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Nigri A, Dalla Bella E, Ferraro S, Medina Carrion JP, Demichelis G, Bersano E, Consonni M, Bischof A, Stanziano M, Palermo S, Lauria G, Bruzzone MG, Papinutto N. Cervical spinal cord atrophy in amyotrophic lateral sclerosis across disease stages. Ann Clin Transl Neurol 2023; 10:213-224. [PMID: 36599092 PMCID: PMC9930423 DOI: 10.1002/acn3.51712] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Spinal cord degeneration is a hallmark of amyotrophic lateral sclerosis. The assessment of gray matter and white matter cervical spinal cord atrophy across clinical stages defined using the King's staging system could advance the understanding of amyotrophic lateral sclerosis progression. METHODS We assessed the in vivo spatial pattern of gray and white matter atrophy along cervical spinal cord (C2 to C6 segments) using 2D phase-sensitive inversion recovery imaging in a cohort of 44 amyotrophic lateral sclerosis patients, evaluating its change across the King's stages and the correlation with disability scored by the amyotrophic lateral sclerosis functional rating scale revised (ALSFRS-R) and disease duration. A mathematical model inferring the potential onset of cervical gray matter atrophy was developed. RESULTS In amyotrophic lateral sclerosis patients at King's stage 1, significant cervical spinal cord alterations were mainly identified in gray matter, whereas they involved both gray and white matter in patients at King's stage ≥ 2. Gray and white matter areas correlated with clinical disability at all cervical segments. C3-C4 level was the segment showing early gray matter atrophy starting about 7 to 20 months before symptom onset according to our model. INTERPRETATION Our findings suggest that cervical spinal cord atrophy spreads from gray to white matter across King's stages in amyotrophic lateral sclerosis, making spinal cord magnetic resonance imaging an in vivo assessment tool to measure the progression of the disease.
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Affiliation(s)
- Anna Nigri
- Neuroradiology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Eleonora Dalla Bella
- 3rd Neurology Unit and Motor Neuron Disease CentreFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Stefania Ferraro
- Neuroradiology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly,School of Life Science and Technology, MOE Key Laboratory for NeuroinformationUniversity of Electronic Science and Technology of ChinaChengduChina
| | | | - Greta Demichelis
- Neuroradiology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Enrica Bersano
- 3rd Neurology Unit and Motor Neuron Disease CentreFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly,Department of Medical Biotechnology and Translational MedicineUniversity of MilanMilanItaly
| | - Monica Consonni
- 3rd Neurology Unit and Motor Neuron Disease CentreFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Antje Bischof
- Weill Institute for Neurosciences, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA,Department of Neurology with Institute for Translational NeurologyUniversity Hospital MünsterMünsterGermany
| | - Mario Stanziano
- Neuroradiology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly,ALS Centre, “Rita Levi Montalcini” Department of NeuroscienceUniversity of TurinTurinItaly
| | - Sara Palermo
- Neuroradiology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Giuseppe Lauria
- 3rd Neurology Unit and Motor Neuron Disease CentreFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly,Department of Medical Biotechnology and Translational MedicineUniversity of MilanMilanItaly
| | | | - Nico Papinutto
- Weill Institute for Neurosciences, Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
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102
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Schading S, David G, Max Emmenegger T, Achim C, Thompson A, Weiskopf N, Curt A, Freund P. Dynamics of progressive degeneration of major spinal pathways following spinal cord injury: A longitudinal study. Neuroimage Clin 2023; 37:103339. [PMID: 36758456 PMCID: PMC9939725 DOI: 10.1016/j.nicl.2023.103339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/23/2022] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Following spinal cord injury (SCI), disease processes spread gradually along the spinal cord forming a spatial gradient with most pronounced changes located at the lesion site. However, the dynamics of this gradient in SCI patients is not established. OBJECTIVE This study tracks the spatiotemporal dynamics of remote anterograde and retrograde spinal tract degeneration in the upper cervical cord following SCI over two years utilizing quantitative MRI. METHODS Twenty-three acute SCI patients (11 paraplegics, 12 tetraplegics) and 21 healthy controls were scanned with a T1-weighted sequence for volumetry and a FLASH sequence for myelin-sensitive magnetization transfer saturation (MTsat) of the upper cervical cord. We estimated myelin content from MTsat maps within the corticospinal tracts (CST) and dorsal columns (DC) and measured spinal cord atrophy by means of left-right width (LRW) and anterior-posterior width (APW) on the T1-weighted images across cervical levels C1-C3. MTsat in the CST and LRW were considered proxies for retrograde degeneration, while MTsat in the DC and APW provided evidence for anterograde degeneration, respectively. Using regression models, we compared the temporal and spatial trajectories of these MRI readouts between tetraplegics, paraplegics, and controls over a 2-year period and assessed their associations with clinical improvement. RESULTS Linear rates and absolute differences in myelin-sensitive MTsat indicated retrograde and anterograde neurodegeneration in the CST and DC, respectively. Changes in MTsat within the CST and in LRW progressively developed over time forming a gradient towards lower cervical levels by 2 years after injury, especially in tetraplegics (change per cervical level in MTsat: -0.247 p.u./level, p = 0.034; in LRW: -0.323 mm/level, p = 0.024). MTsat within the DC was already decreased at cervical levels C1-C3 at baseline (1.5 months after injury) in both tetra- and paraplegics, while linear decreases in APW over time were similar across C1-C3, preserving the spatial gradient. The relative improvement in light touch score was associated with MTsat within the DC at baseline (rs = 0.575, p = 0.014). CONCLUSION Rostral and remote to the injury, the CST and DC show ongoing structural changes, indicative of myelin reductions and atrophy within 2 years after SCI. While anterograde degeneration in the DC was already detectable uniformly at C1-C3 early following SCI, retrograde degeneration in the CST developed over time revealing specific spatial and temporal neurodegenerative gradients. Disentangling and quantifying such dynamic pathological processes may provide biomarkers for regenerative and remyelinating therapies along entire spinal pathways.
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Affiliation(s)
- Simon Schading
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Gergely David
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Tim Max Emmenegger
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Cristian Achim
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Alan Thompson
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Felix Bloch Institute for Solid State Physics, Faculty of Physics and Earth Sciences, Leipzig University, Leipzig, Germany
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Wellcome Trust Centre for Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK.
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103
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Rocca MA, Valsasina P, Meani A, Gobbi C, Zecca C, Barkhof F, Schoonheim MM, Strijbis EM, Vrenken H, Gallo A, Bisecco A, Ciccarelli O, Yiannakas M, Rovira A, Sastre-Garriga J, Palace J, Matthews L, Gass A, Eisele P, Lukas C, Bellenberg B, Margoni M, Preziosa P, Filippi M. Spinal cord lesions and brain grey matter atrophy independently predict clinical worsening in definite multiple sclerosis: a 5-year, multicentre study. J Neurol Neurosurg Psychiatry 2023; 94:10-18. [PMID: 36171105 DOI: 10.1136/jnnp-2022-329854] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the combined contribution of brain and cervical cord damage in predicting 5-year clinical worsening in a multicentre cohort of definite multiple sclerosis (MS) patients. METHODS Baseline 3.0T brain and cervical cord T2-weighted and three-dimensional T1-weighted MRI was acquired in 367 patients with MS (326 relapse-onset and 41 progressive-onset) and 179 healthy controls. Expanded Disability Status Scale (EDSS) score was obtained at baseline and after a median follow-up of 5.1 years (IQR=4.8-5.2). At follow-up, patients were classified as clinically stable/worsened according to EDSS changes. Generalised linear mixed models identified predictors of clinical worsening, evolution to secondary progressive (SP) MS and reaching EDSS=3.0, 4.0 and 6.0 milestones at 5 years. RESULTS At follow-up, 120/367 (33%) patients with MS worsened clinically; 36/256 (14%) patients with relapsing-remitting evolved to SPMS. Baseline predictors of EDSS worsening were progressive-onset versus relapse-onset MS (standardised beta (β)=0.97), higher EDSS (β=0.41), higher cord lesion number (β=0.41), lower normalised cortical volume (β=-0.15) and lower cord area (β=-0.28) (C-index=0.81). Older age (β=0.86), higher EDSS (β=1.40) and cord lesion number (β=0.87) independently predicted SPMS conversion (C-index=0.91). Predictors of reaching EDSS=3.0 after 5 years were higher baseline EDSS (β=1.49), cord lesion number (β=1.02) and lower normalised cortical volume (β=-0.56) (C-index=0.88). Baseline age (β=0.30), higher EDSS (β=2.03), higher cord lesion number (β=0.66) and lower cord area (β=-0.41) predicted EDSS=4.0 (C-index=0.92). Finally, higher baseline EDSS (β=1.87) and cord lesion number (β=0.54) predicted EDSS=6.0 (C-index=0.91). CONCLUSIONS Spinal cord damage and, to a lesser extent, cortical volume loss helped predicting worse 5-year clinical outcomes in MS.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy .,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Claudio Gobbi
- Neurology Clinic, MS Center/Headache Center, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Neurology Clinic, MS Center/Headache Center, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Frederik Barkhof
- Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands.,Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Eva M Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Hugo Vrenken
- Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands.,Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Marios Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lucy Matthews
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Achim Gass
- Department of Neurology, and Mannheim Center of Translational Neurosciences (MCTN), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Philipp Eisele
- Department of Neurology, and Mannheim Center of Translational Neurosciences (MCTN), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Department of Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Barbara Bellenberg
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy.,Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurophysiology Service, IRCCS Ospedale San Raffaele, Milano, Italy
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104
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Zhang JK, Jayasekera D, Song C, Greenberg JK, Javeed S, Dibble CF, Blum J, Sun P, Song SK, Ray WZ. Diffusion Basis Spectrum Imaging Provides Insights Into Cervical Spondylotic Myelopathy Pathology. Neurosurgery 2023; 92:102-109. [PMID: 36519861 PMCID: PMC10158908 DOI: 10.1227/neu.0000000000002183] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diffusion basis spectrum imaging (DBSI) is a noninvasive quantitative imaging modality that may improve understanding of cervical spondylotic myelopathy (CSM) pathology through detailed evaluations of spinal cord microstructural compartments. OBJECTIVE To determine the utility of DBSI as a biomarker of CSM disease severity. METHODS A single-center prospective cohort study enrolled 50 patients with CSM and 20 controls from 2018 to 2020. All patients underwent clinical evaluation and diffusion-weighted MRI, followed by diffusion tensor imaging and DBSI analyses. Diffusion-weighted MRI metrics assessed white matter integrity by fractional anisotropy, axial diffusivity, radial diffusivity, and fiber fraction. In addition, DBSI further evaluates extra-axonal changes by isotropic restricted and nonrestricted fraction. Including an intra-axonal diffusion compartment, DBSI improves estimations of axonal injury through intra-axonal axial diffusivity. Patients were categorized into mild, moderate, and severe CSM using modified Japanese Orthopedic Association classifications. Imaging parameters were compared among patient groups using independent samples t tests and ANOVA. RESULTS Twenty controls, 27 mild (modified Japanese Orthopedic Association 15-17), 12 moderate (12-14), and 11 severe (0-11) patients with CSM were enrolled. Diffusion tensor imaging and DBSI fractional anisotropy, axial diffusivity, and radial diffusivity were significantly different between control and patients with CSM ( P < .05). DBSI fiber fraction, restricted fraction, and nonrestricted fraction were significantly different between groups ( P < .01). DBSI intra-axonal axial diffusivity was lower in mild compared with moderate (mean difference [95% CI]: 1.1 [0.3-2.1], P < .01) and severe (1.9 [1.3-2.4], P < .001) CSM. CONCLUSION DBSI offers granular data on white matter tract integrity in CSM that provide novel insights into disease pathology, supporting its potential utility as a biomarker of CSM disease progression.
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Affiliation(s)
- Justin K. Zhang
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Dinal Jayasekera
- Department of Biomedical Engineering, Washington University in St. Louis McKelvey School of Engineering, Saint Louis, Missouri, USA
| | - Chunyu Song
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob K. Greenberg
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Saad Javeed
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Christopher F. Dibble
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Jacob Blum
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peng Sun
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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105
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Nozawa K, Maki S, Furuya T, Okimatsu S, Inoue T, Yunde A, Miura M, Shiratani Y, Shiga Y, Inage K, Eguchi Y, Ohtori S, Orita S. Magnetic resonance image segmentation of the compressed spinal cord in patients with degenerative cervical myelopathy using convolutional neural networks. Int J Comput Assist Radiol Surg 2023; 18:45-54. [PMID: 36342593 DOI: 10.1007/s11548-022-02783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Spinal cord segmentation is the first step in atlas-based spinal cord image analysis, but segmentation of compressed spinal cords from patients with degenerative cervical myelopathy is challenging. We applied convolutional neural network models to segment the spinal cord from T2-weighted axial magnetic resonance images of DCM patients. Furthermore, we assessed the correlation between the cross-sectional area segmented by this network and the neurological symptoms of the patients. METHODS The CNN architecture was built using U-Net and DeepLabv3 + and PyTorch. The CNN was trained on 2762 axial slices from 174 patients, and an additional 517 axial slices from 33 patients were held out for validation and 777 axial slices from 46 patients for testing. The performance of the CNN was evaluated on a test dataset with Dice coefficients as the outcome measure. The ratio of CSA at the maximum compression level to CSA at the C2 level, as segmented by the CNN, was calculated. The correlation between the spinal cord CSA ratio and the Japanese Orthopaedic Association score in DCM patients from the test dataset was investigated using Spearman's rank correlation coefficient. RESULTS The best Dice coefficient was achieved when U-Net was used as the architecture and EfficientNet-b7 as the model for transfer learning. Spearman's rs between the spinal cord CSA ratio and the JOA score of DCM patients was 0.38 (p = 0.007), showing a weak correlation. CONCLUSION Using deep learning with magnetic resonance images of deformed spinal cords as training data, we were able to segment compressed spinal cords of DCM patients with a high concordance with expert manual segmentation. In addition, the spinal cord CSA ratio was weakly, but significantly, correlated with neurological symptoms. Our study demonstrated the first steps needed to implement automated atlas-based analysis of DCM patients.
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Affiliation(s)
- Kyohei Nozawa
- Department of Medical Engineering, Graduate School of Science and Engineering, Chiba University, Chiba, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan.
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sho Okimatsu
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takaki Inoue
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Atsushi Yunde
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masataka Miura
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuki Shiratani
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
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106
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Toh C, Keslake A, Payne T, Onwuegbuzie A, Harding J, Baster K, Hoggard N, Shaw PJ, Wilkinson ID, Jenkins TM. Analysis of brain and spinal MRI measures in a common domain to investigate directional neurodegeneration in motor neuron disease. J Neurol 2023; 270:1682-1690. [PMID: 36509983 PMCID: PMC9971079 DOI: 10.1007/s00415-022-11520-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) of the brain and cervical spinal cord is often performed in diagnostic evaluation of suspected motor neuron disease/amyotrophic lateral sclerosis (MND/ALS). Analysis of MRI-derived tissue damage metrics in a common domain facilitates group-level inferences on pathophysiology. This approach was applied to address competing hypotheses of directionality of neurodegeneration, whether anterograde, cranio-caudal dying-forward from precentral gyrus or retrograde, dying-back. METHODS In this cross-sectional study, MRI was performed on 75 MND patients and 13 healthy controls. Precentral gyral thickness was estimated from volumetric T1-weighted images using FreeSurfer, corticospinal tract fractional anisotropy (FA) from diffusion tensor imaging using FSL, and cross-sectional cervical cord area between C1-C8 levels using Spinal Cord Toolbox. To analyse these multimodal data within a common domain, individual parameter estimates representing tissue damage at each corticospinal tract level were first converted to z-scores, referenced to healthy control norms. Mixed-effects linear regression models were then fitted to these z-scores, with gradients hypothesised to represent directionality of neurodegeneration. RESULTS At group-level, z-scores did not differ significantly between precentral gyral and intracranial corticospinal tract tissue damage estimates (regression coefficient - 0.24, [95% CI - 0.62, 0.14], p = 0.222), but step-changes were evident between intracranial corticospinal tract and C1 (1.14, [95% CI 0.74, 1.53], p < 0.001), and between C5 and C6 cord levels (0.98, [95% CI 0.58, 1.38], p < 0.001). DISCUSSION Analysis of brain and cervical spinal MRI data in a common domain enabled investigation of pathophysiological hypotheses in vivo. A cranio-caudal step-change in MND patients was observed, and requires further investigation in larger cohorts.
