Texture analysis of spinal cord signal in pre- and post-operative T2-weighted magnetic resonance images of patients with Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy (CSM) represents the most commonly acquired cause of spinal cord dysfunction among individuals over 55 years old. The pathophysiology of the condition involves mechanical factors, which result to injury of the cervical spinal cord. In T-2 weighted magnetic resonance (MR) images of the spine the site of injury is depicted as a region of high intensity signal within the cervical spine cord. The present study aims to investigate whether texture analysis of MR signal in CSM could provide novel quantitative prognostic factors, rendering possible the prognostic estimation of the outcome of a therapeutic surgical intervention for CSM. The sample of the study comprised 12 MR images of the cervical spine, corresponding to 6 CSM patients, who had undergone surgical intervention with anterior cervical discectomy and spinal canal decompression. Following a specific MR imaging protocol a pair of T2-weighted sagittal images of the spine, corresponding to pre- and post-operative MR scans, were obtained for each of the patients. Employing custom developed software, the region of high intensity signal, associated to CSM, was automatically segmented from each MR image. Utilizing custom developed algorithms a number of textural features were extracted from the segmented ROIs and employed in the design of a classification system, based on the Quadratic classifier. The latter was used for the discrimination between pre-operative and post-operative MR images. Statistical analysis revealed the existence of statistically significant differences between textural features, corresponding to pre- and post-operative CSM MR signals. The quadratic classifier characterized correctly all the pre- and post-operative MR images (100% classification accuracy). The results of the present study indicate that textural features, generated from MR images of the spine, may serve as prognostic factors regarding the prediction of the post-operative outcome of CSM patients.