Reliability and validity of multi-shot DWI in diagnosis of cervical spondylotic myelopathy: a study based on 3-T MRI



To investigate whether multi-shot diffusion-weighted imaging (ms-DWI) could be applied in diagnosis and quantitative evaluation of cervical spondylotic myelopathy (CSM).


Thirty-three normal volunteers and 78 patients with CSM were included in this study. The apparent diffusion coefficient (ADC) values were measured at C2–C7 levels on sagittal section ADC map. The intraclass correlation coefficient (ICC) and Bland and Altman plot and Spearman coefficient were used to quantify the reproducibility of test and retest and inter-rater reliability. Pearson correlations were calculated to compare lADC and rADC versus mJOA and NDI scores. Receiver operating characteristic curve and the area under the curve (AUC) were applied to evaluate the diagnostic reliability.


There was no statistically significant difference between ADC values obtained from normal volunteers at C2–C7 levels (P < 0.05). The ICC and spearman coefficient of lADC and rADC indicated excellent test–retest and inter-rater reliability. The mean lADC and rADC were significantly higher from patients than that from volunteers (all P < 0.01). The lADC had moderate to good correlations with mJOA and NDI (all P < 0.0001). Moreover, rADC had good to excellent correlations with mJOA and NDI (all P < 0.0001). Comparing AUCs, rADC was significantly superior in diagnosis which participants were CSM than lADC (P = 0.0118).


The ms-DWI could be applied in diagnosis and quantitive assessment of CSM according to lADC and rADC. A new parameter, rADC, could be served as a diagnostic indice for CSM, which may quantitively reflect the severity of CSM.

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This study was supported by grants from the National Natural Science Foundation of China (81702141), National Natural Science Foundation of China (CN) (No. 81802218), and National Natural Science Foundation of China (CN) (81871828).

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Correspondence to Jiangang Shi.

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Xu, X., Zhang, B., Sun, K. et al. Reliability and validity of multi-shot DWI in diagnosis of cervical spondylotic myelopathy: a study based on 3-T MRI. Eur Spine J 29, 1219–1226 (2020).

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  • Cervical spondylotic myelopathy (CSM)
  • Multi-shot diffusion-weighted imaging (ms-DWI)
  • Largest apparent diffusion coefficient (lADC)
  • Relative ADC (rADC)