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Affiliation(s)
- C Toh
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - A Keslake
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - T Payne
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - A Onwuegbuzie
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - J Harding
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - K Baster
- School of Mathematics and Statistics, University of Sheffield, Sheffield, UK
| | - N Hoggard
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - P J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - I D Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - T M Jenkins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.
- Royal Perth Hospital, Victoria Square, Perth, WA, 6000, Australia.
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107
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Ganzetti M, Graves JS, Holm SP, Dondelinger F, Midaglia L, Gaetano L, Craveiro L, Lipsmeier F, Bernasconi C, Montalban X, Hauser SL, Lindemann M. Neural correlates of digital measures shown by structural MRI: a post-hoc analysis of a smartphone-based remote assessment feasibility study in multiple sclerosis. J Neurol 2023; 270:1624-1636. [PMID: 36469103 PMCID: PMC9970954 DOI: 10.1007/s00415-022-11494-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND A study was undertaken to evaluate remote monitoring via smartphone sensor-based tests in people with multiple sclerosis (PwMS). This analysis aimed to explore regional neural correlates of digital measures derived from these tests. METHODS In a 24-week, non-randomized, interventional, feasibility study (NCT02952911), sensor-based tests on the Floodlight Proof-of-Concept app were used to assess cognition (smartphone-based electronic Symbol Digit Modalities Test), upper extremity function (Draw a Shape Test, Pinching Test), and gait and balance (Static Balance Test, Two-Minute Walk Test, U-Turn Test). In this post-hoc analysis, digital measures and standard clinical measures (e.g., Nine-Hole Peg Test [9HPT]) were correlated against regional structural magnetic resonance imaging outcomes. Seventy-six PwMS aged 18-55 years with an Expanded Disability Status Scale score of 0.0-5.5 were enrolled from two different sites (USA and Spain). Sixty-two PwMS were included in this analysis. RESULTS Worse performance on digital and clinical measures was associated with smaller regional brain volumes and larger ventricular volumes. Whereas digital and clinical measures had many neural correlates in common (e.g., putamen, globus pallidus, caudate nucleus, lateral occipital cortex), some were observed only for digital measures. For example, Draw a Shape Test and Pinching Test measures, but not 9HPT score, correlated with volume of the hippocampus (r = 0.37 [drawing accuracy over time on the Draw a Shape Test]/ - 0.45 [touching asynchrony on the Pinching Test]), thalamus (r = 0.38/ - 0.41), and pons (r = 0.35/ - 0.35). CONCLUSIONS Multiple neural correlates were identified for the digital measures in a cohort of people with early MS. Digital measures showed associations with brain regions that clinical measures were unable to demonstrate, thus providing potential novel information on functional ability compared with standard clinical assessments.
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Affiliation(s)
- Marco Ganzetti
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Jennifer S. Graves
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California San Diego, San Diego, CA USA
| | - Sven P. Holm
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Frank Dondelinger
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland ,grid.419481.10000 0001 1515 9979Present Address: Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Luciana Midaglia
- grid.411083.f0000 0001 0675 8654Department of Neurology-Neuroimmunology, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Gaetano
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Licinio Craveiro
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Corrado Bernasconi
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Xavier Montalban
- grid.411083.f0000 0001 0675 8654Department of Neurology-Neuroimmunology, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Stephen L. Hauser
- grid.266102.10000 0001 2297 6811Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Michael Lindemann
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
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108
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Rezende TJR, Adanyeguh IM, Arrigoni F, Bender B, Cendes F, Corben LA, Deistung A, Delatycki M, Dogan I, Egan GF, Göricke SL, Georgiou-Karistianis N, Henry PG, Hutter D, Jahanshad N, Joers JM, Lenglet C, Lindig T, Martinez ARM, Martinuzzi A, Paparella G, Peruzzo D, Reetz K, Romanzetti S, Schöls L, Schulz JB, Synofzik M, Thomopoulos SI, Thompson PM, Timmann D, Harding IH, França MC. Progressive Spinal Cord Degeneration in Friedreich's Ataxia: Results from ENIGMA-Ataxia. Mov Disord 2023; 38:45-56. [PMID: 36308733 PMCID: PMC9852007 DOI: 10.1002/mds.29261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/23/2022] [Accepted: 10/04/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Spinal cord damage is a hallmark of Friedreich's ataxia (FRDA), but its progression and clinical correlates remain unclear. OBJECTIVE The objective of this study was to perform a characterization of cervical spinal cord structural damage in a large multisite FRDA cohort. METHODS We performed a cross-sectional analysis of cervical spinal cord (C1-C4) cross-sectional area (CSA) and eccentricity using magnetic resonance imaging data from eight sites within the ENIGMA-Ataxia initiative, including 256 individuals with FRDA and 223 age- and sex-matched control subjects. Correlations and subgroup analyses within the FRDA cohort were undertaken based on disease duration, ataxia severity, and onset age. RESULTS Individuals with FRDA, relative to control subjects, had significantly reduced CSA at all examined levels, with large effect sizes (d > 2.1) and significant correlations with disease severity (r < -0.4). Similarly, we found significantly increased eccentricity (d > 1.2), but without significant clinical correlations. Subgroup analyses showed that CSA and eccentricity are abnormal at all disease stages. However, although CSA appears to decrease progressively, eccentricity remains stable over time. CONCLUSIONS Previous research has shown that increased eccentricity reflects dorsal column (DC) damage, while decreased CSA reflects either DC or corticospinal tract (CST) damage, or both. Hence our data support the hypothesis that damage to the DC and damage to CST follow distinct courses in FRDA: developmental abnormalities likely define the DC, while CST alterations may be both developmental and degenerative. These results provide new insights about FRDA pathogenesis and indicate that CSA of the cervical spinal cord should be investigated further as a potential biomarker of disease progression. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Thiago JR Rezende
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Isaac M Adanyeguh
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Filippo Arrigoni
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Fernando Cendes
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Louise A Corben
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Bruce Lefroy Centre, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Andreas Deistung
- University Clinic and Outpatient Clinic for Radiology, Department for Radiation Medicine, University Hospital Halle (Saale), Halle (Saale), Germany
- Department of Neurology and Center for Translational and Behavioral Neuroscience “(C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Delatycki
- Bruce Lefroy Centre, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich GmbH, Jülich, Germany
| | - Gary F Egan
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Sophia L Göricke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Nellie Georgiou-Karistianis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Pierre-Gilles Henry
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Diane Hutter
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - James M Joers
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Christophe Lenglet
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Alberto RM Martinez
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Andrea Martinuzzi
- Scientific Institute, IRCCS Eugenio Medea, Conegliano-Pieve di Soligo Research Centre, Conegliano, Italy
| | - Gabriella Paparella
- Scientific Institute, IRCCS Eugenio Medea, Conegliano-Pieve di Soligo Research Centre, Conegliano, Italy
| | - Denis Peruzzo
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich GmbH, Jülich, Germany
| | - Sandro Romanzetti
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich GmbH, Jülich, Germany
| | - Ludger Schöls
- Department of Neurodegenerative Diseases, Center of Neurology and Hertie Institute for Clinical Brain Research,University Tuübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich GmbH, Jülich, Germany
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Center of Neurology and Hertie Institute for Clinical Brain Research,University Tuübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Dagmar Timmann
- Department of Neurology and Center for Translational and Behavioral Neuroscience “(C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ian H Harding
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marcondes C. França
- Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
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109
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Tsagkas C, Huck-Horvath A, Cagol A, Haas T, Barakovic M, Amann M, Ruberte E, Melie-Garcia L, Weigel M, Pezold S, Schlaeger R, Kuhle J, Sprenger T, Kappos L, Bieri O, Cattin P, Granziera C, Parmar K. Anterior horn atrophy in the cervical spinal cord: A new biomarker in progressive multiple sclerosis. Mult Scler 2022; 29:702-718. [PMID: 36550626 DOI: 10.1177/13524585221139152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spinal cord (SC) gray and white matter pathology plays a central role in multiple sclerosis (MS). OBJECTIVE We aimed to investigate the extent, pattern, and clinical relevance of SC gray and white matter atrophy in vivo. METHODS 39 relapsing-remitting patients (RRMS), 40 progressive MS patients (PMS), and 24 healthy controls (HC) were imaged at 3T using the averaged magnetization inversion recovery acquisitions sequence. Total and lesional cervical gray and white matter, and posterior (SCPH) and anterior horn (SCAH) areas were automatically quantified. Clinical assessment included the expanded disability status scale, timed 25-foot walk test, nine-hole peg test, and the 12-item MS walking scale. RESULTS PMS patients had significantly reduced cervical SCAH - but not SCPH - areas compared with HC and RRMS (both p < 0.001). In RRMS and PMS, the cervical SCAH areas increased significantly less in the region of cervical SC enlargement compared with HC (all p < 0.001). This reduction was more pronounced in PMS compared with RRMS (both p < 0.001). In PMS, a lower cervical SCAH area was the most important magnetic resonance imaging (MRI)-variable for higher disability scores. CONCLUSION MS patients show clinically relevant cervical SCAH atrophy, which is more pronounced in PMS and at the level of cervical SC enlargement.
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Affiliation(s)
- Charidimos Tsagkas
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Antal Huck-Horvath
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Alessandro Cagol
- Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Tanja Haas
- Division of Radiological Physics, Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Michael Amann
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Medical Image Analysis Center AG, Basel, Switzerland
| | - Esther Ruberte
- Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Medical Image Analysis Center AG, Basel, Switzerland
| | - Lester Melie-Garcia
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland/Division of Radiological Physics, Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Simon Pezold
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Regina Schlaeger
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Till Sprenger
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Neurology, DKD HELIOS Klinik Wiesbaden, Wiesbaden, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland/Division of Radiological Physics, Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe Cattin
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Katrin Parmar
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Reha Rheinfelden, Rheinfelden, Switzerland
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110
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Lee SY, Schmit BD, Kurpad SN, Budde MD. Acute Magnetic Resonance Imaging Predictors of Chronic Motor Function and Tissue Sparing in Rat Cervical Spinal Cord Injury. J Neurotrauma 2022; 39:1727-1740. [PMID: 35708112 PMCID: PMC9734017 DOI: 10.1089/neu.2022.0034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Predicting functional outcomes from spinal cord injury (SCI) at the acute setting is important for patient management. This work investigated the relationship of early magnetic resonance imaging (MRI) biomarkers in a rat model of cervical contusion SCI with long-term functional outcome and tissue sparing. Forty rats with contusion injury at C5 at either the spinal cord midline (bilateral) or over the lateral cord (unilateral) were examined using in vivo multi-modal quantitative MRI at 1 day post-injury. The extent of T2-weighted hyperintensity reflecting edema was greater in the bilateral model compared with the unilateral injury. Diffusion tensor imaging (DTI) exhibited microscopic damage in similar regions of the cord as reductions in fractional anisotropy (FA) and mean diffusivity (MD), but DTI parameter maps were also confounded by the presence of vasogenic edema that locally increased FA and MD. In comparison, filtered diffusion-weighted imaging (fDWI) more clearly delineated the location of acute axonal damage without effects of vasogenic edema. Pairwise correlation analysis revealed that 28-day motor functional outcomes were most strongly associated with the extent of edema (R = -0.69). Principal component analysis identified close associations of motor functional score with tissue sparing, the extent of edema, lesion area, and injury type (unilateral or bilateral). Among the diffusion MRI parameters, lesion areas measured with fDWI had the strongest association with functional outcome (R = -0.41). Voxelwise correlation analysis identified a locus of white matter damage associated with function in the dorsal white matter, although this was likely driven by variance across the two injury patterns (unilateral and bilateral injury). Nonetheless, correlation with motor function within the damaged region found in the voxelwise analysis outperformed morphological lesion area measurement as a predictor of chronic function. Collectively, this study characterized anatomical and diffusion MRI signatures of acute SCI at cervical spine and their association with chronic functional outcomes and histological results.
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Affiliation(s)
- Seung-Yi Lee
- Neuroscience Doctoral Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Biophysics Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew D. Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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111
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Seif M, Leutritz T, Schading S, Emmengger T, Curt A, Weiskopf N, Freund P. Reliability of multi-parameter mapping (MPM) in the cervical cord: A multi-center multi-vendor quantitative MRI study. Neuroimage 2022; 264:119751. [PMID: 36384206 DOI: 10.1016/j.neuroimage.2022.119751] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 11/14/2022] Open
Abstract
MRI based multicenter studies which target neurological pathologies affecting the spinal cord and brain - including spinal cord injury (SCI) - require standardized acquisition protocols and image processing methods. We have optimized and applied a multi-parameter mapping (MPM) protocol that simultaneously covers the brain and the cervical cord within a traveling heads study across six clinical centers (Leutritz et al., 2020). The MPM protocol includes quantitative maps (magnetization transfer saturation (MT), proton density (PD), longitudinal (R1), and effective transverse (R2*) relaxation rates) sensitive to myelination, water content, iron concentration, and morphometric measures, such as cross-sectional cord area. Previously, we assessed the repeatability and reproducibility of the brain MPM data acquired in the five healthy participants who underwent two scan-rescans (Leutritz et al., 2020). This study focuses on the cervical cord MPM data derived from the same acquisitions to determine its repeatability and reproducibility in the cervical cord. MPM matrices of the cervical cord were generated and processed using the hMRI and the spinal cord toolbox. To determine reliability of the cervical MPM data, the intra-site (i.e., scan-rescan) coefficient of variation (CoV), inter-site CoV, and bias within region of interests (C1, C2 and C3 levels) were determined. The range of the mean intra- and inter-site CoV of MT, R1 and PD was between 2.5% and 12%, and between 1.1% and 4.0% for the morphometric measures. In conclusion, the cervical MPM data showed a high repeatability and reproducibility for key imaging biomarkers and hence can be employed as a standardized tool in multi-center studies, including clinical trials.
