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Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The aim of this study was to investigate the relationship between spinal cord microstructures and spinal cord dysfunction in degenerative cervical myelopathy (DCM) patients; a follow-up study was carried out using diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI), an advanced diffusion model. SUMMARY OF BACKGROUND DATA DTI has been used for diagnosis of DCM. Although DTI has advantages of high sensitivity and quantitative features, it is limited by its low specificity for measuring microstructures. METHODS Fifty-eight postoperative DCM patients with 12 to 14 months of surgical recovery were recruited, as well as 14 healthy volunteers for control group. All DTI and NODDI metrics were measured at the most stenotic levels of patients and at all levels of control group. A t test was used to compare the metrics between patient and control groups, and Spearman correlation was used to test the relationship between the metrics and clinical assessment, modified Japanese Orthopedic Association (mJOA) scores. RESULTS t test showed that DTI metrics, neurite density Vic, and free water fraction Viso had significant differences between control group and the most stenotic levels in patients. For DTI metrics, fractional anisotropy (FA), radial diffusivity (RD), and mean diffusivity (MD) in patients were significantly correlated with mJOA. For NODDI metrics, only Vic is positively correlated with mJOA. CONCLUSION The results of t test and correlation with mJOA suggest that DTI and NODDI are valuable for evaluating spinal cord function. Results of NODDI indicate that the reason for FA reduction in DCM may be decreased neurite density, not increased orientation dispersion. LEVEL OF EVIDENCE 3.
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302
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Skinner NP, Lee SY, Kurpad SN, Schmit BD, Muftuler LT, Budde MD. Filter-probe diffusion imaging improves spinal cord injury outcome prediction. Ann Neurol 2018; 84:37-50. [PMID: 29752739 PMCID: PMC6119508 DOI: 10.1002/ana.25260] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Diffusion-weighted imaging (DWI) is a powerful tool for investigating spinal cord injury (SCI), but has limited specificity for axonal damage, which is the most predictive feature of long-term functional outcome. In this study, a technique designed to detect acute axonal injury, filter-probe double diffusion encoding (FP-DDE), is compared with standard DWI for predicting long-term functional and cellular outcomes. METHODS This study extends FP-DDE to predict long-term functional and histological outcomes in a rat SCI model of varying severities (n = 58). Using a 9.4T magnetic resonance imaging (MRI) system, a whole-cord FP-DDE spectroscopic voxel was acquired in 3 minutes at the lesion site and compared to DWI at 48 hours postinjury. Relationships with chronic (30-day) locomotor and histological outcomes were evaluated with linear regression. RESULTS The FP-DDE measure of parallel diffusivity (ADC|| ) was significantly related to chronic hind limb locomotor functional outcome (R2 = 0.63, p < 0.0001), and combining this measurement with acute functional scores demonstrated prognostic benefit versus functional testing alone (p = 0.0007). Acute ADC|| measurements were also more closely related to the number of injured axons measured 30 days after the injury than standard DWI. Furthermore, acute FP-DDE images showed a clear and easily interpretable pattern of injury that closely corresponded with chronic MRI and histology observations. INTERPRETATION Collectively, these results demonstrate FP-DDE benefits from greater specificity for acute axonal damage in predicting functional and histological outcomes with rapid acquisition and fully automated analysis, improving over standard DWI. FP-DDE is a promising technique compatible with clinical settings, with potential research and clinical applications for evaluation of spinal cord pathology. Ann Neurol 2018;83:37-50.
