 409 consecutive patients with PC were retrospectively examined (nonsurgical cohort). Cyst growth and shrinkage were defined as a ≥ 2-mm increase and decrease in cyst diameter in any direction, respectively. In addition to size, MRI signal intensity ratios were analyzed.

RESULTS The median radiological follow-up period was 10.7 years (interquartile range [IQR] 6.4–14.3 years). The median change in maximal diameter was −0.6 mm (IQR −1.5 to 1.3 mm). During the observation period, cyst growth was confirmed in 21 patients (5.1%). Multivariate logistic regression analysis revealed that only age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93–0.99, p < 0.01) was significantly associated with cyst growth. No patient required resection during the observation period. Cyst shrinkage was confirmed in 57 patients (13.9%). Multivariate analysis revealed that maximal diameter (OR 1.22, 95% CI 1.12–1.35, p < 0.01) and cyst CSF T2 signal intensity ratio (OR 9.06, 95% CI 1.38–6.62 × 101, p = 0.02) were significantly associated with cyst shrinkage.

CONCLUSIONS Only 5% of PCs, mainly in patients younger than 50 years of age, have the potential to grow, while cyst shrinkage is more likely to occur across all age groups. Younger age is associated with cyst growth, while larger diameter and higher signal intensity on T2-weighted imaging are associated with shrinkage. Surgery is rarely needed for PCs, despite the possibility of a certain degree of growth.

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Intramedullary high signal intensity and neurological status as prognostic factors in cervical spondylotic myelopathy

Acta Neurochir (2010) 152:1687–1694. DOI 10.1007/s00701-010-0692-8

The neurological outcome of cervical spondylotic myelopathy (CSM) may depend on multiple factors, including age, symptom duration, cord compression ratio, cervical curvature, canal stenosis, and factors related to magnetic resonance (MR) signal intensity (SI). Each factor may act independently or interactively with others. To clarify the factors in prognosis, we prospectively analyzed the outcomes of patients with myelopathy caused by soft disc herniation in correlation with magnetic resonance imaging (MRI) findings and other clinical parameters.

Materials and methods From June 2006 to July 2009, we performed surgical operations in 137 patients with CSM. Of these patients, 70 (51.1%), including 45 men and 25 women with ventral cord compression at one or two levels, underwent anterior cervical discectomy and fusion. The mean duration of follow-up was 32.7 months. We surveyed the cervical curvature index (CCI), canal stenosis (Torg–Pavlov ratio), cord compression ratio, the length of SI change on T2WI, and clinical outcome using the Japanese Orthopedic Association (JOA) score for cervical myelopathy. The MRI SI was evaluated by grade: grade 0, no change in signal intensity; grade 1, light signal change; and grade 2, bright signal change on the T2WI. Multifactorial effects were identified by regression analysis.

Results The mean preoperative and postoperative JOA scores were 10.5±2.9 and 14.9±2.1, respectively (p< 0.05). The mean recovery rate based on the JOA score was 70.0±20.1%. The respective preoperative JOA scores and recovery ratios(%) were 11.6±2.3 and 81.5±17.0% in 20 patients with SI grade 0; 10.8±2.3 and 70.1±17.3% in 25 patients with grade 1; and 9.2±3.6 and 60.7±20.9% in 25 patients with grade 2, respectively. Post-surgical neurological outcome showed no significant relationship to age, symptom duration, cervical alignment, stenosis, or cord compression.

Conclusions Among the variables tested, preoperative neurological status and intramedullary signal intensity were significantly related to neurological outcome. The better the preoperative neurological status was, the better the postoperative neurological outcome. The SI grade on the preoperative T2WI was negatively related to neurological outcome. Hence, the severity of SI change and preoperative neurological status emerged as significant prognostic factors in post-operative CSM.

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Effect of spinal cord signal intensity changes on clinical outcome after surgery for cervical spondylotic myelopathy

J Neurosurg Spine 11:562–567, 2009.DOI: 10.3171/2009.6.SPINE091

The presence of intramedullary T2 high signal intensity changes in patients with cervical spondylotic myelopathy (CSM) indicates the existence of a chronic spinal cord compressive lesion. However, the prognostic significance of signal intensity changes remains controversial. The purpose of this study was to evaluate the effect of spinal cord T2 signal intensity changes on the outcome after surgery for CSM.

Method. In a prospective study, 64 patients with CSM who underwent surgical treatment between October 2006 and April 2008 using an anterior approach were included. Based on the clinical symptoms and signs present, the severity of neurological deficits of all patients was scored according to a modified Japanese Orthopaedic Association scale score for CSM just before the surgery and at 6 months follow-up. Recovery rates were calculated at 6 months.

Results. There were 22 patients who did not have spinal cord intensity changes on MR imaging and 44 who demonstrated high-intensity signal changes on T2-weighted images (focal or segmental). No statistically significant differences were found in recovery rates between cases with T2 signal intensity changes and those with no signal intensity changes. However, the postoperative modified Japanese Orthopaedic Association scale scores and the recovery rates were much lower in patients with multisegmental signal intensity changes compared with those without these changes or those with focal signal intensity change, and ANOVA demonstrated this difference to be statistically significant (p < 0.05).

Conclusion. Multisegmental spinal cord signal intensity changes on T2-weighted MR imaging are predictors of a poor outcome in terms of functional recovery rate in patients undergoing operations for CSM.

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