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Affiliation(s)
- Maryam Seif
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Tobias Leutritz
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Simon Schading
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland
| | - Tim Emmengger
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Faculty of Physics and Earth Sciences, Felix Bloch Institute for Solid State Physics, Leipzig University, Leipzig, Germany
| | - Patrick Freund
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, London, UK
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112
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Bédard S, Cohen-Adad J. Automatic measure and normalization of spinal cord cross-sectional area using the pontomedullary junction. FRONTIERS IN NEUROIMAGING 2022; 1:1031253. [PMID: 37555172 PMCID: PMC10406309 DOI: 10.3389/fnimg.2022.1031253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/04/2022] [Indexed: 08/10/2023]
Abstract
Spinal cord cross-sectional area (CSA) is a relevant biomarker to assess spinal cord atrophy in neurodegenerative diseases. However, the considerable inter-subject variability among healthy participants currently limits its usage. Previous studies explored factors contributing to the variability, yet the normalization models required manual intervention and used vertebral levels as a reference, which is an imprecise prediction of the spinal levels. In this study we implemented a method to measure CSA automatically from a spatial reference based on the central nervous system (the pontomedullary junction, PMJ), we investigated factors to explain variability, and developed normalization strategies on a large cohort (N = 804). Following automatic spinal cord segmentation, vertebral labeling and PMJ labeling, the spinal cord CSA was computed on T1w MRI scans from the UK Biobank database. The CSA was computed using two methods. For the first method, the CSA was computed at the level of the C2-C3 intervertebral disc. For the second method, the CSA was computed at 64 mm caudally from the PMJ, this distance corresponding to the average distance between the PMJ and the C2-C3 disc across all participants. The effect of various demographic and anatomical factors was explored, and a stepwise regression found significant predictors; the coefficients of the best fit model were used to normalize CSA. CSA measured at C2-C3 disc and using the PMJ differed significantly (paired t-test, p-value = 0.0002). The best normalization model included thalamus, brain volume, sex and the interaction between brain volume and sex. The coefficient of variation went down for PMJ CSA from 10.09 (without normalization) to 8.59%, a reduction of 14.85%. For CSA at C2-C3, it went down from 9.96 to 8.42%, a reduction of 15.13 %. This study introduces an end-to-end automatic pipeline to measure and normalize cord CSA from a neurological reference. This approach requires further validation to assess atrophy in longitudinal studies. The inter-subject variability of CSA can be partly accounted for by demographics and anatomical factors.
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Affiliation(s)
- Sandrine Bédard
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), University of Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
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113
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Seyman E, Kim D, Bharatha A, Casserly C. Quantitative spinal cord MRI and sexual dysfunction in multiple sclerosis. Mult Scler J Exp Transl Clin 2022; 8:20552173221132170. [PMID: 36277232 PMCID: PMC9585573 DOI: 10.1177/20552173221132170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Sexual dysfunction (SD) is frequently reported in multiple sclerosis (MS) and is likely related to MS-related damage to the spinal cord (SC). Objective To assess associations between SD and quantitative MRI measures in people with MS (pwMS). Methods This pilot study included 17 pwMS with SD who completed questionnaires assessing SD, mood, and fatigue. All participants underwent brain, cervical, and thoracic SC-MRI at 3T. Quantitative brain and SC-MRI measures, including brain/SC atrophy, SC lesion count, diffusion-tensor imaging (DTI) indices (fractional anisotropy [FA], mean, perpendicular, parallel diffusivity [MD, λ⊥, λ||]) and magnetization-transfer ratio (MTR) were obtained. Associations between quantitative MRI measures and SD were assessed while controlling for the extent of mood and fatigue symptomatology. Results Subjects were a mean age of 46.9 years and 29% female. All subjects had self-reported SD (MSISQ-19 = 40.7, SQoL: 55.9) and 65% had a concurrent psychiatric diagnosis. When correlations between SD severity were assessed with individual brain and SC-MRI measures while controlling for psychiatric symptomatology, no associations were found. The only variables showing independent associations with SD were anxiety (p = 0.03), depression (p = 0.05), and fatigue (p = 0.04). Conclusion We found no correlations between quantitative MRI measures in the brain and SC and severity of SD in pwMS, but psychiatric symptomatology and fatigue severity demonstrated relationships with SD. The multifactorial nature of SD in pwMS mandates a multidisciplinary approach.
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Affiliation(s)
- Estelle Seyman
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada,Division of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - David Kim
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Aditya Bharatha
- Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, London, Ontario, Canada
| | - Courtney Casserly
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
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Hoggarth MA, Wang MC, Hemmerling KJ, Vigotsky AD, Smith ZA, Parrish TB, Weber KA, Bright MG. Effects of variability in manually contoured spinal cord masks on fMRI co-registration and interpretation. Front Neurol 2022; 13:907581. [PMID: 36341092 PMCID: PMC9630922 DOI: 10.3389/fneur.2022.907581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/26/2022] [Indexed: 02/01/2023] Open
Abstract
Functional magnetic resonance imaging (fMRI) of the human spinal cord (SC) is a unique non-invasive method for characterizing neurovascular responses to stimuli. Group-analysis of SC fMRI data involves co-registration of subject-level data to standard space, which requires manual masking of the cord and may result in bias of group-level SC fMRI results. To test this, we examined variability in SC masks drawn in fMRI data from 21 healthy participants from a completed study mapping responses to sensory stimuli of the C7 dermatome. Masks were drawn on temporal mean functional image by eight raters with varying levels of neuroimaging experience, and the rater from the original study acted as a reference. Spatial agreement between rater and reference masks was measured using the Dice Similarity Coefficient, and the influence of rater and dataset was examined using ANOVA. Each rater's masks were used to register functional data to the PAM50 template. Gray matter-white matter signal contrast of registered functional data was used to evaluate the spatial normalization accuracy across raters. Subject- and group-level analyses of activation during left- and right-sided sensory stimuli were performed for each rater's co-registered data. Agreement with the reference SC mask was associated with both rater (F(7, 140) = 32.12, P < 2 × 10-16, η2 = 0.29) and dataset (F(20, 140) = 20.58, P < 2 × 10-16, η2 = 0.53). Dataset variations may reflect image quality metrics: the ratio between the signal intensity of spinal cord voxels and surrounding cerebrospinal fluid was correlated with DSC results (p < 0.001). As predicted, variability in the manually-drawn masks influenced spatial normalization, and GM:WM contrast in the registered data showed significant effects of rater and dataset (rater: F(8, 160) = 23.57, P < 2 × 10-16, η2 = 0.24; dataset: F(20, 160) = 22.00, P < 2 × 10-16, η2 = 0.56). Registration differences propagated into subject-level activation maps which showed rater-dependent agreement with the reference. Although group-level activation maps differed between raters, no systematic bias was identified. Increasing consistency in manual contouring of spinal cord fMRI data improved co-registration and inter-rater agreement in activation mapping, however our results suggest that improvements in image acquisition and post-processing are also critical to address.
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Affiliation(s)
- Mark A. Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Max C. Wang
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Kimberly J. Hemmerling
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Andrew D. Vigotsky
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
- Department of Statistics, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Zachary A. Smith
- Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Todd B. Parrish
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kenneth A. Weber
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Molly G. Bright
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
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115
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Joers JM, Adanyeguh IM, Deelchand DK, Hutter DH, Eberly LE, Iltis I, Bushara KO, Lenglet C, Henry PG. Spinal cord magnetic resonance imaging and spectroscopy detect early-stage alterations and disease progression in Friedreich ataxia. Brain Commun 2022; 4:fcac246. [PMID: 36300142 PMCID: PMC9581897 DOI: 10.1093/braincomms/fcac246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/04/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023] Open
Abstract
Friedreich ataxia is the most common hereditary ataxia. Atrophy of the spinal cord is one of the hallmarks of the disease. MRI and magnetic resonance spectroscopy are powerful and non-invasive tools to investigate pathological changes in the spinal cord. A handful of studies have reported cross-sectional alterations in Friedreich ataxia using MRI and diffusion MRI. However, to our knowledge no longitudinal MRI, diffusion MRI or MRS results have been reported in the spinal cord. Here, we investigated early-stage cross-sectional alterations and longitudinal changes in the cervical spinal cord in Friedreich ataxia, using a multimodal magnetic resonance protocol comprising morphometric (anatomical MRI), microstructural (diffusion MRI), and neurochemical (1H-MRS) assessments.We enrolled 28 early-stage individuals with Friedreich ataxia and 20 age- and gender-matched controls (cross-sectional study). Disease duration at baseline was 5.5 ± 4.0 years and Friedreich Ataxia Rating Scale total neurological score at baseline was 42.7 ± 13.6. Twenty-one Friedreich ataxia participants returned for 1-year follow-up, and 19 of those for 2-year follow-up (cohort study). Each visit consisted in clinical assessments and magnetic resonance scans. Controls were scanned at baseline only. At baseline, individuals with Friedreich ataxia had significantly lower spinal cord cross-sectional area (-31%, P = 8 × 10-17), higher eccentricity (+10%, P = 5 × 10-7), lower total N-acetyl-aspartate (tNAA) (-36%, P = 6 × 10-9) and higher myo-inositol (mIns) (+37%, P = 2 × 10-6) corresponding to a lower ratio tNAA/mIns (-52%, P = 2 × 10-13), lower fractional anisotropy (-24%, P = 10-9), as well as higher radial diffusivity (+56%, P = 2 × 10-9), mean diffusivity (+35%, P = 10-8) and axial diffusivity (+17%, P = 4 × 10-5) relative to controls. Longitudinally, spinal cord cross-sectional area decreased by 2.4% per year relative to baseline (P = 4 × 10-4), the ratio tNAA/mIns decreased by 5.8% per year (P = 0.03), and fractional anisotropy showed a trend to decrease (-3.2% per year, P = 0.08). Spinal cord cross-sectional area correlated strongly with clinical measures, with the strongest correlation coefficients found between cross-sectional area and Scale for the Assessment and Rating of Ataxia (R = -0.55, P = 7 × 10-6) and between cross-sectional area and Friedreich ataxia Rating Scale total neurological score (R = -0.60, P = 4 × 10-7). Less strong but still significant correlations were found for fractional anisotropy and tNAA/mIns. We report here the first quantitative longitudinal magnetic resonance results in the spinal cord in Friedreich ataxia. The largest longitudinal effect size was found for spinal cord cross-sectional area, followed by tNAA/mIns and fractional anisotropy. Our results provide direct evidence that abnormalities in the spinal cord result not solely from hypoplasia, but also from neurodegeneration, and show that disease progression can be monitored non-invasively in the spinal cord.
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Affiliation(s)
| | | | - Dinesh K Deelchand
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Diane H Hutter
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Isabelle Iltis
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Khalaf O Bushara
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | | | - Pierre-Gilles Henry
- Correspondence to: Pierre-Gilles Henry, Ph.D Associate Professor, Center for Magnetic Resonance Research 2021 6th Street SE Minneapolis MN 55455, USA E-mail:
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Bueno A, Bosch I, Rodríguez A, Jiménez A, Carreres J, Fernández M, Marti-Bonmati L, Alberich-Bayarri A. Automated Cervical Spinal Cord Segmentation in Real-World MRI of Multiple Sclerosis Patients by Optimized Hybrid Residual Attention-Aware Convolutional Neural Networks. J Digit Imaging 2022; 35:1131-1142. [PMID: 35789447 PMCID: PMC9582086 DOI: 10.1007/s10278-022-00637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 03/22/2022] [Accepted: 04/09/2022] [Indexed: 10/17/2022] Open
Abstract
Magnetic resonance (MR) imaging is the most sensitive clinical tool in the diagnosis and monitoring of multiple sclerosis (MS) alterations. Spinal cord evaluation has gained interest in this clinical scenario in recent years, but, unlike the brain, there is a more limited choice of algorithms to assist spinal cord segmentation. Our goal was to investigate and develop an automatic MR cervical cord segmentation method, enabling automated and seamless spinal cord atrophy assessment and setting the stage for the development of an aggregated algorithm for the extraction of lesion-related imaging biomarkers. The algorithm was developed using a real-world MR imaging dataset of 121 MS patients (96 cases used as a training dataset and 25 cases as a validation dataset). Transversal, 3D T1-weighted gradient echo MR images (TE/TR/FA = 1.7-2.7 ms/5.6-8.2 ms/12°) were acquired in a 3 T system (Signa HD, GEHC) as standard of care in our clinical practice. Experienced radiologists supervised the manual labelling, which was considered the ground-truth. The 2D convolutional neural network consisted of a hybrid residual attention-aware segmentation method trained to delineate the cervical spinal cord. The training was conducted using a focal loss function, based on the Tversky index to address label imbalance, and an automatic optimal learning rate finder. Our automated model provided an accurate segmentation, achieving a validation DICE coefficient of 0.904 ± 0.101 compared with the manual delineation. An automatic method for cervical spinal cord segmentation on T1-weighted MR images was successfully implemented. It will have direct implications serving as the first step for accelerating the process for MS staging and follow-up through imaging biomarkers.
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Affiliation(s)
- América Bueno
- Instituto de Tecnologías y Aplicaciones Multimedia, Universitat Politècnica de Valencia, Valencia, Spain.
| | - Ignacio Bosch
- Instituto de Tecnologías y Aplicaciones Multimedia, Universitat Politècnica de Valencia, Valencia, Spain
| | - Alejandro Rodríguez
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Ana Jiménez
- Quantitative Imaging Biomarkers in Medicine, QUIBIM S.L, Valencia, Spain
| | - Joan Carreres
- Radiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Matías Fernández
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Luis Marti-Bonmati
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Imaging La Fe node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), Valencia, Spain
| | - Angel Alberich-Bayarri
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Quantitative Imaging Biomarkers in Medicine, QUIBIM S.L, Valencia, Spain
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Jayasekera D, Zhang JK, Blum J, Jakes R, Sun P, Javeed S, Greenberg JK, Song SK, Ray WZ. Analysis of combined clinical and diffusion basis spectrum imaging metrics to predict the outcome of chronic cervical spondylotic myelopathy following cervical decompression surgery. J Neurosurg Spine 2022; 37:588-598. [PMID: 35523255 PMCID: PMC10629375 DOI: 10.3171/2022.3.spine2294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical spondylotic myelopathy (CSM) is the most common cause of chronic spinal cord injury, a significant public health problem. Diffusion tensor imaging (DTI) is a neuroimaging technique widely used to assess CNS tissue pathology and is increasingly used in CSM. However, DTI lacks the needed accuracy, precision, and recall to image pathologies of spinal cord injury as the disease progresses. Thus, the authors used diffusion basis spectrum imaging (DBSI) to delineate white matter injury more accurately in the setting of spinal cord compression. It was hypothesized that the profiles of multiple DBSI metrics can serve as imaging outcome predictors to accurately predict a patient's response to therapy and his or her long-term prognosis. This hypothesis was tested by using DBSI metrics as input features in a support vector machine (SVM) algorithm. METHODS Fifty patients with CSM and 20 healthy controls were recruited to receive diffusion-weighted MRI examinations. All spinal cord white matter was identified as the region of interest (ROI). DBSI and DTI metrics were extracted from all voxels in the ROI and the median value of each patient was used in analyses. An SVM with optimized hyperparameters was trained using clinical and imaging metrics separately and collectively to predict patient outcomes. Patient outcomes were determined by calculating changes between pre- and postoperative modified Japanese Orthopaedic Association (mJOA) scale scores. RESULTS Accuracy, precision, recall, and F1 score were reported for each SVM iteration. The highest performance was observed when a combination of clinical and DBSI metrics was used to train an SVM. When assessing patient outcomes using mJOA scale scores, the SVM trained with clinical and DBSI metrics achieved accuracy and an area under the curve of 88.1% and 0.95, compared with 66.7% and 0.65, respectively, when clinical and DTI metrics were used together. CONCLUSIONS The accuracy and efficacy of the SVM incorporating clinical and DBSI metrics show promise for clinical applications in predicting patient outcomes. These results suggest that DBSI metrics, along with the clinical presentation, could serve as a surrogate in prognosticating outcomes of patients with CSM.
