DIFFUSION TENSOR IMAGING AS A DIAGNOSTIC TOOL FOR EARLY CERVICAL SPONDYLOTIC MYELOPATHY: AN IN-DEPTH CLINICAL APPRAISAL

Background: Early detection of cervical spondylotic myelopathy (CSM) remains a clinical challenge, as conventional MRI can overlook subtle microstructural changes preceding symptomatic neurological decline. Diffusion tensor imaging (DTI) has emerged as a promising tool, providing quantitative insights into spinal cord microarchitecture. Objective: This study systematically evaluates DTI metrics as early biomarkers of CSM, contrasting their diagnostic value with standard MRI, and explores clinical integration pathways, limitations, and translational impact. Methods: In a prospective observational study, adult patients with clinical features suspicious for CSM and equivocal or negative standard cervical MRI were enrolled. All subjects underwent 3T MRI with DTI sequences. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were extracted, alongside clinical metrics including the modified Japanese Orthopaedic Association (mJOA) score. AI-based segmentation and statistical analysis were applied. Results were compared against controls and reference values from contemporary literature. Results: Among 32 subjects (mean age 56, range 43-71), 24 had CSM symptoms despite negative or ambiguous T2 signals. DTI revealed significantly reduced FA and elevated ADC at symptomatic levels in 91% of affected patients, with clear separation from healthy controls (FA mean 0.45 vs. 0.59, p