Diagnostic and prognostic utility of diffusion kurtosis imaging in cervical spine degeneration: systematic review and meta-analysis.

BACKGROUND

Degenerative cervical spine disorders are common and may cause progressive neurological impairment if not detected early. Conventional magnetic resonance imaging has limitations in identifying subtle microstructural changes. Diffusion kurtosis imaging (DKI) is sensitive to non-Gaussian water diffusion and may improve diagnostic and prognostic evaluation, but its utility in cervical spine degeneration remains unclear.

AIM: The aim of this study is to systematically assess the diagnostic and prognostic utility of DKI-derived metrics in cervical spine degeneration.

MATERIALS AND

METHODS

A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Scopus, Web of Science, and Embase were searched (2005-2025). Eligible studies evaluated mean kurtosis (MK), fractional anisotropy (FA), and mean diffusivity (MD) in grey matter (GM) and white matter (WM). Methodological quality was assessed using QUADAS-2 (University of Bristol, Bristol, UK). Random-effects models were applied to calculate pooled standardised mean differences, and heterogeneity was quantified using Q and I2 statistics.

RESULTS

Eight studies (n=273) were included; three underwent meta-analysis. In GM, MK and FA showed significant differences, with higher values in patients compared to controls. White matter findings were nonsignificant with moderate heterogeneity. MD showed no significant differences, with substantial heterogeneity in WM. Several studies reported associations between DKI metrics and clinical severity scores, supporting potential prognostic value.

CONCLUSION

DKI shows promise as a sensitive tool for detecting microstructural alterations in the cervical spinal cord. Significant changes in MK and FA in GM suggest consistent involvement, while findings in WM and MD remain variable. Further standardised, large-scale studies are needed to confirm clinical utility.