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Affiliation(s)
- Dinal Jayasekera
- Department of Biomedical Engineering, Washington University in St. Louis McKelvey School of Engineering, St. Louis
| | - Justin K. Zhang
- Department of Neurosurgery, Washington University School of Medicine, St. Louis
| | - Jacob Blum
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Rachel Jakes
- Department of Biomedical Engineering, Case School of Engineering, Cleveland, Ohio
| | - Peng Sun
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Saad Javeed
- Department of Neurosurgery, Washington University School of Medicine, St. Louis
| | - Jacob K. Greenberg
- Department of Neurosurgery, Washington University School of Medicine, St. Louis
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Wilson Z. Ray
- Department of Biomedical Engineering, Washington University in St. Louis McKelvey School of Engineering, St. Louis
- Department of Neurosurgery, Washington University School of Medicine, St. Louis
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118
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Dauleac C, Frindel C, Pélissou-Guyotat I, Nicolas C, Yeh FC, Fernandez-Miranda J, Cotton F, Jacquesson T. Full cervical cord tractography: A new method for clinical use. Front Neuroanat 2022; 16:993464. [PMID: 36237419 PMCID: PMC9550930 DOI: 10.3389/fnana.2022.993464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
Despite recent improvements in diffusion-weighted imaging, spinal cord tractography is not used in routine clinical practice because of difficulties in reconstructing tractograms, with a pertinent tri-dimensional-rendering, in a long post-processing time. We propose a new full tractography approach to the cervical spinal cord without extensive manual filtering or multiple regions of interest seeding that could help neurosurgeons manage various spinal cord disorders. Four healthy volunteers and two patients with either cervical intramedullary tumors or spinal cord injuries were included. Diffusion-weighted images of the cervical spinal cord were acquired using a Philips 3 Tesla machine, 32 diffusion directions, 1,000 s/mm2b-value, 2 × 2 × 2 mm voxel size, reduced field-of-view (ZOOM), with two opposing phase-encoding directions. Distortion corrections were then achieved using the FSL software package, and tracking of the full cervical spinal cord was performed using the DSI Studio software (quantitative anisotropy-based deterministic algorithm). A unique region of avoidance was used to exclude everything that is not of the nervous system. Fiber tracking parameters used adaptative fractional anisotropy from 0.015 to 0.045, fiber length from 10 to 1,000 mm, and angular threshold of 90°. In all participants, a full cervical cord tractography was performed from the medulla to the C7 spine level. On a ventral view, the junction between the medulla and spinal cord was identified with its pyramidal bulging, and by an invagination corresponding to the median ventral sulcus. On a dorsal view, the fourth ventricle—superior, middle, and inferior cerebellar peduncles—was seen, as well as its floor and the obex; and gracile and cuneate tracts were recognized on each side of the dorsal median sulcus. In the case of the intramedullary tumor or spinal cord injury, the spinal tracts were seen to be displaced, and this helped to adjust the neurosurgical strategy. This new full tractography approach simplifies the tractography pipeline and provides a reliable 3D-rendering of the spinal cord that could help to adjust the neurosurgical strategy.
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Affiliation(s)
- Corentin Dauleac
- Service de Neurochirurgie, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
- *Correspondence: Corentin Dauleac
| | - Carole Frindel
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
| | - Isabelle Pélissou-Guyotat
- Service de Neurochirurgie, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Célia Nicolas
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de Radiologie, Lyon, France
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - François Cotton
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de Radiologie, Lyon, France
| | - Timothée Jacquesson
- Service de Neurochirurgie, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
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119
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Olafson E, Russello G, Jamison KW, Liu H, Wang D, Bruss JE, Boes AD, Kuceyeski A. Frontoparietal network activation is associated with motor recovery in ischemic stroke patients. Commun Biol 2022; 5:993. [PMID: 36131012 PMCID: PMC9492673 DOI: 10.1038/s42003-022-03950-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Strokes cause lesions that damage brain tissue, disrupt normal brain activity patterns and can lead to impairments in motor function. Although modulation of cortical activity is central to stimulation-based rehabilitative therapies, aberrant and adaptive patterns of brain activity after stroke have not yet been fully characterized. Here, we apply a brain dynamics analysis approach to study longitudinal brain activity patterns in individuals with ischemic pontine stroke. We first found 4 commonly occurring brain states largely characterized by high amplitude activations in the visual, frontoparietal, default mode, and motor networks. Stroke subjects spent less time in the frontoparietal state compared to controls. For individuals with dominant-hand CST damage, more time spent in the frontoparietal state from 1 week to 3-6 months post-stroke was associated with better motor recovery over the same time period, an association which was independent of baseline impairment. Furthermore, the amount of time spent in brain states was linked empirically to functional connectivity. This work suggests that when the dominant-hand CST is compromised in stroke, resting state configurations may include increased activation of the frontoparietal network, which may facilitate compensatory neural pathways that support recovery of motor function when traditional motor circuits of the dominant-hemisphere are compromised.
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Affiliation(s)
- Emily Olafson
- Department of Radiology, Weill Cornell Medicine, New York City, NY, 10021, USA.
| | - Georgia Russello
- Pelham Memorial High School, 575 Colonial Ave, Village of Pelham, NY, 10803, USA
| | - Keith W Jamison
- Department of Radiology, Weill Cornell Medicine, New York City, NY, 10021, USA
| | - Hesheng Liu
- Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA
| | - Danhong Wang
- Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA
| | - Joel E Bruss
- Department of Neurology, University of Iowa, Iowa City, IA, 52242, USA
| | - Aaron D Boes
- Department of Neurology, University of Iowa, Iowa City, IA, 52242, USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York City, NY, 10021, USA
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120
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Barry RL, Torrado-Carvajal A, Kirsch JE, Arabasz GE, Albrecht DS, Alshelh Z, Pijanowski O, Lewis AJ, Keegan M, Reynolds B, Knight PC, Morrissey EJ, Loggia ML, Atassi N, Hooker JM, Babu S. Selective atrophy of the cervical enlargement in whole spinal cord MRI of amyotrophic lateral sclerosis. Neuroimage Clin 2022; 36:103199. [PMID: 36137496 PMCID: PMC9668597 DOI: 10.1016/j.nicl.2022.103199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/26/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a deadly neurodegenerative disorder affecting motor neurons in the spinal cord and brain. Studies have reported on atrophy within segments of the cervical cord, but we are not aware of previous investigations of the whole spinal cord. Herein we present our findings from a 3T MRI study involving 32 subjects (15 ALS participants and 17 healthy controls) characterizing cross-sectional area along the entire cord. We report atrophy of the cervical enlargement in ALS participants, but no evidence of atrophy of the thoracolumbar enlargement. These results suggest that MR-based analyses of the cervical cord may be sufficient for in vivo investigations of spinal cord atrophy in ALS, and that atrophy of the cervical enlargement (C4-C7) is a potential imaging marker for quantifying lower motor neuron degradation.
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Affiliation(s)
- Robert L. Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA,Department of Radiology, Harvard Medical School, Boston, MA, USA,Harvard–Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA,Corresponding authors.
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA,Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - John E. Kirsch
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Grae E. Arabasz
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Daniel S. Albrecht
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Zeynab Alshelh
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Olivia Pijanowski
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA
| | - Austin J. Lewis
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA
| | - Mackenzie Keegan
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA
| | - Beverly Reynolds
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA
| | - Paulina C. Knight
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA
| | - Erin J. Morrissey
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Marco L. Loggia
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA,Department of Radiology, Harvard Medical School, Boston, MA, USA,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nazem Atassi
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA,Department of Neurology, Harvard Medical School, Boston, MA, USA,Sanofi Genzyme, Cambridge, MA, USA
| | - Jacob M. Hooker
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Suma Babu
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA,Department of Neurology, Harvard Medical School, Boston, MA, USA,Corresponding authors.
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Kim Y, Varosanec M, Kosa P, Bielekova B. Confounder-adjusted MRI-based predictors of multiple sclerosis disability. FRONTIERS IN RADIOLOGY 2022; 2:971157. [PMID: 37492673 PMCID: PMC10365278 DOI: 10.3389/fradi.2022.971157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/02/2022] [Indexed: 07/27/2023]
Abstract
Introduction Both aging and multiple sclerosis (MS) cause central nervous system (CNS) atrophy. Excess brain atrophy in MS has been interpreted as "accelerated aging." Current paper tests an alternative hypothesis: MS causes CNS atrophy by mechanism(s) different from physiological aging. Thus, subtracting effects of physiological confounders on CNS structures would isolate MS-specific effects. Methods Standardized brain MRI and neurological examination were acquired prospectively in 646 participants enrolled in ClinicalTrials.gov Identifier: NCT00794352 protocol. CNS volumes were measured retrospectively, by automated Lesion-TOADS algorithm and by Spinal Cord Toolbox, in a blinded fashion. Physiological confounders identified in 80 healthy volunteers were regressed out by stepwise multiple linear regression. MS specificity of confounder-adjusted MRI features was assessed in non-MS cohort (n = 158). MS patients were randomly split into training (n = 277) and validation (n = 131) cohorts. Gradient boosting machine (GBM) models were generated in MS training cohort from unadjusted and confounder-adjusted CNS volumes against four disability scales. Results Confounder adjustment highlighted MS-specific progressive loss of CNS white matter. GBM model performance decreased substantially from training to cross-validation, to independent validation cohorts, but all models predicted cognitive and physical disability with low p-values and effect sizes that outperform published literature based on recent meta-analysis. Models built from confounder-adjusted MRI predictors outperformed models from unadjusted predictors in the validation cohort. Conclusion GBM models from confounder-adjusted volumetric MRI features reflect MS-specific CNS injury, and due to stronger correlation with clinical outcomes compared to brain atrophy these models should be explored in future MS clinical trials.
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Yang HE, Kim WT, Kim DH, Kim SW, Yoo WK. Utility of Diffusion and Magnetization Transfer MRI in Cervical Spondylotic Myelopathy: A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12092090. [PMID: 36140491 PMCID: PMC9497906 DOI: 10.3390/diagnostics12092090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
Diffusion tensor imaging (DTI) and magnetization transfer (MT) magnetic resonance imaging (MRI) can help detect spinal cord pathology, and tract-specific analysis of their parameters, such as fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD), radial diffusivity (RD) and MT ratio (MTR), can give microstructural information. We performed the tract-based acquisition of MR parameters of three major motor tracts: the lateral corticospinal (CS), rubrospinal (RuS) tract, and lateral reticulospinal (RS) tract as well as two major sensory tracts, i.e., the fasciculus cuneatus (FC) and spinal lemniscus, to detect pathologic change and find correlations with clinical items. MR parameters were extracted for each tract at three levels: the most compressed lesion level and above and below the lesion. We compared the MR parameters of eight cervical spondylotic myelopathy patients and 12 normal controls and analyzed the correlation between clinical evaluation items and MR parameters in patients. RuS and lateral RS showed worse DTI parameters at the lesion level in patients compared to the controls. Worse DTI parameters in those tracts were correlated with weaker power grasp at the lesion level. FC and lateral CS showed a correlation between higher RD and lower FA and MTR with a weaker lateral pinch below the lesion level.
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Affiliation(s)
- Hea-Eun Yang
- Department of Rehabilitation Medicine, VHS Medical Center, Seoul 05368, Korea
| | - Wan-Tae Kim
- Department of Radiology, VHS Medical Center, Seoul 05368, Korea
| | - Dae-Hyun Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Seok-Woo Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
- Correspondence:
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Kossowski B, Kong Y, Klimiec-Moskal E, Emir U, Palace J, Juryńczyk M. Relapsing antibody-negative patients with features of neuromyelitis optica spectrum disorders: Differences in N-acetylaspartate level in the cervical spinal cord indicate distinct underlying processes. Mult Scler 2022; 28:2221-2230. [PMID: 35971567 DOI: 10.1177/13524585221115304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Due to lack of biomarkers, antibody-negative patients with features of neuromyelitis optica spectrum disorders (NMOSD) are among the most challenging to diagnose and treat. Using unsupervised clustering, we recently identified 'MS-like', 'spinal MS-like', 'classic NMOSD-like' and 'NMOSD-like with brain involvement' subgroups in this cohort. OBJECTIVE We used magnetic resonance spectroscopy (MRS) to examine differences in the level of key metabolites in the spinal cord between the four identified subgroups. METHODS Twenty-five relapsing antibody-negative patients with NMOSD features classified by the unsupervised algorithm to one of the subgroups underwent a prospective cervical spinal cord MRS. Spectra from 16 patients fulfilled quality criteria and were included in the analysis. RESULTS Total N-acetylaspartate (tNAA), but not total choline (tCho) or myo-inositol (Ins), was significantly different between the four subgroups (p = 0.03). In particular, tNAA was 47.8% lower in the 'MS-like' subgroup as compared with the 'classic NMOSD-like' subgroup (p = 0.02). While we found a negative overall correlation between tNAA and disability score (r = -0.514, p = 0.04) in the whole cohort, the disability score did not differ significantly between the subgroups to explain subgroup differences in tNAA level. CONCLUSIONS Significant differences in the cervical spinal cord tNAA measurements confirm that the previously identified clinico-radiologic subgroups contain patients with distinct underlying disease processes.
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Affiliation(s)
- Bartosz Kossowski
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Yazhuo Kong
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Uzay Emir
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Headley Way, OX3 9DU Oxford, UK.,Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Maciej Juryńczyk
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Pasteura 3 Street, 02-098 Warsaw, Poland.,Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland; Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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124
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Kaptan M, Vannesjo SJ, Mildner T, Horn U, Hartley‐Davies R, Oliva V, Brooks JCW, Weiskopf N, Finsterbusch J, Eippert F. Automated slice-specific z-shimming for functional magnetic resonance imaging of the human spinal cord. Hum Brain Mapp 2022; 43:5389-5407. [PMID: 35938527 PMCID: PMC9704784 DOI: 10.1002/hbm.26018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 01/15/2023] Open
Abstract
Functional magnetic resonance imaging (fMRI) of the human spinal cord faces many challenges, such as signal loss due to local magnetic field inhomogeneities. This issue can be addressed with slice-specific z-shimming, which compensates for the dephasing effect of the inhomogeneities using a slice-specific gradient pulse. Here, we aim to address outstanding issues regarding this technique by evaluating its effects on several aspects that are directly relevant for spinal fMRI and by developing two automated procedures in order to improve upon the time-consuming and subjective nature of manual selection of z-shims: one procedure finds the z-shim that maximizes signal intensity in each slice of an EPI reference-scan and the other finds the through-slice field inhomogeneity for each EPI-slice in field map data and calculates the required compensation gradient moment. We demonstrate that the beneficial effects of z-shimming are apparent across different echo times, hold true for both the dorsal and ventral horn, and are also apparent in the temporal signal-to-noise ratio (tSNR) of EPI time-series data. Both of our automated approaches were faster than the manual approach, lead to significant improvements in gray matter tSNR compared to no z-shimming and resulted in beneficial effects that were stable across time. While the field-map-based approach performed slightly worse than the manual approach, the EPI-based approach performed as well as the manual one and was furthermore validated on an external corticospinal data-set (N > 100). Together, automated z-shimming may improve the data quality of future spinal fMRI studies and lead to increased reproducibility in longitudinal studies.