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Affiliation(s)
- Nathan P Skinner
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
- Medical Scientist Training Program, Medical College of Wisconsin, Milwaukee, WI
| | - Seung-Yi Lee
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
- Neuroscience Doctoral Program, Medical College of Wisconsin, Milwaukee, WI
- Biophysics Graduate Program, Medical College of Wisconsin, Milwaukee, WI
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
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303
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Combès B, Kerbrat A, Ferré JC, Callot V, Maranzano J, Badji A, Le Page E, Labauge P, Ayrignac X, Carra Dallière C, de Champfleur NM, Pelletier J, Maarouf A, de Seze J, Collongues N, Brassat D, Durand-Dubief F, Barillot C, Bannier E, Edan G. Focal and diffuse cervical spinal cord damage in patients with early relapsing-remitting MS: A multicentre magnetisation transfer ratio study. Mult Scler 2018; 25:1113-1123. [PMID: 29909771 DOI: 10.1177/1352458518781999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Studies including patients with well-established multiple sclerosis (MS) have shown a significant and disability-related reduction in the cervical spinal cord (SC) magnetisation transfer ratio (MTR). OBJECTIVES The objectives are to (1) assess whether MTR reduction is already measurable in the SC of patients with early relapsing-remitting multiple sclerosis (RRMS) and (2) describe its spatial distribution. METHODS We included 60 patients with RRMS <12 months and 34 age-matched controls at five centres. Axial T2*w, sagittal T2w, sagittal phase-sensitive inversion recovery (PSIR), 3DT1w, and axial magnetisation transfer (MT) images were acquired from C1 to C7. Lesions were manually labelled and mean MTR values computed both for the whole SC and for normal-appearing SC in different regions of interest. RESULTS Mean whole SC MTR was significantly lower in patients than controls (33.7 vs 34.9 pu, p = 0.00005), even after excluding lesions (33.9 pu, p = 0.0003). We observed a greater mean reduction in MTR for vertebral levels displaying the highest lesion loads (C2-C4). In the axial plane, we observed a greater mean MTR reduction at the SC periphery and barycentre. CONCLUSION Cervical SC tissue damage measured using MTR is not restricted to macroscopic lesions in patients with early RRMS and is not homogeneously distributed.
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Affiliation(s)
- Benoît Combès
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France
| | - Anne Kerbrat
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France.,Neurology Department, Rennes University Hospital, Rennes, France
| | - Jean Christophe Ferré
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France.,Radiology Department, CHU Rennes, Rennes, France
| | - Virginie Callot
- AP-HM, Pôle d'Imagerie Médicale, Hôpital de La Timone, CEMEREM, Marseille, France.,Aix-Marseille Université, CNRS, UMR 7339, CRMBM, Marseille, France
| | | | - Atef Badji
- Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montreal, Montreal, QC, Canada
| | | | | | | | | | | | - Jean Pelletier
- AP-HM, Pôle d'Imagerie Médicale, Hôpital de La Timone, CEMEREM, Marseille, France.,AP-HM, CHU Timone, Pole de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Adil Maarouf
- AP-HM, Pôle d'Imagerie Médicale, Hôpital de La Timone, CEMEREM, Marseille, France.,AP-HM, CHU Timone, Pole de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Jérôme de Seze
- CIC, INSERM 1434, University Hospital of Strasbourg, Strasbourg, France
| | | | | | | | - Christian Barillot
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France
| | - Elise Bannier
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France.,Radiology Department, CHU Rennes, Rennes, France
| | - Gilles Edan
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France.,Neurology Department, Rennes University Hospital, Rennes, France
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304
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Quantitative Magnetization Transfer MRI Measurements of the Anterior Spinal Cord Region are Associated With Clinical Outcomes in Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2018; 43:675-680. [PMID: 29068880 PMCID: PMC6621550 DOI: 10.1097/brs.0000000000002470] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case-control study. OBJECTIVE The aim of this study was to understand the role of magnetization transfer ratio (MTR) in identifying patients with clinically significant myelopathy and disability. SUMMARY OF BACKGROUND DATA MTR is a quantitative measure that correlates with myelin loss and neural tissue destruction in a variety of neurological diseases. However, the usefulness of MTR in patients with cervical spondylotic myelopathy (CSM) has not been examined. METHODS We prospectively enrolled seven CSM patients and seven age-matched controls to undergo magnetic resonance imaging (MRI) of the cervical spine. Nurick, Neck Disability Index (NDI), and modified Japanese Orthopedic Association (mJOA) scores were collected for all patients. Clinical hyperreflexia was tested at the MCP joint, using a six-axis load cell. Reflex was simulated by quickly moving the joint from maximum flexion to maximum extension (300°/second). Anterior, lateral, and posterior cord MTR measurements were compared with clinical outcomes. RESULTS Compared with controls, CSM patients had lower anterior cord MTR (38.29 vs. 29.97, Δ = -8.314, P = 0.0022), and equivalent posterior cord (P = 0.2896) and lateral cord (P = 0.3062) MTR. Higher Nurick scores were associated with lower anterior cord MTR (P = 0.0205), but not lateral cord (P = 0.5446) or posterior cord MTR (P = 0.1222). Lower mJOA was associated with lower anterior cord MTR (P = 0.0090), but not lateral cord (P = 0.4864) or posterior cord MTR (P = 0.4819). There was no association between NDI and MTR of the anterior (P = 0.4351), lateral (P = 0.7557), or posterior cord (P = 0.9171). There was a linear relationship between hyperreflexia and anterior cord MTR (slope = -117.3, R = 0.6598, P = 0.0379), but not lateral cord (P = 0.1906, R = 0.4511) or posterior cord (P = 0.2577, R = 0.3957) MTR. CONCLUSION Anterior cord MTR correlates with clinical outcomes as measured by mJOA index, Nurick score, and quantitative hyperreflexia, and could play a role in the preoperative assessment of CSM. LEVEL OF EVIDENCE 2.
