Objective: To comprehensively investigate structural, vascular, and metabolic alterations in cervical dystonia (CD) patients using ultra-high-field 5.0T magnetic resonance imaging (MRI) and ^99mTc-MIBI SPECT/CT.

Background: CD is a focal dystonia characterized by involuntary contractions of neck muscles. Conventional imaging often fails to detect its subtle energy metabolism changes. The superior signal-to-noise ratios of 5.0T MRI enables precise delineation of CD, thus addressing this limitation. Botulinum neurotoxin (BoNT) injection is an effective treatment for CD. The combination of 5.0T Chemical Exchange Saturation Transfer (CEST) and ^99mTc-MIBI SPECT/CT helps targeting muscles for BoNT injections from a metabolic perspective.

Method: Eight patients with idiopathic CD were enrolled. All participants underwent 5.0T MRI including 0.6mm thin-slice sagittal T1-weighted imaging, 3D SNAP-MRA, Arterial Spin Labeling (ASL), Diffusion Tensor Imaging and CEST. ^99mTc-MIBI SPECT/CT was also carried on all patients.

Results: Patients’ clinical information were presented in Table 1. Unless traditional cervical spine MRI, the T1 sequence in our study covered the entire head and neck, which not only demonstrated morphological alterations of the cervical spine and muscles, but also yielded high-resolution data for probable morphometry analysis of the brain (Figure 1). The combination of SNAP-MRA and ASL provided direct visual assessment of cerebral vascular structure and perfusion. Following BoNT injection, Patient 6 showed increased branches of bilateral middle cerebral arteries, particularly on the left side. Concurrently, perfusion in the left hemisphere was markedly improved (Figure 2). Comparative analysis revealed high concordance between pre-treatment CEST MRI and ^9mTc-MIBI SPECT/CT in targeting muscles for BoNT injection. Moreover, given its radiation-free nature, CEST served as an ideal non-invasive tool for follow-up evaluation after BoNT therapy (Figure 3).

Conclusion: Our study established a comprehensive multimodal imaging framework in CD with BoNT injection. This framework comprised high-resolution structural sequences for gray and white matter, vascular and perfusion imaging, alongside CEST and SPECT/CT metabolic imaging. By integrating anatomical, vascular and metabolic dimensions, this system allows for a holistic assessment of CD.

Table 1. Clinical information of the patients

Figure 1

Figure 2

Figure 3

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MDS Abstracts - https://www.mdsabstracts.org/abstract/multimodal-imaging-in-cervical-dystonia-with-botulinum-toxin-treatment-a-pilot-5-0t-mri-and-99mtc-mibi-spect-ct-study/