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Affiliation(s)
- Merve Kaptan
- Max Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
| | - S. Johanna Vannesjo
- Department of PhysicsNorwegian University of Science and TechnologyTrondheimNorway
| | - Toralf Mildner
- Max Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
| | - Ulrike Horn
- Max Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
| | | | - Valeria Oliva
- School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - Jonathan C. W. Brooks
- School of PsychologyUniversity of East Anglia Wellcome Wolfson Brain Imaging Centre (UWWBIC)NorwichUK
| | - Nikolaus Weiskopf
- Max Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany,Felix Bloch Institute for Solid State Physics, Faculty of Physics and Earth SciencesLeipzig UniversityLeipzigGermany
| | - Jürgen Finsterbusch
- Department of Systems NeuroscienceUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Falk Eippert
- Max Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
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125
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Alami Marrouni K, Duquette P. Clinical insights on the spasticity-plus syndrome in multiple sclerosis. Front Neurol 2022; 13:958665. [PMID: 35989901 PMCID: PMC9390998 DOI: 10.3389/fneur.2022.958665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kanza Alami Marrouni
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Pierre Duquette
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Neurology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- *Correspondence: Pierre Duquette
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126
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Combes AJE, O'Grady KP, Rogers BP, Schilling KG, Lawless RD, Visagie M, Houston D, Prock L, Malone S, Satish S, Witt AA, McKnight CD, Bagnato F, Gore JC, Smith SA. Functional connectivity in the dorsal network of the cervical spinal cord is correlated with diffusion tensor imaging indices in relapsing-remitting multiple sclerosis. Neuroimage Clin 2022; 35:103127. [PMID: 35917721 PMCID: PMC9421501 DOI: 10.1016/j.nicl.2022.103127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/03/2022] [Accepted: 07/23/2022] [Indexed: 01/12/2023]
Abstract
Focal lesions may affect functional connectivity (FC) of the ventral and dorsal networks in the cervical spinal cord of people with relapsing-remitting multiple sclerosis (RRMS). Resting-state FC can be measured using functional MRI (fMRI) at 3T. This study sought to determine whether alterations in FC may be related to the degree of damage in the normal-appearing tissue. Tissue integrity and FC in the cervical spinal cord were assessed with diffusion tensor imaging (DTI) and resting-state fMRI, respectively, in a group of 26 RRMS participants with high cervical lesion load, low disability, and minimally impaired sensorimotor function, and healthy controls. Lower fractional anisotropy (FA) and higher radial diffusivity (RD) were observed in the normal-appearing white matter in the RRMS group relative to controls. Average FC in ventral and dorsal networks was similar between groups. Significant associations were found between higher FC in the dorsal sensory network and several DTI markers of pathology in the normal-appearing tissue. In the normal-appearing grey matter, dorsal FC was positively correlated with axial diffusivity (AD) (r = 0.46, p = 0.020) and mean diffusivity (MD) (r = 0.43, p = 0.032). In the normal-appearing white matter, dorsal FC was negatively correlated with FA (r = -0.43, p = 0.028) and positively correlated with RD (r = 0.49, p = 0.012), AD (r = 0.42, p = 0.037) and MD (r = 0.53, p = 0.006). These results suggest that increased connectivity, while remaining within the normal range, may represent a compensatory mechanism in response to structural damage in support of preserved sensory function in RRMS.
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Affiliation(s)
- Anna J E Combes
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. South, Nashville, TN 37232, United States.
| | - Kristin P O'Grady
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. South, Nashville, TN 37232, United States
| | - Baxter P Rogers
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. South, Nashville, TN 37232, United States
| | - Kurt G Schilling
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. South, Nashville, TN 37232, United States
| | - Richard D Lawless
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States; Department of Biomedical Engineering, Vanderbilt University, 2301 Vanderbilt Place, PMB 351826, Nashville, TN 37235-1826, United States
| | - Mereze Visagie
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States
| | - Delaney Houston
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States
| | - Logan Prock
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States
| | - Shekinah Malone
- School of Medicine, Meharry Medical College, 1005 Dr. D. B. Todd, Jr. Blvd., Nashville, TN 37208, United States
| | - Sanjana Satish
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States
| | - Atlee A Witt
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States
| | - Colin D McKnight
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. South, Nashville, TN 37232, United States
| | - Francesca Bagnato
- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, 1161 21st Ave. South, A-0118 Medical Center North, Nashville, TN 37232, United States; Department of Neurology, Nashville VA Medical Center, TN Valley Healthcare System, 1310 24th Avenue South, Nashville, TN 37212-2637, United States
| | - John C Gore
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. South, Nashville, TN 37232, United States; Department of Biomedical Engineering, Vanderbilt University, 2301 Vanderbilt Place, PMB 351826, Nashville, TN 37235-1826, United States
| | - Seth A Smith
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. South, Nashville, TN 37232, United States; Department of Biomedical Engineering, Vanderbilt University, 2301 Vanderbilt Place, PMB 351826, Nashville, TN 37235-1826, United States
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127
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Shinn R, Riffe A, Edwards M, Rossmeisl J. MRI diffusion tensor imaging scalar values in dogs with intervertebral disc herniation: A comparison between manual and semiautomated region of interest methods. Vet Radiol Ultrasound 2022; 63:753-762. [PMID: 35789512 DOI: 10.1111/vru.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
Magnetic resonance imaging (MRI) diffusion tensor imaging (DTI) measures have been described as methods for quantifying spinal cord injury and predicting outcome in dogs with intervertebral disc herniation (IVDH); however, studies comparing methods for selecting regions of interest (ROIs) are currently lacking. The aims of this retrospective, methods comparison, observational study were to compare DTI measurements acquired using manual (mROI) versus semiautomated ROI (sROI) methods and to compare DTI measurements with patient outcomes. Magnetic resonance imaging scans that included DTI pulse sequences were retrieved for 65 dogs with confirmed IVDH. Regions of interest were placed at one vertebral length cranial and caudal to the region of spinal cord compression (RSCC) using the mROI and sROI methods. Scalar values based on the mROI and sROI methods were compared. There was a significant difference for all DTI measures (P < 0.0001), where fractional anisotropy was higher (95% confidence interval [CI]: 0.15, 0.19) and mean diffusivity (MD; CI: -0.41, -0.35), axial diffusivity (AD; CI: -0.47, -0.36) and radial diffusivity (RD; CI: -0.36, -0.27) were lower for the mROI than for the sROI. For both the mROI and sROI, MD, AD, and RD were significantly lower (p < 0.05) at the RSCC in paraplegic dogs that did not regain motor function. The findings indicated that DTI methods for quantifying SCI using open source software and ROI were feasible for use in dogs with IVDH; however, values based on sROI methods differed from values based on mROI methods. Some DTI measures based on both the mROI and sROI methods were predictive of poor patient outcome.
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Affiliation(s)
- Richard Shinn
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Ashley Riffe
- VCA Alameda East Veterinary Hospital, Denver, Colorado, USA
| | - Michael Edwards
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - John Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
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128
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Usuda N, Sugawara SK, Fukuyama H, Nakazawa K, Amemiya K, Nishimura Y. Quantitative comparison of corticospinal tracts arising from different cortical areas in humans. Neurosci Res 2022; 183:30-49. [PMID: 35787428 DOI: 10.1016/j.neures.2022.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/05/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
The corticospinal tract (CST), which plays a major role in the control of voluntary limb movements, arises from multiple motor- and somatosensory-related areas in monkeys. Although the cortical origin and quantitative differences in CSTs among the cortical areas are well-documented in monkeys, they are unclear in humans. We quantitatively investigated the CSTs from the cerebral cortex to the cervical cord in healthy volunteers using fiber tractography of diffusion-weighted magnetic resonance imaging. The corticospinal (CS) streamlines arose from nine cortical areas: primary motor area (mean ± SD = 49.71 ± 1.61%), dorsal (16.33 ± 1.37%) and ventral (11.02 ± 0.90%) premotor cortex, supplementary motor area (5.14 ± 0.36%), pre-supplementary motor area (2.46 ± 0.26%), primary somatosensory cortex (11.06 ± 0.91%), Brodmann area 5 (0.88 ± 0.09%), caudal cingulate zone (1.70 ± 0.30%), and posterior part of the rostral cingulate zone (1.70 ± 0.34%). In all cortical areas, the number of CS streamlines gradually decreased from the rostral to caudal spinal segments, but the proportion was maintained throughout the cervical cord. Over 75% of CS streamlines arose from the lateral surface of the frontal lobe, which may explain the voluntary control of dexterous and flexible limb movements in humans. (197/200 words).
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Affiliation(s)
- Noboru Usuda
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan; Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Meguro, Tokyo 153-8902, Japan
| | - Sho K Sugawara
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan
| | - Hiroyuki Fukuyama
- Department of Radiology, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo 156-0057, Japan
| | - Kimitaka Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Meguro, Tokyo 153-8902, Japan
| | - Kiyomi Amemiya
- Department of Radiology, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo 156-0057, Japan
| | - Yukio Nishimura
- Neural Prosthetics Project, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo 156-8506, Japan.
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129
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Han X, Ma X, Li D, Wang J, Jiang W, Li G, Cheng X, Guo H, Tian W. Application of Neurite Orientation Dispersion and Density Imaging to Evaluate and Predict the Surgical Outcome for Degenerative Cervical Myelopathy. Orthop Surg 2022; 14:1482-1488. [PMID: 35686537 PMCID: PMC9251269 DOI: 10.1111/os.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Although the neurite orientation dispersion and density imaging (NODDI) has been shown useful to evaluate the spinal cord dysfunction, there are few prospective studies on analyzing the operation recovery of degenerative cervical myelopathy (DCM) disease using NODDI. This study aims to investigate the preoperative evaluation and predictive ability of NODDI in DCM patients who received posterior cervical laminoplasty. Methods This prospective study included 55 patients with DCM from January to December 2017. NODDI metrics, including intracellular volume fraction (Vic), isotropic volume fraction (Viso), and orientation dispersion index (ODI) were measured at the maximally compressed (MC) level and the non‐compressed C2 level in each patient at the preoperative and the 3‐ and 6‐month postoperative follow‐up stages. Neurological function was assessed using the modified Japanese Orthopaedic Association (mJOA) scoring system at each stage. Spearman's correlation and Kendall's tau‐b correlation were used to analyze the relationship between NODDI metrics and mJOA scores. Wilcoxon signed rank test was used to examine the changes in the NODDI and mJOA scores between the preoperative and 6‐month follow‐up stages. ROC analysis was used to further evaluate the predictive capability. Results Preoperative Vic at the level of C2 has a significant correlation with the preoperative mJOA score (r = 0.278, p = 0.048). Vic and Viso at the MC level were significantly different between the preoperative period and 6‐month follow‐up. Viso at the MC level was correlated with the mJOA score at 6‐month follow‐up (r = −0.302, p = 0.044). Vic and ODI at the C2 level predicted the surgical prognosis, with areas under the receiver‐operating characteristic curve of 0.663 (p = 0.042) and 0.716 (p = 0.014). Conclusions The preoperative NODDI metrics at the C2 level are capable of evaluating the severity of spinal cord dysfunction and predict the surgical outcome.
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Affiliation(s)
- Xiao Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Research Institute of Traumatology and Orthopaedics, Beijing, China
| | - Xiaodong Ma
- Center for Magnetic Resonance Research, Department of Radiology, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Donghang Li
- Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jinchao Wang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Wen Jiang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Guangqi Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Hua Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China
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130
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Madsen MAJ, Wiggermann V, Marques MFM, Lundell H, Cerri S, Puonti O, Blinkenberg M, Christensen JR, Sellebjerg F, Siebner HR. Linking lesions in sensorimotor cortex to contralateral hand function in multiple sclerosis: a 7 T MRI study. Brain 2022; 145:3522-3535. [PMID: 35653498 PMCID: PMC9586550 DOI: 10.1093/brain/awac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Cortical lesions constitute a key manifestation of multiple sclerosis and contribute to clinical disability and cognitive impairment. Yet it is unknown whether local cortical lesions and cortical lesion subtypes contribute to domain-specific impairments attributable to the function of the lesioned cortex.
In this cross-sectional study, we assessed how cortical lesions in the primary sensorimotor hand area (SM1-HAND) relate to corticomotor physiology and sensorimotor function of the contralateral hand. 50 relapse-free patients with relapsing-remitting or secondary-progressive multiple sclerosis and 28 healthy age- and sex-matched participants underwent whole-brain 7 T MRI to map cortical lesions. Brain scans were also used to estimate normalized brain volume, pericentral cortical thickness, white matter lesion fraction of the corticospinal tract, infratentorial lesion volume and the cross-sectional area of the upper cervical spinal cord. We tested sensorimotor hand function and calculated a motor and sensory composite score for each hand. In 37 patients and 20 healthy controls, we measured maximal motor evoked potential (MEP) amplitude, resting motor threshold and corticomotor conduction time with transcranial magnetic stimulation (TMS) and the N20 latency from somatosensory evoked potentials (SSEPs).
Patients showed at least one cortical lesion in the SM1-HAND in 47 of 100 hemispheres. The presence of a lesion was associated with worse contralateral sensory (P = 0.014) and motor (P = 0.009) composite scores. TMS of a lesion-positive SM1-HAND revealed a decreased maximal MEP amplitude (P < 0.001) and delayed corticomotor conduction (P = 0.002) relative to a lesion-negative SM1-HAND. Stepwise mixed linear regressions showed that the presence of an SM1-HAND lesion, higher white-matter lesion fraction of the corticospinal tract, reduced spinal cord cross-sectional area and higher infratentorial lesion volume were associated with reduced contralateral motor hand function. Cortical lesions in SM1-HAND, spinal cord cross-sectional area and normalized brain volume were also associated with smaller maximal MEP amplitude and longer corticomotor conduction times. The effect of cortical lesions on sensory function was no longer significant when controlling for MRI-based covariates. Lastly, we found that intracortical and subpial lesions had the largest effect on reduced motor hand function, intracortical lesions on reduced MEP amplitude and leukocortical lesions on delayed corticomotor conduction.
Together, this comprehensive multi-level assessment of sensorimotor brain damage shows that the presence of a cortical lesion in SM1-HAND is associated with impaired corticomotor function of the hand, after accounting for damage at the subcortical level. The results also provide preliminary evidence that cortical lesion types may affect the various facets of corticomotor function differentially.
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Affiliation(s)
- Mads A. J. Madsen
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Vanessa Wiggermann
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Marta F. M. Marques
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Henrik Lundell
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Stefano Cerri
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
- Technical University of Denmark Department of Health Technology, , 2800 Kgs. Lyngby, Denmark
| | - Oula Puonti
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Morten Blinkenberg
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
| | - Jeppe Romme Christensen
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
| | - Finn Sellebjerg
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
- University of Copenhagen Department of Clinical Medicine, , 2200 Copenhagen, Denmark
| | - Hartwig R. Siebner
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
- Copenhagen University Hospital - Bispebjerg & Frederiksberg Department of Neurology, , 2400 Copenhagen, Denmark
- University of Copenhagen Department of Clinical Medicine, , 2200 Copenhagen, Denmark
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131
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Trò R, Roascio M, Tortora D, Severino M, Rossi A, Cohen-Adad J, Fato MM, Arnulfo G. Diffusion Kurtosis Imaging of Neonatal Spinal Cord in Clinical Routine. FRONTIERS IN RADIOLOGY 2022; 2:794981. [PMID: 37492682 PMCID: PMC10365122 DOI: 10.3389/fradi.2022.794981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/20/2022] [Indexed: 07/27/2023]
Abstract
Diffusion kurtosis imaging (DKI) has undisputed advantages over the more classical diffusion magnetic resonance imaging (dMRI) as witnessed by the fast-increasing number of clinical applications and software packages widely adopted in brain imaging. However, in the neonatal setting, DKI is still largely underutilized, in particular in spinal cord (SC) imaging, because of its inherently demanding technological requirements. Due to its extreme sensitivity to non-Gaussian diffusion, DKI proves particularly suitable for detecting complex, subtle, fast microstructural changes occurring in this area at this early and critical stage of development, which are not identifiable with only DTI. Given the multiplicity of congenital anomalies of the spinal canal, their crucial effect on later developmental outcome, and the close interconnection between the SC region and the brain above, managing to apply such a method to the neonatal cohort becomes of utmost importance. This study will (i) mention current methodological challenges associated with the application of advanced dMRI methods, like DKI, in early infancy, (ii) illustrate the first semi-automated pipeline built on Spinal Cord Toolbox for handling the DKI data of neonatal SC, from acquisition setting to estimation of diffusion measures, through accurate adjustment of processing algorithms customized for adult SC, and (iii) present results of its application in a pilot clinical case study. With the proposed pipeline, we preliminarily show that DKI is more sensitive than DTI-related measures to alterations caused by brain white matter injuries in the underlying cervical SC.