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305
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Duval T, Smith V, Stikov N, Klawiter EC, Cohen-Adad J. Scan-rescan of axcaliber, macromolecular tissue volume, and g-ratio in the spinal cord. Magn Reson Med 2018; 79:2759-2765. [PMID: 28994487 PMCID: PMC5821542 DOI: 10.1002/mrm.26945] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE Recent MRI techniques have been introduced that can extract microstructural information in the white matter, such as the density or macromolecular content. Translating quantitative MRI to the clinic raises many challenges in terms of acquisition strategy, modeling of the MRI signal, artifact corrections, and metric extraction (template registration and partial volume effects). In this work, we investigated the scan-rescan repeatability of several quantitative MRI techniques in the human spinal cord. METHODS AxCaliber metrics, macromolecular tissue volume, and the fiber g-ratio were estimated in the spinal cord of eight healthy subjects, scanned and rescanned the same day in two different sessions. RESULTS Scan-rescan repeatability deviation was 3% for all metrics, in average in the white matter of all subjects. Intraclass correlation coefficient was up to 0.9. A three-way analysis of variance showed significant effects of white matter pathway, laterality, and subject. CONCLUSION The present study suggests that quantitative MRI gives stable measurements of white matter microstructure in the spinal cord of healthy subjects. Our findings remain to be evaluated in diseased populations. Magn Reson Med 79:2759-2765, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Tanguy Duval
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Victoria Smith
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Nikola Stikov
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Montreal Heart Institute, Montreal, QC, Canada
| | - Eric C. Klawiter
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montréal, QC, Canada
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306
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Albrecht D, Ahmed S, Kettner N, Borra R, Cohen-Adad J, Deng H, Houle T, Opalacz A, Roth S, Melo MV, Chen L, Mao J, Hooker J, Loggia ML, Zhang Y. Neuroinflammation of the spinal cord and nerve roots in chronic radicular pain patients. Pain 2018; 159:968-977. [PMID: 29419657 PMCID: PMC5908728 DOI: 10.1097/j.pain.0000000000001171] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Numerous preclinical studies support the role of spinal neuroimmune activation in the pathogenesis of chronic pain, and targeting glia (eg, microglia/astrocyte)- or macrophage-mediated neuroinflammatory responses effectively prevents or reverses the establishment of persistent nocifensive behaviors in laboratory animals. However, thus far, the translation of those findings into novel treatments for clinical use has been hindered by the scarcity of data supporting the role of neuroinflammation in human pain. Here, we show that patients suffering from a common chronic pain disorder (lumbar radiculopathy), compared with healthy volunteers, exhibit elevated levels of the neuroinflammation marker 18 kDa translocator protein, in both the neuroforamina (containing dorsal root ganglion and nerve roots) and spinal cord. These elevations demonstrated a pattern of spatial specificity correlating with the patients' clinical presentation, as they were observed in the neuroforamen ipsilateral to the symptomatic leg (compared with both contralateral neuroforamen in the same patients as well as to healthy controls) and in the most caudal spinal cord segments, which are known to process sensory information from the lumbosacral nerve roots affected in these patients (compared with more superior segments). Furthermore, the neuroforaminal translocator protein signal was associated with responses to fluoroscopy-guided epidural steroid injections, supporting its role as an imaging marker of neuroinflammation, and highlighting the clinical significance of these observations. These results implicate immunoactivation at multiple levels of the nervous system as a potentially important and clinically relevant mechanism in human radicular pain, and suggest that therapies targeting immune cell activation may be beneficial for chronic pain patients.
