Increased cervical spinal cord signal intensity corresponds to specific cerebellar and cerebral functional changes in degenerative cervical myelopathy patients

Increased signal intensity (ISI) on T2-weighted cervical MR is common in patients with degenerative cervical myelopathy (DCM). However, the subtype-specific brain mechanisms for different ISI types remain unclear. The current study aimed to investigate the subtype-specific brain mechanisms associated with different types of ISI and their impact on the prognosis of DCM patients. ISI types were identified according to axial images for cervical compressive myelopathy (CCM) (Ax-CCM system). 54 CSM patients and 50 healthy controls were analyzed using resting-state fMRI data to derive the voxel-wise amplitude of low frequency fluctuation (ALFF). We conducted one-way ANOVA to compare the discrepancy in ALFF among patients of DCM with type 2 ISI and patients with other types of ISI and normal controls (NCs). The clusters surviving ANOVA were entered into pairwise two-sample t tests to disclose the pairwise ALFF differences among three groups. Pearson correlation coefficients were computed separately for each patient group in brain regions that exhibited significant between-group differences. In addition, we tested the utility of ALFF within brain regions identified by ANOVA for predicting preoperative symptom severity and prognosis of DCM via support vector regression (SVR). DCM patients with type 2 ISI identified by the axial images for cervical compressive myelopathy system (Ax-CCM) exhibited significantly lower ALFF within the right posterior cerebellum, which positively correlated with the prognosis in patients. Additionally, DCM patients with other types of ISI showed significantly lower ALFF within the left precentral gyrus. Moreover, the addition of functional imaging metrics to the set improved the SVR model's prediction accuracy for predicting symptom severity and prognosis in DCM patients. DCM patients can display distinct functional alterations in cerebral/cerebellar regions, which correspond to specific structural lesions in the spinal cord, as indicated by ISI subtypes. Including these functional alterations in the prognostic prediction model of DCM patients undergoing decompression surgery can be valuable in predicting their prognosis.