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Affiliation(s)
- Rosella Trò
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Monica Roascio
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | | | | | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
- Mila—Quebec AI Institute, Montreal, QC, Canada
| | - Marco Massimo Fato
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Gabriele Arnulfo
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
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132
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De Stefano N, Battaglini M, Pareto D, Cortese R, Zhang J, Oesingmann N, Prados F, Rocca MA, Valsasina P, Vrenken H, Gandini Wheeler-Kingshott CAM, Filippi M, Barkhof F, Rovira À. MAGNIMS recommendations for harmonization of MRI data in MS multicenter studies. Neuroimage Clin 2022; 34:102972. [PMID: 35245791 PMCID: PMC8892169 DOI: 10.1016/j.nicl.2022.102972] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022]
Abstract
Sharing data from cooperative studies is essential to develop new biomarkers in MS. Differences in MRI acquisition, analysis, storage represent a substantial constraint. We review the state of the art and developments in the harmonization of MRI. We provide recommendations to harmonize large MRI datasets in the MS field.
There is an increasing need of sharing harmonized data from large, cooperative studies as this is essential to develop new diagnostic and prognostic biomarkers. In the field of multiple sclerosis (MS), the issue has become of paramount importance due to the need to translate into the clinical setting some of the most recent MRI achievements. However, differences in MRI acquisition parameters, image analysis and data storage across sites, with their potential bias, represent a substantial constraint. This review focuses on the state of the art, recent technical advances, and desirable future developments of the harmonization of acquisition, analysis and storage of large-scale multicentre MRI data of MS cohorts. Huge efforts are currently being made to achieve all the requirements needed to provide harmonized MRI datasets in the MS field, as proper management of large imaging datasets is one of our greatest opportunities and challenges in the coming years. Recommendations based on these achievements will be provided here. Despite the advances that have been made, the complexity of these tasks requires further research by specialized academical centres, with dedicated technical and human resources. Such collective efforts involving different professional figures are of crucial importance to offer to MS patients a personalised management while minimizing consumption of resources.
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Affiliation(s)
- Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Jian Zhang
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Ferran Prados
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Center for Medical Imaging Computing, Medical Physics and Biomedical Engineering, UCL, London, WC1V 6LJ, United Kingdom; e-Health Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Hugo Vrenken
- Amsterdam Neuroscience, MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Brain MRI 3T Research Center, C. Mondino National Neurological Institute, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Center for Medical Imaging Computing, Medical Physics and Biomedical Engineering, UCL, London, WC1V 6LJ, United Kingdom; Amsterdam Neuroscience, MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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133
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Tinnermann A, Sprenger C, Büchel C. Opioid analgesia alters corticospinal coupling along the descending pain system in healthy participants. eLife 2022; 11:74293. [PMID: 35471139 PMCID: PMC9042228 DOI: 10.7554/elife.74293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
Opioids are potent analgesic drugs with widespread cortical, subcortical, and spinal targets. In particular, the central pain system comprising ascending and descending pain pathways has high opioid receptor densities and is thus crucial for opioid analgesia. Here, we investigated the effects of the opioid remifentanil in a large sample (n = 78) of healthy male participants using combined corticospinal functional MRI. This approach offers the possibility to measure BOLD responses simultaneously in the brain and spinal cord, allowing us to investigate the role of corticospinal coupling in opioid analgesia. Our data show that opioids altered activity in regions involved in pain processing such as somatosensory regions, including the spinal cord and pain modulation such as prefrontal regions. Moreover, coupling strength along the descending pain system, that is, between the anterior cingulate cortex, periaqueductal gray, and spinal cord, was stronger in participants who reported stronger analgesia during opioid treatment while participants that received saline showed reduced coupling when experiencing less pain. These results indicate that coupling along the descending pain pathway is a potential mechanism of opioid analgesia and can differentiate between opioid analgesia and unspecific reductions in pain such as habituation.
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Affiliation(s)
- Alexandra Tinnermann
- Department for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Max Planck School of Cognition, Leipzig, Germany
| | - Christian Sprenger
- Department for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Büchel
- Department for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Max Planck School of Cognition, Leipzig, Germany
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134
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Valošek J, Bednařík P, Keřkovský M, Hluštík P, Bednařík J, Svatkova A. Quantitative MR Markers in Non-Myelopathic Spinal Cord Compression: A Narrative Review. J Clin Med 2022; 11:2301. [PMID: 35566426 PMCID: PMC9105390 DOI: 10.3390/jcm11092301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
Degenerative spinal cord compression is a frequent pathological condition with increasing prevalence throughout aging. Initial non-myelopathic cervical spinal cord compression (NMDC) might progress over time into potentially irreversible degenerative cervical myelopathy (DCM). While quantitative MRI (qMRI) techniques demonstrated the ability to depict intrinsic tissue properties, longitudinal in-vivo biomarkers to identify NMDC patients who will eventually develop DCM are still missing. Thus, we aim to review the ability of qMRI techniques (such as diffusion MRI, diffusion tensor imaging (DTI), magnetization transfer (MT) imaging, and magnetic resonance spectroscopy (1H-MRS)) to serve as prognostic markers in NMDC. While DTI in NMDC patients consistently detected lower fractional anisotropy and higher mean diffusivity at compressed levels, caused by demyelination and axonal injury, MT and 1H-MRS, along with advanced and tract-specific diffusion MRI, recently revealed microstructural alterations, also rostrally pointing to Wallerian degeneration. Recent studies also disclosed a significant relationship between microstructural damage and functional deficits, as assessed by qMRI and electrophysiology, respectively. Thus, tract-specific qMRI, in combination with electrophysiology, critically extends our understanding of the underlying pathophysiology of degenerative spinal cord compression and may provide predictive markers of DCM development for accurate patient management. However, the prognostic value must be validated in longitudinal studies.
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Affiliation(s)
- Jan Valošek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (J.V.); (P.H.)
- Department of Radiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
- Department of Biomedical Engineering, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Petr Bednařík
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark;
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Miloš Keřkovský
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (J.B.)
- Department of Radiology and Nuclear Medicine, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Petr Hluštík
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (J.V.); (P.H.)
- Department of Neurology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Josef Bednařík
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (J.B.)
- Department of Neurology, University Hospital Brno, 625 00 Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, 625 00 Brno, Czech Republic
| | - Alena Svatkova
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark;
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, 1090 Vienna, Austria
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135
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Cohen‐Adad J, Alonso‐Ortiz E, Alley S, Lagana MM, Baglio F, Vannesjo SJ, Karbasforoushan H, Seif M, Seifert AC, Xu J, Kim J, Labounek R, Vojtíšek L, Dostál M, Valošek J, Samson RS, Grussu F, Battiston M, Gandini Wheeler‐Kingshott CAM, Yiannakas MC, Gilbert G, Schneider T, Johnson B, Prados F. Comparison of multicenter
MRI
protocols for visualizing the spinal cord gray matter. Magn Reson Med 2022; 88:849-859. [DOI: 10.1002/mrm.29249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Julien Cohen‐Adad
- NeuroPoly Lab Institute of Biomedical Engineering, Polytechnique Montreal Montreal Canada
- Functional Neuroimaging Unit, CRIUGM University of Montreal Montreal Canada
- Mila ‐ Quebec AI Institute Montreal Canada
| | - Eva Alonso‐Ortiz
- NeuroPoly Lab Institute of Biomedical Engineering, Polytechnique Montreal Montreal Canada
| | - Stephanie Alley
- NeuroPoly Lab Institute of Biomedical Engineering, Polytechnique Montreal Montreal Canada
| | | | | | - Signe Johanna Vannesjo
- Wellcome Center for Integrative Neuroimaging, FMRIB University of Oxford, John Radcliffe Hospital Oxford UK
- Department of Physics Norwegian University of Science and Technology Trondheim Norway
| | - Haleh Karbasforoushan
- Interdepartmental Neuroscience Program Northwestern University School of Medicine Chicago IL USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine Stanford University Stanford CA USA
| | - Maryam Seif
- Spinal Cord Injury Center, Balgrist University Hospital University of Zurich Zurich Switzerland
- Department of Neurophysics Max Planck Institute for Human Cognitive and Brain Sciences Leipzig Germany
| | - Alan C. Seifert
- Biomedical Engineering and Imaging Institute, Department of Radiology, Graduate School of Biomedical Sciences Icahn School of Medicine at Mount Sinai New York NY USA
| | - Junqian Xu
- Biomedical Engineering and Imaging Institute, Department of Radiology, Graduate School of Biomedical Sciences Icahn School of Medicine at Mount Sinai New York NY USA
| | - Joo‐Won Kim
- Biomedical Engineering and Imaging Institute, Department of Radiology, Graduate School of Biomedical Sciences Icahn School of Medicine at Mount Sinai New York NY USA
| | - René Labounek
- Departments of Neurology and Biomedical Engineering University Hospital Olomouc Olomouc Czech Republic
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics Masonic Institute for the Developing Brain, University of Minnesota Minneapolis MN USA
| | - Lubomír Vojtíšek
- Central European Institute of Technology Masaryk University Brno Czech Republic
| | - Marek Dostál
- Department of Radiology and Nuclear Medicine University Hospital Brno Brno Czech Republic
| | - Jan Valošek
- Departments of Neurology and Biomedical Engineering University Hospital Olomouc Olomouc Czech Republic
| | - Rebecca S. Samson
- Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences University College London London UK
| | - Francesco Grussu
- Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences University College London London UK
- Radiomics Group, Vall d'Hebron Institute of Oncology Vall d'Hebron Barcelona Hospital Campus Barcelona Spain
| | - Marco Battiston
- Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences University College London London UK
| | - Claudia A. M. Gandini Wheeler‐Kingshott
- Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences University College London London UK
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
- Brain MRI 3T Research Center C. Mondino National Neurological Institute Pavia Italy
| | - Marios C. Yiannakas
- Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences University College London London UK
| | | | | | - Brian Johnson
- MR Clinical Development, Philips North America Gainesville FL USA
| | - Ferran Prados
- Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences University College London London UK
- e‐Health Center, Universitat Oberta de Catalunya Barcelona Spain
- Center for Medical Imaging Computing, Medical Physics and Biomedical Engineering, University College London London UK
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136
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Khatibi A, Vahdat S, Lungu O, Finsterbusch J, Büchel C, Cohen-Adad J, Marchand-Pauvert V, Doyon J. Brain-spinal cord interaction in long-term motor sequence learning in human: An fMRI study. Neuroimage 2022; 253:119111. [PMID: 35331873 DOI: 10.1016/j.neuroimage.2022.119111] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022] Open
Abstract
The spinal cord is important for sensory guidance and execution of skilled movements. Yet its role in human motor learning is not well understood. Despite evidence revealing an active involvement of spinal circuits in the early phase of motor learning, whether long-term learning engages similar changes in spinal cord activation and functional connectivity remains unknown. Here, we investigated spinal-cerebral functional plasticity associated with learning of a specific sequence of visually-guided joystick movements (sequence task) over six days of training. On the first and last training days, we acquired high-resolution functional images of the brain and cervical cord simultaneously, while participants practiced the sequence or a random task while electromyography was recorded from wrist muscles. After six days of training, the subjects' motor performance improved in the sequence compared to the control condition. These behavioral changes were associated with decreased co-contractions and increased reciprocal activations between antagonist wrist muscles. Importantly, early learning was characterized by activation in the C8 level, whereas a more rostral activation in the C6-C7 was found during the later learning phase. Motor sequence learning was also supported by increased spinal cord functional connectivity with distinct brain networks, including the motor cortex, superior parietal lobule, and the cerebellum at the early stage, and the angular gyrus and cerebellum at a later stage of learning. Our results suggest that the early vs. late shift in spinal activation from caudal to rostral cervical segments synchronized with distinct brain networks, including parietal and cerebellar regions, is related to progressive changes reflecting the increasing fine control of wrist muscles during motor sequence learning.
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Affiliation(s)
- Ali Khatibi
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, Canada; Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada; Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), University of Birmingham, UK; Centre for Human Brain Health, University of Birmingham, UK.
| | - Shahabeddin Vahdat
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, Canada; Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Ovidiu Lungu
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, Canada; Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada; Department of psychiatry and addictology, University of Montreal, Montreal, QC, Canada
| | - Jurgen Finsterbusch
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, QC, Canada; Mila Quebec AI Institute, Montreal, QC, Canada
| | | | - Julien Doyon
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, Canada; Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
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137
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Trevarrow MP, Reelfs A, Baker SE, Hoffman RM, Wilson TW, Kurz MJ. Spinal cord microstructural changes are connected with the aberrant sensorimotor cortical oscillatory activity in adults with cerebral palsy. Sci Rep 2022; 12:4807. [PMID: 35314729 PMCID: PMC8938462 DOI: 10.1038/s41598-022-08741-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/21/2022] [Indexed: 11/20/2022] Open
Abstract
Previous animal models have illustrated that reduced cortical activity in the developing brain has cascading activity-dependent effects on the microstructural organization of the spinal cord. A limited number of studies have attempted to translate these findings to humans with cerebral palsy (CP). Essentially, the aberrations in sensorimotor cortical activity in those with CP could have an adverse effect on the spinal cord microstructure. To investigate this knowledge gap, we utilized magnetoencephalographic (MEG) brain imaging to quantify motor-related oscillatory activity in fourteen adults with CP and sixteen neurotypical (NT) controls. A subset of these participants also underwent cervical-thoracic spinal cord MRI. Our results showed that the strength of the peri-movement beta desynchronization and the post-movement beta rebound were each weaker in the adults with CP relative to the controls, and these weakened responses were associated with poorer task performance. Additionally, our results showed that the strength of the peri-movement beta response was associated with the total cross-sectional area of the spinal cord and the white matter cross-sectional area. Altogether these results suggest that the altered sensorimotor cortical activity seen in CP may result in activity-dependent plastic changes within the spinal cord microstructure, which could ultimately contribute to the sensorimotor deficits seen in this population.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE, 68010, USA
| | - Anna Reelfs
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE, 68010, USA
| | - Sarah E Baker
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE, 68010, USA
| | | | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE, 68010, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE, 68010, USA.