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Affiliation(s)
- Daniel Albrecht
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114
| | - Shihab Ahmed
- MGH Translational Pain Research Center, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114
| | - Norman Kettner
- Department of Radiology, Logan University, Chesterfield, MO, 63017
| | - Ronald Borra
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland; Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Julien Cohen-Adad
- Department of Electrical Engineering, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, Quebec, Canada
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114
| | - Timothy Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114
| | - Arissa Opalacz
- MGH Translational Pain Research Center, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114
| | - Sarah Roth
- MGH Translational Pain Research Center, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114
| | - Marcos Vidal Melo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114
| | - Lucy Chen
- MGH Translational Pain Research Center, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114
| | - Jianren Mao
- MGH Translational Pain Research Center, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114
| | - Jacob Hooker
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129
| | - Marco L Loggia
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129
| | - Yi Zhang
- MGH Translational Pain Research Center, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114
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307
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Dostál M, Keřkovský M, Korit′áková E, Němcová E, Stulík J, Staňková M, Bernard V. Analysis of diffusion tensor measurements of the human cervical spinal cord based on semiautomatic segmentation of the white and gray matter. J Magn Reson Imaging 2018; 48:1217-1227. [DOI: 10.1002/jmri.26166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/10/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Marek Dostál
- Department of Biophysics, Faculty of Medicine; Masaryk University; Brno Czech Republic
- Department of Radiology; University Hospital Brno and Masaryk University; Brno Czech Republic
| | - Miloš Keřkovský
- Department of Radiology; University Hospital Brno and Masaryk University; Brno Czech Republic
| | - Eva Korit′áková
- Institute of Biostatistics and Analyses, Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Eva Němcová
- Department of Radiology; University Hospital Brno and Masaryk University; Brno Czech Republic
| | - Jakub Stulík
- Department of Radiology; University Hospital Brno and Masaryk University; Brno Czech Republic
| | - Monika Staňková
- Department of Radiology; University Hospital Brno and Masaryk University; Brno Czech Republic
| | - Vladan Bernard
- Department of Biophysics, Faculty of Medicine; Masaryk University; Brno Czech Republic
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308
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Sinnecker T, Granziera C, Wuerfel J, Schlaeger R. Future Brain and Spinal Cord Volumetric Imaging in the Clinic for Monitoring Treatment Response in MS. Curr Treat Options Neurol 2018; 20:17. [PMID: 29679165 DOI: 10.1007/s11940-018-0504-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Volumetric analysis of brain imaging has emerged as a standard approach used in clinical research, e.g., in the field of multiple sclerosis (MS), but its application in individual disease course monitoring is still hampered by biological and technical limitations. This review summarizes novel developments in volumetric imaging on the road towards clinical application to eventually monitor treatment response in patients with MS. RECENT FINDINGS In addition to the assessment of whole-brain volume changes, recent work was focused on the volumetry of specific compartments and substructures of the central nervous system (CNS) in MS. This included volumetric imaging of the deep brain structures and of the spinal cord white and gray matter. Volume changes of the latter indeed independently correlate with clinical outcome measures especially in progressive MS. Ultrahigh field MRI and quantitative MRI added to this trend by providing a better visualization of small compartments on highly resolving MR images as well as microstructural information. New developments in volumetric imaging have the potential to improve sensitivity as well as specificity in detecting and hence monitoring disease-related CNS volume changes in MS.
