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14.09.2023 | Ultrasound

Predictive value of intraoperative contrast-enhanced ultrasound in functional recovery of non-traumatic cervical spinal cord injury

verfasst von: Xuankun Liang, Xianxiang Wang, Yanfang Chen, Danni He, Lujing Li, Guoliang Chen, Jiachun Li, Jie Li, Shaoyu Liu, Zuofeng Xu

Erschienen in: European Radiology | Ausgabe 4/2024

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Abstract

Objectives

To evaluate the ability of intraoperative CEUS to predict neurological recovery in patients with degenerative cervical myelopathy (DCM).

Methods

Twenty-six patients with DCM who underwent laminoplasty and intraoperative ultrasound (IOUS) were included in this prospective study. The modified Japanese Orthopaedic Association (mJOA) scores and MRI were assessed before surgery and 12 months postoperatively. The anteroposterior diameter (APD), maximum spinal cord compression (MSCC), and area of signal changes in the cord at the compressed and normal levels were measured and compared using MRI and IOUS. Conventional blood flow and CEUS indices (time to peak, ascending slope, peak intensity (PI), and area under the curve (AUC)) at different levels during IOUS were calculated and analysed. Correlations between all indicators and the neurological recovery rate were evaluated.

Results

All patients underwent IOUS and intraoperative CEUS, and the total recovery rate was 50.7 ± 33.3%. APD and MSCC improved significantly (p < 0.01). The recovery rate of the hyperechoic lesion group was significantly worse than that of the isoechoic group (p = 0.016). 22 patients were analysed by contrast analysis software. PI was higher in the compressed zone than in the normal zone (24.58 ± 3.19 versus 22.43 ± 2.39, p = 0.019). ΔPI _{compress-normal} and ΔAUC _{compress-normal} of the hyperechoic lesion group were significantly higher than those of the isoechoic group (median 2.19 versus 0.55, p = 0.017; 135.7 versus 21.54, p = 0.014, respectively), and both indices were moderately negatively correlated with the recovery rate (r = − 0.463, p = 0.030; r = − 0.466, p = 0.029).

Conclusions

Signal changes and microvascular perfusion evaluated using CEUS during surgery are valuable predictors of cervical myelopathy prognosis.

Clinical relevance statement

In the spinal cord compression area of degenerative cervical myelopathy, especially in the hyperechoic lesions, intraoperative CEUS showed more significant contrast agent perfusion than in the normal area, and the degree was negatively correlated with the neurological prognosis.

Key Points

• Recovery rates in patients with hyperechoic findings were lower than those of patients without lesions detected during intraoperative ultrasound.

• The peak intensity of CEUS was higher in compressed zones than in the normal parts of the spinal cord.

• Quantitative CEUS comparisons of the peak intensity and area under the curve at the compressed and normal levels of the spinal cord revealed differences that were inversely correlated to the recovery rate.

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Titel: Predictive value of intraoperative contrast-enhanced ultrasound in functional recovery of non-traumatic cervical spinal cord injury
verfasst von: Xuankun Liang
Xianxiang Wang
Yanfang Chen
Danni He
Lujing Li
Guoliang Chen
Jiachun Li
Jie Li
Shaoyu Liu
Zuofeng Xu
Publikationsdatum: 14.09.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 4/2024
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-10221-1

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Predictive value of intraoperative contrast-enhanced ultrasound in functional recovery of non-traumatic cervical spinal cord injury