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138
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Hori M, Maekawa T, Kamiya K, Hagiwara A, Goto M, Takemura MY, Fujita S, Andica C, Kamagata K, Cohen-Adad J, Aoki S. Advanced Diffusion MR Imaging for Multiple Sclerosis in the Brain and Spinal Cord. Magn Reson Med Sci 2022; 21:58-70. [PMID: 35173096 PMCID: PMC9199983 DOI: 10.2463/mrms.rev.2021-0091] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diffusion tensor imaging (DTI) has been established its usefulness in evaluating normal-appearing white matter (NAWM) and other lesions that are difficult to evaluate with routine clinical MRI in the evaluation of the brain and spinal cord lesions in multiple sclerosis (MS), a demyelinating disease. With the recent advances in the software and hardware of MRI systems, increasingly complex and sophisticated MRI and analysis methods, such as q-space imaging, diffusional kurtosis imaging, neurite orientation dispersion and density imaging, white matter tract integrity, and multiple diffusion encoding, referred to as advanced diffusion MRI, have been proposed. These are capable of capturing in vivo microstructural changes in the brain and spinal cord in normal and pathological states in greater detail than DTI. This paper reviews the current status of recent advanced diffusion MRI for assessing MS in vivo as part of an issue celebrating two decades of magnetic resonance in medical sciences (MRMS), an official journal of the Japanese Society of Magnetic Resonance in Medicine.
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Affiliation(s)
- Masaaki Hori
- Department of Radiology, Toho University Omori Medical Center.,Department of Radiology, Juntendo University School of Medicine
| | - Tomoko Maekawa
- Department of Radiology, Juntendo University School of Medicine
| | - Kouhei Kamiya
- Department of Radiology, Toho University Omori Medical Center.,Department of Radiology, Juntendo University School of Medicine
| | | | - Masami Goto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| | | | - Shohei Fujita
- Department of Radiology, Juntendo University School of Medicine
| | | | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine
| | | | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine
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139
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Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis. Nat Med 2022; 28:260-271. [PMID: 35132264 DOI: 10.1038/s41591-021-01663-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/16/2021] [Indexed: 12/15/2022]
Abstract
Epidural electrical stimulation (EES) targeting the dorsal roots of lumbosacral segments restores walking in people with spinal cord injury (SCI). However, EES is delivered with multielectrode paddle leads that were originally designed to target the dorsal column of the spinal cord. Here, we hypothesized that an arrangement of electrodes targeting the ensemble of dorsal roots involved in leg and trunk movements would result in superior efficacy, restoring more diverse motor activities after the most severe SCI. To test this hypothesis, we established a computational framework that informed the optimal arrangement of electrodes on a new paddle lead and guided its neurosurgical positioning. We also developed software supporting the rapid configuration of activity-specific stimulation programs that reproduced the natural activation of motor neurons underlying each activity. We tested these neurotechnologies in three individuals with complete sensorimotor paralysis as part of an ongoing clinical trial ( www.clinicaltrials.gov identifier NCT02936453). Within a single day, activity-specific stimulation programs enabled these three individuals to stand, walk, cycle, swim and control trunk movements. Neurorehabilitation mediated sufficient improvement to restore these activities in community settings, opening a realistic path to support everyday mobility with EES in people with SCI.
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140
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Towards reliable spinal cord fMRI: assessment of common imaging protocols. Neuroimage 2022; 250:118964. [DOI: 10.1016/j.neuroimage.2022.118964] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 01/29/2023] Open
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141
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Oliva V, Hartley-Davies R, Moran R, Pickering AE, Brooks JC. Simultaneous brain, brainstem and spinal cord pharmacological-fMRI reveals involvement of an endogenous opioid network in attentional analgesia. eLife 2022; 11:71877. [PMID: 35080494 PMCID: PMC8843089 DOI: 10.7554/elife.71877] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Pain perception is decreased by shifting attentional focus away from a threatening event. This attentional analgesia engages parallel descending control pathways from anterior cingulate (ACC) to locus coeruleus, and ACC to periaqueductal grey (PAG) – rostral ventromedial medulla (RVM), indicating possible roles for noradrenergic or opioidergic neuromodulators. To determine which pathway modulates nociceptive activity in humans, we used simultaneous whole brain-spinal cord pharmacological-fMRI (N = 39) across three sessions. Noxious thermal forearm stimulation generated somatotopic-activation of dorsal horn (DH) whose activity correlated with pain report and mirrored attentional pain modulation. Activity in an adjacent cluster reported the interaction between task and noxious stimulus. Effective connectivity analysis revealed that ACC interacts with PAG and RVM to modulate spinal cord activity. Blocking endogenous opioids with Naltrexone impairs attentional analgesia and disrupts RVM-spinal and ACC-PAG connectivity. Noradrenergic augmentation with Reboxetine did not alter attentional analgesia. Cognitive pain modulation involves opioidergic ACC-PAG-RVM descending control which suppresses spinal nociceptive activity.
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Affiliation(s)
- Valeria Oliva
- Department of Anesthesiology, University of California, San Diego, La Jolla, United States
| | - Ron Hartley-Davies
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Rosalyn Moran
- Department of Neuroimaging, King's College London, London, United Kingdom
| | - Anthony E Pickering
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
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142
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Taheri K, Vavasour IM, Abel S, Lee LE, Johnson P, Ristow S, Tam R, Laule C, Ackermans NC, Schabas A, Cross H, Chan JK, Sayao AL, Bhan V, Devonshire V, Carruthers R, Li DK, Traboulsee AL, Kolind SH, Dvorak AV. Cervical Spinal Cord Atrophy can be Accurately Quantified Using Head Images. Mult Scler J Exp Transl Clin 2022; 8:20552173211070760. [PMID: 35024164 PMCID: PMC8743948 DOI: 10.1177/20552173211070760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background Spinal cord atrophy provides a clinically relevant metric for monitoring MS. However, the spinal cord is imaged far less frequently than brain due to artefacts and acquisition time, whereas MRI of the brain is routinely performed. Objective To validate spinal cord cross-sectional area measurements from routine 3DT1 whole-brain MRI versus those from dedicated cord MRI in healthy controls and people with MS. Methods We calculated cross-sectional area at C1 and C2/3 using T2*-weighted spinal cord images and 3DT1 brain images, for 28 healthy controls and 73 people with MS. Correlations for both groups were assessed between: (1) C1 and C2/3 using cord images; (2) C1 from brain and C1 from cord; and (3) C1 from brain and C2/3 from cord. Results and Conclusion C1 and C2/3 from cord were strongly correlated in controls (r = 0.94, p<0.0001) and MS (r = 0.85, p<0.0001). There was strong agreement between C1 from brain and C2/3 from cord in controls (r = 0.84, p<0.0001) and MS (r = 0.81, p<0.0001). This supports the use of C1 cross-sectional area calculated from brain imaging as a surrogate for the traditional C2/3 cross-sectional area measure for spinal cord atrophy.
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Affiliation(s)
- Kamyar Taheri
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Irene M Vavasour
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Stephen Ristow
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Cornelia Laule
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | - Robert Carruthers
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David Kb Li
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Shannon H Kolind
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adam Vladimir Dvorak
- Department of Physics & Astronomy, University of British Columbia, Vancouver, BC, Canada
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143
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Zhang MZ, Ou-Yang HQ, Liu JF, Jin D, Wang CJ, Ni M, Liu XG, Lang N, Jiang L, Yuan HS. Predicting postoperative recovery in cervical spondylotic myelopathy: construction and interpretation of T 2*-weighted radiomic-based extra trees models. Eur Radiol 2022; 32:3565-3575. [PMID: 35024949 DOI: 10.1007/s00330-021-08383-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Conventional MRI may not be ideal for predicting cervical spondylotic myelopathy (CSM) prognosis. In this study, we used radiomics in predicting postoperative recovery in CSM. We aimed to develop and validate radiomic feature-based extra trees models. METHODS There were 151 patients with CSM who underwent preoperative T2-/ T2*-weighted imaging (WI) and surgery. They were divided into good/poor outcome groups based on the recovery rate. Datasets from multiple scanners were randomised into training and internal validation sets, while the dataset from an independent scanner was used for external validation. Radiomic features were extracted from the transverse spinal cord at the maximum compressed level. Threshold selection algorithm, collinearity removal, and tree-based feature selection were applied sequentially in the training set to obtain the optimal radiomic features. The classification of intramedullary increased signal on T2/T2*WI and compression ratio of the spinal cord on T2*WI were selected as the conventional MRI features. Clinical features were age, preoperative mJOA, and symptom duration. Four models were constructed: radiological, radiomic, clinical-radiological, and clinical-radiomic. An AUC significantly > 0.5 was considered meaningful predictive performance based on the DeLong test. The mean decrease in impurity was used to measure feature importance. p < 0.05 was considered statistically significant. RESULTS On internal and external validations, AUCs of the radiomic and clinical-radiomic models, and radiological and clinical-radiological models ranged from 0.71 to 0.81 (significantly > 0.5) and 0.40 to 0.55, respectively. Wavelet-LL first-order variance was the most important feature in the radiomic model. CONCLUSION Radiomic features, especially wavelet-LL first-order variance, contribute to meaningful predictive models for CSM prognosis. KEY POINTS • Conventional MRI features may not be ideal in predicting prognosis. • Radiomics provides greater predictive efficiency in the recovery from cervical spondylotic myelopathy.
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Affiliation(s)
- Meng-Ze Zhang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Han-Qiang Ou-Yang
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Jian-Fang Liu
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Dan Jin
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Chun-Jie Wang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Ming Ni
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Xiao-Guang Liu
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
| | - Hui-Shu Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China.
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David G, Vallotton K, Hupp M, Curt A, Freund P, Seif M. Extent of cord pathology in the lumbosacral enlargement in non-traumatic versus traumatic spinal cord injury. J Neurotrauma 2022; 39:639-650. [PMID: 35018824 DOI: 10.1089/neu.2021.0389] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study compares remote neurodegenerative changes caudal to a cervical injury in degenerative cervical myelopathy (DCM) (i.e., non-traumatic) and incomplete traumatic spinal cord injury (tSCI) patients, using MRI-based tissue area measurements and diffusion tensor imaging (DTI). Eighteen mild to moderate DCM patients with sensory impairments (mJOA score: 16.2±1.9), 14 incomplete tetraplegic tSCI patients (AIS C&D), and 20 healthy controls were recruited. All participants received DTI and T2*-weighted scans in the lumbosacral enlargement (caudal to injury) and at C2/C3 (rostral to injury). MRI readouts included DTI metrics in the white matter (WM) columns and cross-sectional WM and gray matter area. One-way ANOVA with Tukey's post-hoc comparison (p<0.05) was used to assess group differences. In the lumbosacral enlargement, compared to DCM, tSCI patients exhibited decreased fractional anisotropy in the lateral (tSCI vs. DCM, -11.9%, p=0.007) and ventral WM column (-8.0%, p=0.021), and showed trend toward lower values in the dorsal column (-8.9%, p=0.068). At C2/C3, compared to controls, fractional anisotropy was lower in both groups in the dorsal (DCM vs. controls, -7.9%, p=0.024; tSCI vs. controls, -10.0%, p=0.007) and in the lateral column (DCM: -6.2%, p=0.039; tSCI: -13.3%, p<0.001), while tSCI patients had lower fractional anisotropy than DCM patients in the lateral column (-7.6%, p=0.029). WM areas were not different between patient groups but were lower compared to controls in the lumbosacral enlargement (DCM: -16.9%, p<0.001; tSCI, -10.5%, p=0.043) and at C2/C3 (DCM: -16.0%, p<0.001; tSCI: -18.1%, p<0.001). In conclusion, mild to moderate DCM and incomplete tSCI lead to similar degree of degeneration of the dorsal and lateral columns at C2/C3, but tSCI results in more widespread white matter damage in the lumbosacral enlargement. These remote changes are likely to contribute to the patients' impairment and recovery. DTI is a sensitive tool to assess remote pathological changes in DCM and tSCI patients.
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Affiliation(s)
- Gergely David
- University of Zurich, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.,University Medical Center Hamburg-Eppendorf, 37734, Department of Systems Neuroscience, Hamburg, Germany;
| | - Kevin Vallotton
- University of Zurich, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland;
| | - Markus Hupp
- University of Zurich, 27217, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland;
| | - Armin Curt
- University of Zurich, 27217, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland;
| | - Patrick Freund
- University of Zurich, 27217, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.,UCL Institute of Neurology, 61554, Department of Brain Repair and Rehabilitation, London, United Kingdom of Great Britain and Northern Ireland.,UCL Institute of Neurology, 61554, Wellcome Trust Centre for Neuroimaging, London, United Kingdom of Great Britain and Northern Ireland.,Max Planck Institute for Human Cognitive and Brain Sciences, 27184, Department of Neurophysics, Leipzig, Germany;
| | - Maryam Seif
- University of Zurich, 27217, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.,Max Planck Institute for Human Cognitive and Brain Sciences, 27184, Leipzig, Department of Neurophysics, Germany;
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145
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Qiu YS, Zeng YH, Yuan RY, Ye ZX, Bi J, Lin XH, Chen YJ, Wang MW, Liu Y, Yao SB, Chen YK, Jiang JY, Lin Y, Lin X, Wang N, Fu Y, Chen WJ. Chinese patients with hereditary spastic paraplegias (HSPs): a protocol for a hospital-based cohort study. BMJ Open 2022; 12:e054011. [PMID: 35017251 PMCID: PMC8753405 DOI: 10.1136/bmjopen-2021-054011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Hereditary spastic paraplegias (HSPs) are uncommon but not rare neurodegenerative diseases. More than 100 pathogenic genes and loci related to spastic paraplegia symptoms have been reported. HSPs have the same core clinical features, including progressive spasticity in the lower limbs, though HSPs are heterogeneous (eg, clinical signs, MRI features, gene mutation). The age of onset varies greatly, from infant to adulthood. In addition, the slow and variable rates of disease progression in patients with HSP represent a substantial challenge for informative assessment of therapeutic efficacy. To address this, we are undertaking a prospective cohort study to investigate genetic-clinical characteristics, find surrogates for monitoring disease progress and identify clinical readouts for treatment. METHODS AND ANALYSIS In this case-control cohort study, we will enrol 200 patients with HSP and 200 healthy individuals in parallel. Participants will be continuously assessed for 3 years at 12-month intervals. Six aspects, including clinical signs, genetic spectrum, cognitive competence, MRI features, potential biochemical indicators and nerve electrophysiological factors, will be assessed in detail. This study will observe clinical manifestations and disease severity based on different molecular mechanisms, including oxidative stress, cholesterol metabolism and microtubule dynamics, all of which have been proposed as potential treatment targets or modalities. The analysis will also assess disease progression in different types of HSPs and cellular pathways with a longitudinal study using t tests and χ2 tests. ETHICS AND DISSEMINATION The study was granted ethics committee approval by the first affiliated hospital of Fujian Medical University (MRCTA, ECFAH of FMU (2019)194) in 2019. Findings will be disseminated via presentations and peer-reviewed publications. Dissemination will target different audiences, including national stakeholders, researchers from different disciplines and the general public. TRIAL REGISTRATION NUMBER NCT04006418.