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Affiliation(s)
- Tim Sinnecker
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Medical Image Analysis Center Basel AG, Basel, Switzerland
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center Basel AG, Basel, Switzerland
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Ultrahigh Field Facility, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Regina Schlaeger
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
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309
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Martin AR, De Leener B, Cohen-Adad J, Kalsi-Ryan S, Cadotte DW, Wilson JR, Tetreault L, Nouri A, Crawley A, Mikulis DJ, Ginsberg H, Massicotte EM, Fehlings MG. Monitoring for myelopathic progression with multiparametric quantitative MRI. PLoS One 2018; 13:e0195733. [PMID: 29664964 PMCID: PMC5903654 DOI: 10.1371/journal.pone.0195733] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 03/28/2018] [Indexed: 12/04/2022] Open
Abstract
Background Patients with mild degenerative cervical myelopathy (DCM) are often managed non-operatively, and surgery is recommended if neurological progression occurs. However, detection of progression is often subjective. Quantitative MRI (qMRI) directly measures spinal cord (SC) tissue changes, detecting axonal injury, demyelination, and atrophy. This longitudinal study compared multiparametric qMRI with clinical measures of progression in non-operative DCM patients. Methods 26 DCM patients were followed. Clinical data included modified Japanese Orthopedic Association (mJOA) and additional assessments. 3T qMRI data included cross sectional area, diffusion fractional anisotropy, magnetization transfer ratio, and T2*-weighted white/grey matter signal ratio, extracted from the compressed SC and above/below. Progression was defined as 1) patients’ subjective impression, 2) 2-point mJOA decrease, 3) ≥3 clinical measures worsening ≥5%, 4) increased compression on MRI, or 5) ≥1 of 10 qMRI measures or composite score worsening (p < 0.004, corrected). Results Follow-up (13.5 ± 4.9 months) included mJOA in all 26 patients, MRI in 25, and clinical/qMRI in 22. 42.3% reported subjective worsening, compared with mJOA (11.5%), MRI (20%), comprehensive assessments (54.6%), and qMRI (68.2%). Relative to subjective worsening, qMRI showed 100% sensitivity and 53.3% specificity compared with comprehensive assessments (75%, 60%), mJOA (27.3%, 100%), and MRI (18.2%, 81.3%). A decision-making algorithm incorporating qMRI identified progression and recommended surgery for 11 subjects (42.3%). Conclusions Quantitative MRI shows high sensitivity to detect myelopathic progression. Our results suggest that neuroplasticity and behavioural adaptation may mask progressive SC tissue injury. qMRI appears to be a useful method to confirm subtle myelopathic progression in individual patients, representing an advance toward clinical translation of qMRI.
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Affiliation(s)
| | | | | | | | | | | | | | - Aria Nouri
- University of Toronto, Toronto, Ontario, Canada
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310
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Martin AR, De Leener B, Cohen-Adad J, Cadotte DW, Nouri A, Wilson JR, Tetreault L, Crawley AP, Mikulis DJ, Ginsberg H, Fehlings MG. Can microstructural MRI detect subclinical tissue injury in subjects with asymptomatic cervical spinal cord compression? A prospective cohort study. BMJ Open 2018; 8:e019809. [PMID: 29654015 PMCID: PMC5905727 DOI: 10.1136/bmjopen-2017-019809] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Degenerative cervical myelopathy (DCM) involves extrinsic spinal cord compression causing tissue injury and neurological dysfunction. Asymptomatic spinal cord compression (ASCC) is more common, but its significance is poorly defined. This study investigates if: (1) ASCC can be automatically diagnosed using spinal cord shape analysis; (2) multiparametric quantitative MRI can detect similar spinal cord tissue injury as previously observed in DCM. DESIGN Prospective observational longitudinal cohort study. SETTING Single centre, tertiary care and research institution. PARTICIPANTS 40 neurologically intact subjects (19 female, 21 male) divided into groups with and without ASCC. INTERVENTIONS None. OUTCOME MEASURES Clinical assessments: modified Japanese Orthopaedic Association score and physical examination. 3T MRI assessments: automated morphometric analysis compared with consensus ratings of spinal cord compression, and measures of tissue injury: cross-sectional area, diffusion fractional anisotropy, magnetisation transfer ratio and T2*-weighted imaging white to grey matter signal intensity ratio (T2*WI WM/GM) extracted from rostral (C1-3), caudal (C6-7) and maximally compressed levels. RESULTS ASCC was present in 20/40 subjects. Diagnosis with automated shape analysis showed area under the curve >97%. Five MRI metrics showed differences suggestive of tissue injury in ASCC compared with uncompressed subjects (p<0.05), while a composite of all 10 measures (average of z scores) showed highly significant differences (p=0.002). At follow-up (median 21 months), two ASCC subjects developed DCM. CONCLUSIONS ASCC appears to be common and can be accurately and objectively diagnosed with automated morphometric analysis. Quantitative MRI appears to detect subclinical tissue injury in ASCC prior to the onset of neurological symptoms and signs. These findings require further validation, but offer the intriguing possibility of presymptomatic diagnosis and treatment of DCM and other spinal pathologies.
