Pre and postoperative perfusion MRI in degenerative cervical myelopathy suggest different patterns of pathophysiological compensatory mechanisms

INTRODUCTION: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord (SC) dysfunction. Conventional MRI, particularly T2-weighted imaging, depicts SC changes well but often fails to provide satisfactory clinico-radiological correlation. We assessed the value of quantitative perfusion MRI-specifically Golden-angle RAdial Sparse Parallel (GRASP) Dynamic Contrast-Enhanced (DCE) MRI. MATERIALS AND METHODS: Thirteen patients with chronic-onset DCM were enrolled. Clinical status was assessed using the modified Japanese Orthopaedic Association (mJOA) scale. Sagittal cervical SC T2-w 3D SPACE imaging and GRASP-DCE mapping were performed at baseline (M0) and 3 months postoperatively (M3). Semi-quantitative parameters-area under the curve (AUC60), wash-in (WI), and wash-out (WO)-were derived from time-signal intensity curves to compare regional perfusion pre- and postoperatively. Patients were divided into good (>30%) and poor (<30%) recovery groups based on postoperative mean mJOA Recovery Rate (RR). RESULTS: mJOA grade was mild in 4 patients, moderate in 7, and severe in 2. SC compression was multi-level in 4. Mean postoperative RRmJOA was 31.6% ± 58%. Mean M0 and M3 AUC60, WI, and WO values in the whole cord and compressed zone showed no significant difference across the whole population. However, in the 8 patients with RRmJOA >30%, mean whole-cord AUC60 was significantly higher at M0 than M3 (48.0 ± 7.8 vs. 39.7 ± 6.7; p = 0.024). Conversely, AUC60 and WI increased in the poor-recovery group. CONCLUSION: GRASP-DCE MRI offers valuable insight into SC perfusion. Divergent AUC60/WI patterns by recovery status suggest two distinct compensatory pathophysiological mechanisms, highlighting the complexity of disease and recovery.