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Affiliation(s)
- Yu-Sen Qiu
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Yi-Heng Zeng
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Ru-Ying Yuan
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhi-Xian Ye
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Jin Bi
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiao-Hong Lin
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Yi-Jun Chen
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Meng-Wen Wang
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Ying Liu
- Department of Radiology of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, Fujian, China
| | - Shao-Bo Yao
- Department of Nuclear Medicine of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yi-Kun Chen
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Jun-Yi Jiang
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Yi Lin
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiang Lin
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Ying Fu
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology of The First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian, China
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Navas-Sánchez FJ, Marcos-Vidal L, de Blas DM, Fernández-Pena A, Alemán-Gómez Y, Guzmán-de-Villoria JA, Romero J, Catalina I, Lillo L, Muñoz-Blanco JL, Ordoñez-Ugalde A, Quintáns B, Sobrido MJ, Carmona S, Grandas F, Desco M. Tract-specific damage at spinal cord level in pure hereditary spastic paraplegia type 4: a diffusion tensor imaging study. J Neurol 2022; 269:3189-3203. [PMID: 34999956 DOI: 10.1007/s00415-021-10933-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND SPG4 is a subtype of hereditary spastic paraplegia (HSP), an upper motor neuron disorder characterized by axonal degeneration of the corticospinal tracts and the fasciculus gracilis. The few neuroimaging studies that have focused on the spinal cord in HSP are based mainly on the analysis of structural characteristics. METHODS We assessed diffusion-related characteristics of the spinal cord using diffusion tensor imaging (DTI), as well as structural and shape-related properties in 12 SPG4 patients and 14 controls. We used linear mixed effects models up to T3 in order to analyze the global effects of 'group' and 'clinical data' on structural and diffusion data. For DTI, we carried out a region of interest (ROI) analysis in native space for the whole spinal cord, the anterior and lateral funiculi, and the dorsal columns. We also performed a voxelwise analysis of the spinal cord to study local diffusion-related changes. RESULTS A reduced cross-sectional area was observed in the cervical region of SPG4 patients, with significant anteroposterior flattening. DTI analyses revealed significantly decreased fractional anisotropy (FA) and increased radial diffusivity at all the cervical and thoracic levels, particularly in the lateral funiculi and dorsal columns. The FA changes in SPG4 patients were significantly related to disease severity, measured as the Spastic Paraplegia Rating Scale score. CONCLUSIONS Our results in SPG4 indicate tract-specific axonal damage at the level of the cervical and thoracic spinal cord. This finding is correlated with the degree of motor disability.
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Affiliation(s)
- Francisco J Navas-Sánchez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr Esquerdo 46, 28007, Madrid, Spain. .,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Luis Marcos-Vidal
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr Esquerdo 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Departamento de Bioingeniería E Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Daniel Martín de Blas
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr Esquerdo 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Departamento de Bioingeniería E Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Alberto Fernández-Pena
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr Esquerdo 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Departamento de Bioingeniería E Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Yasser Alemán-Gómez
- Department of Psychiatry, Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland.,Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Medical Image Analysis Laboratory (MIAL), Centre d'Imagerie BioMédicale (CIBM), Lausanne, Switzerland
| | - Juan A Guzmán-de-Villoria
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr Esquerdo 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Julia Romero
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Irene Catalina
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Laura Lillo
- Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain
| | - José L Muñoz-Blanco
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Andrés Ordoñez-Ugalde
- Instituto de Investigación Sanitaria, Hospital Clínico Universitario, Santiago de Compostela, Spain.,Laboratorio Biomolecular, Cuenca, Ecuador.,Unidad de Genética y Molecular, Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador
| | - Beatriz Quintáns
- Instituto de Investigación Sanitaria, Hospital Clínico Universitario, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER-U711), Madrid, Spain.,Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain
| | - María-Jesús Sobrido
- Instituto de Investigación Sanitaria, Hospital Clínico Universitario, Santiago de Compostela, Spain.,Instituto de Investigación Biomédica, Hospital Clínico Universitario de A Coruña, SERGAS, A Coruña, Spain
| | - Susanna Carmona
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr Esquerdo 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Francisco Grandas
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Desco
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr Esquerdo 46, 28007, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Departamento de Bioingeniería E Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Uhrenholt L, Brix L, Wichmann TO, Pedersen M, Ringgaard S, Jensen TS. Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study. Chiropr Man Therap 2022; 30:2. [PMID: 34996490 PMCID: PMC8742358 DOI: 10.1186/s12998-022-00410-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whiplash injury is common following road traffic crashes affecting millions worldwide, with up to 50% of the injured developing chronic symptoms and 15% having a reduced working capability due to ongoing disability. Many of these patients receive treatment in primary care settings based upon clinical and diagnostic imaging findings. Despite the identification of different types of injuries in the whiplash patients, clinically significant relationships between injuries and chronic symptoms remains to be fully established. This study investigated the feasibility of magnetic resonance imaging (MRI) techniques including quantitative diffusion weighted imaging and measurements of cerebrospinal fluid (CSF) flow as novel non-invasive biomarkers in a population of healthy volunteers and chronic whiplash patients recruited from a chiropractic clinic for the purpose of improving our understanding of whiplash injury. METHODS Twenty chronic whiplash patients and 18 healthy age- and gender matched control subjects were included [mean age ± SD (sex ratio; females/males), case group: 37.8 years ± 9.1 (1.22), control group: 35.1 years ± 9.2 (1.25)]. Data was collected from May 2019 to July 2020. Data from questionnaires pertaining to the car crash, acute and current symptoms were retrieved and findings from clinical examination and MRI including morphologic, diffusion weighted and phase-contrast images were recorded. The apparent diffusion coefficient and fractional anisotropy were calculated, and measurement and analysis of CSF flow was conducted. Statistical analyses included Fisher's exact test, Mann Whitney U test and analysis of variance between groups. RESULTS The studied population was described in detail using readily available clinical tools. No statistically significant differences were found between the groups on MRI. CONCLUSIONS This study did not show that MRI-based measures of morphology, spinal cord and nerve root diffusion or cerebrospinal fluid flow are sensitive biomarkers to distinguish between chronic whiplash patients and healthy controls. The detailed description of the chronic whiplash patients using readily available clinical tools may be of great relevance to the clinician. In the context of feasibility, clinical practice-based advanced imaging studies with a technical setup similar to the presented can be expected to have a high likelihood of successful completion.
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Affiliation(s)
- Lars Uhrenholt
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark. .,Nortvig & Uhrenholt Kiropraktisk Klinik, 8200, Aarhus, Denmark.
| | - Lau Brix
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark.,Department of Procurement and Biomedical Engineering, Region Midt, Aarhus N, Denmark
| | | | - Michael Pedersen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.,Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steffen Ringgaard
- MR Research Centre, Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tue Secher Jensen
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark.,Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Liu Y, Ye Z, Hu J, Xiao Z, Zhang F, Yang X, Chen W, Fu Y, Cao D. White Matter Alterations in Spastic Paraplegia Type 5: A Multiparametric Structural MRI Study and Correlations with Biochemical Measurements. AJNR Am J Neuroradiol 2022; 43:56-62. [PMID: 34794945 PMCID: PMC8757563 DOI: 10.3174/ajnr.a7344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/10/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE In spastic paraplegia type 5, spinal cord atrophy and white matter signal abnormalities in the brain are the main MR imaging alterations. However, the specific mechanism remains unclear. We explored the microstructural changes occurring in spastic paraplegia type 5 and assessed the relation between MR imaging and clinical data. MATERIALS AND METHODS Seventeen patients with spastic paraplegia type 5 and 17 healthy controls were scanned with DTI and T1 mapping on a 3T MR imaging scanner. Fractional anisotropy, mean diffusivity, radial diffusivity, axial diffusivity, and T1 values were obtained using Tract-Based Spatial Statistics and the Spinal Cord Toolbox. Neurofilament light and myelin basic protein in the CSF were measured. The differences in MR imaging and biochemical data between patients with spastic paraplegia type 5 and healthy controls were compared using the Student t test. RESULTS A widespread reduction of fractional anisotropy values and an elevation of mean diffusivity, T1, and radial diffusivity values were found in most cervical, T4, and T5 spinal cords; corona radiata; optic radiations; and internal capsules in spastic paraplegia type 5. A variation in axial diffusivity values was shown only in C2, C6, and the corona radiata but not in the gray matter. The levels of neurofilament light and myelin basic protein were higher in those with spastic paraplegia type 5 than in healthy controls (myelin basic protein, 3507 [SD, 2291] versus 127 [SD, 219] pg/mL; neurofilament light, 617 [SD, 207] versus 265 [SD, 187] pg/mL; P < .001). No correlation was found between the clinical data and MR imaging-derived measures. CONCLUSIONS Multiparametric MR imaging and biochemical indicators demonstrated that demyelination (mainly) and axonal loss led to the white matter integrity loss without gray matter injury in spastic paraplegia type 5.
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Affiliation(s)
- Y. Liu
- From the Departments of Radiology (Y.L., J.H., F.Z., X.Y., D.C.),Department of Medical Imaging Technology (Y.L.), College of Medical Technology and Engineering
| | - Z. Ye
- Neurology and Institute of Neurology (Z.Y., W.C., Y.F.),Department of Neurology and Institute of Neurology (Z.Y., W.C., Y.F.)
| | - J. Hu
- From the Departments of Radiology (Y.L., J.H., F.Z., X.Y., D.C.)
| | - Z. Xiao
- Department of Biomedical Sciences (Z.X.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - F. Zhang
- From the Departments of Radiology (Y.L., J.H., F.Z., X.Y., D.C.)
| | - X. Yang
- From the Departments of Radiology (Y.L., J.H., F.Z., X.Y., D.C.)
| | - W. Chen
- Neurology and Institute of Neurology (Z.Y., W.C., Y.F.),Department of Neurology and Institute of Neurology (Z.Y., W.C., Y.F.),Fujian Key Laboratory of Molecular Neurology (W.C.), Fujian Medical University, Fuzhou, China
| | - Y. Fu
- Neurology and Institute of Neurology (Z.Y., W.C., Y.F.),Department of Neurology and Institute of Neurology (Z.Y., W.C., Y.F.)
| | - D. Cao
- From the Departments of Radiology (Y.L., J.H., F.Z., X.Y., D.C.),Key Laboratory of Radiation Biology of Fujian Higher Education Institutions (D.C.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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149
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Juryńczyk M, Klimiec-Moskal E, Kong Y, Hurley S, Messina S, Yeo T, Jenkinson M, Leite MI, Palace J. Elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis. J Neurol 2022; 269:269-279. [PMID: 34043042 PMCID: PMC8738499 DOI: 10.1007/s00415-021-10619-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND Separating antibody-negative neuromyelitis optica spectrum disorders (NMOSD) from multiple sclerosis (MS) in borderline cases is extremely challenging due to lack of biomarkers. Elucidating different pathologies within the likely heterogenous antibody-negative NMOSD/MS overlap syndrome is, therefore, a major unmet need which would help avoid disability from inappropriate treatment. OBJECTIVE In this study we aimed to identify distinct subgroups within the antibody-negative NMOSD/MS overlap syndrome. METHODS Twenty-five relapsing antibody-negative patients with NMOSD features underwent a prospective brain and spinal cord MRI. Subgroups were identified by an unsupervised algorithm based on pre-selected NMOSD/MS discriminators. RESULTS Four subgroups were identified. Patients from Group 1 termed "MS-like" (n = 6) often had central vein sign and cortical lesions (83% and 67%, respectively). All patients from Group 2 ("spinal MS-like", 8) had short-segment myelitis and no MS-like brain lesions. Group 3 ("classic NMO-like", 6) had high percentage of bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM, 80% and 60%, respectively) and normal brain appearance (100%). Group 4 ("NMO-like with brain involvement", 5) typically had a history of NMOSD-like brain lesions and LETM. When compared with other groups, Group 4 had significantly decreased fractional anisotropy in non-lesioned tracts (0.46 vs. 0.49, p = 0.003) and decreased thalamus volume (0.84 vs. 0.98, p = 0.04). CONCLUSIONS NMOSD/MS cohort contains distinct subgroups likely corresponding to different pathologies and requiring tailored treatment. We propose that non-conventional MRI might help optimise diagnosis in these challenging patients.
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Affiliation(s)
- Maciej Juryńczyk
- Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK. .,Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland.
| | - Elżbieta Klimiec-Moskal
- grid.4991.50000 0004 1936 8948Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK ,grid.5522.00000 0001 2162 9631Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Yazhuo Kong
- grid.4991.50000 0004 1936 8948Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK ,grid.454868.30000 0004 1797 8574CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101 China ,grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Samuel Hurley
- grid.4991.50000 0004 1936 8948Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Silvia Messina
- grid.4991.50000 0004 1936 8948Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK
| | - Tianrong Yeo
- grid.4991.50000 0004 1936 8948Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK
| | - Mark Jenkinson
- grid.4991.50000 0004 1936 8948Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Maria Isabel Leite
- grid.4991.50000 0004 1936 8948Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK.
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150
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Smith AC, O’Dell DR, Albin SR, Berliner JC, Dungan D, Robinson E, Elliott JM, Carballido-Gamio J, Stevens-Lapsley J, Weber KA. Lateral Corticospinal Tract and Dorsal Column Damage: Predictive Relationships With Motor and Sensory Scores at Discharge From Acute Rehabilitation After Spinal Cord Injury. Arch Phys Med Rehabil 2022; 103:62-68. [PMID: 34371017 PMCID: PMC8712383 DOI: 10.1016/j.apmr.2021.07.792] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine if lateral corticospinal tract (LCST) integrity demonstrates a significant predictive relationship with future ipsilateral lower extremity motor function (LEMS) and if dorsal column (DC) integrity demonstrates a significant predictive relationship with future light touch (LT) sensory function post spinal cord injury (SCI) at time of discharge from inpatient rehabilitation. DESIGN Retrospective analyses of imaging and clinical outcomes. SETTING University and academic hospital. PARTICIPANTS A total of 151 participants (N=151) with SCI. INTERVENTIONS Inpatient rehabilitation. MAIN OUTCOME MEASURES LEMS and LT scores at discharge from inpatient rehabilitation. RESULTS In 151 participants, right LCST spared tissue demonstrated a significant predictive relationship with right LEMS percentage recovered (β=0.56; 95% confidence interval [CI], 0.37-0.73; R=0.43; P<.001). Left LCST spared tissue demonstrated a significant predictive relationship with left LEMS percentage recovered (β=0.66; 95% CI, 0.50-0.82; R=0.51; P<.001). DC spared tissue demonstrated a significant predictive relationship with LT percentage recovered (β=0.69; 95% CI, 0.52-0.87; R=0.55; P<.001). When subgrouping the participants into motor complete vs incomplete SCI, motor relationships were no longer significant, but the sensory relationship remained significant. Those who had no voluntary motor function but recovered some also had significantly greater LCST spared tissue than those who did not recover motor function. CONCLUSIONS LCST demonstrated significant moderate predictive relationships with lower extremity motor function at the time of discharge from inpatient rehabilitation, in an ipsilesional manner. DC integrity demonstrated a significant moderate predictive relationship with recovered function of LT. With further development, these neuroimaging methods might be used to predict potential deficits after SCI and to provide corresponding targeted interventions.
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Affiliation(s)
- Andrew C. Smith
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO USA,Regis University School of Physical Therapy, Denver, CO USA
| | - Denise R. O’Dell
- Regis University School of Physical Therapy, Denver, CO USA,Craig Hospital, Englewood, CO USA
| | | | | | - David Dungan
- Craig Hospital, Englewood, CO USA,Radiology Imaging Associates, Denver, CO USA
| | | | - James M. Elliott
- Faculty of Medicine and Health, The University of Sydney, Northern Sydney Local Health District, The Kolling Research Institute, St Leonards, Sydney, Australia
| | | | - Jennifer Stevens-Lapsley
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO USA
| | - Kenneth A. Weber
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto, CA USA
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