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Affiliation(s)
- Allan R Martin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin De Leener
- Institute of Biomedical Engineering, École Polytechnique de Montréal, Montréal, Québec, Canada
| | - Julien Cohen-Adad
- Institute of Biomedical Engineering, École Polytechnique de Montréal, Montréal, Québec, Canada
| | - David W Cadotte
- Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Aria Nouri
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lindsay Tetreault
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University College Cork, Cork, Ireland
| | - Adrian P Crawley
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - David J Mikulis
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Howard Ginsberg
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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311
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Spinal cord gray matter segmentation using deep dilated convolutions. Sci Rep 2018; 8:5966. [PMID: 29654236 PMCID: PMC5899127 DOI: 10.1038/s41598-018-24304-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/28/2018] [Indexed: 12/12/2022] Open
Abstract
Gray matter (GM) tissue changes have been associated with a wide range of neurological disorders and were recently found relevant as a biomarker for disability in amyotrophic lateral sclerosis. The ability to automatically segment the GM is, therefore, an important task for modern studies of the spinal cord. In this work, we devise a modern, simple and end-to-end fully-automated human spinal cord gray matter segmentation method using Deep Learning, that works both on in vivo and ex vivo MRI acquisitions. We evaluate our method against six independently developed methods on a GM segmentation challenge. We report state-of-the-art results in 8 out of 10 evaluation metrics as well as major network parameter reduction when compared to the traditional medical imaging architectures such as U-Nets.
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312
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Cohen-Adad J. Microstructural imaging in the spinal cord and validation strategies. Neuroimage 2018; 182:169-183. [PMID: 29635029 DOI: 10.1016/j.neuroimage.2018.04.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/02/2018] [Accepted: 04/06/2018] [Indexed: 12/13/2022] Open
Abstract
In vivo histology using magnetic resonance imaging (MRI) is a newly emerging research field that aims to non-invasively characterize tissue microstructure. The implications of in vivo histology are many, from discovering novel biomarkers to studying human development, to providing tools for disease diagnosis and monitoring the effects of novel treatments on tissue. This review focuses on quantitative MRI (qMRI) techniques that are used to map spinal cord microstructure. Opening with a rationale for non-invasive imaging of the spinal cord, this article continues with a brief overview of the existing MRI techniques for axon and myelin imaging, followed by the specific challenges and potential solutions for acquiring and processing such data. The final part of this review focuses on histological validation, with suggested tissue preparation, acquisition and processing protocols for large-scale microscopy.
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Affiliation(s)
- J Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada.
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313
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Huber E, David G, Thompson AJ, Weiskopf N, Mohammadi S, Freund P. Dorsal and ventral horn atrophy is associated with clinical outcome after spinal cord injury. Neurology 2018; 90:e1510-e1522. [PMID: 29592888 PMCID: PMC5921039 DOI: 10.1212/wnl.0000000000005361] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/24/2018] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To investigate whether gray matter pathology above the level of injury, alongside white matter changes, also contributes to sensorimotor impairments after spinal cord injury. METHODS A 3T MRI protocol was acquired in 17 tetraplegic patients and 21 controls. A sagittal T2-weighted sequence was used to characterize lesion severity. At the C2-3 level, a high-resolution T2*-weighted sequence was used to assess cross-sectional areas of gray and white matter, including their subcompartments; a diffusion-weighted sequence was used to compute voxel-based diffusion indices. Regression models determined associations between lesion severity and tissue-specific neurodegeneration and associations between the latter with neurophysiologic and clinical outcome. RESULTS Neurodegeneration was evident within the dorsal and ventral horns and white matter above the level of injury. Tract-specific neurodegeneration was associated with prolonged conduction of appropriate electrophysiologic recordings. Dorsal horn atrophy was associated with sensory outcome, while ventral horn atrophy was associated with motor outcome. White matter integrity of dorsal columns and corticospinal tracts was associated with daily-life independence. CONCLUSION Our results suggest that, next to anterograde and retrograde degeneration of white matter tracts, neuronal circuits within the spinal cord far above the level of injury undergo transsynaptic neurodegeneration, resulting in specific gray matter changes. Such improved understanding of tissue-specific cord pathology offers potential biomarkers with more efficient targeting and monitoring of neuroregenerative (i.e., white matter) and neuroprotective (i.e., gray matter) agents.
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Affiliation(s)
- Eveline Huber
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Gergely David
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Alan J Thompson
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Nikolaus Weiskopf
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Siawoosh Mohammadi
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Patrick Freund
- From the Spinal Cord Injury Center (E.H., G.D., P.F.), Balgrist University Hospital, Zurich, Switzerland; Department of Brain Repair and Rehabilitation (A.J.T., P.F.) and Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, University College London, UK; Department of Neurophysics (N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Germany.
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314
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Hori M, Hagiwara A, Fukunaga I, Ueda R, Kamiya K, Suzuki Y, Liu W, Murata K, Takamura T, Hamasaki N, Irie R, Kamagata K, Kumamaru KK, Suzuki M, Aoki S. Application of Quantitative Microstructural MR Imaging with Atlas-based Analysis for the Spinal Cord in Cervical Spondylotic Myelopathy. Sci Rep 2018; 8:5213. [PMID: 29581458 PMCID: PMC5979956 DOI: 10.1038/s41598-018-23527-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/15/2018] [Indexed: 12/14/2022] Open
Abstract
Mapping of MR fiber g-ratio, which is the ratio of the diameter of the axon to the diameter of the neuronal fiber, is introduced in this article. We investigated the MR fiber g-ratio, the axon volume fraction (AVF) and the myelin volume fraction (MVF) to evaluate microstructural changes in the spinal cord in patients with cervical spondylotic myelopathy (CSM) in vivo, using atlas-based analysis. We used diffusion MRI data acquired with a new simultaneous multi-slice accelerated readout-segmented echo planar imaging sequence for diffusion analysis for AVF calculation and magnetization transfer saturation imaging for MVF calculation. The AVFs of fasciculus gracilis in the affected side spinal cord, fasciculus cuneatus and lateral corticospinal tracts (LSCT) in the affected and unaffected side spinal cord were significantly lower (P = 0.019, 0.001, 0019, 0.000, and 0.002, respectively) than those of normal controls. No difference was found in the MVFs. The fiber g-ratio of LSCT was significantly lower (P = 0.040) in the affected side spinal cords than in the normal controls. The pathological microstructural changes in the spinal cord in patients with CSM, presumably partial axonal degenerations with preserved myelin. This technique has the potential to be a clinical biomarker in patients with CSM in vivo.
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Affiliation(s)
- Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.,Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Fukunaga
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryo Ueda
- Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Kouhei Kamiya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichi Suzuki
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | | | - Tomohiro Takamura
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Nozomi Hamasaki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryusuke Irie
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.,Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Michimasa Suzuki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
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315
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Barry RL, Vannesjo SJ, By S, Gore JC, Smith SA. Spinal cord MRI at 7T. Neuroimage 2018; 168:437-451. [PMID: 28684332 PMCID: PMC5894871 DOI: 10.1016/j.neuroimage.2017.07.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 06/30/2017] [Accepted: 07/02/2017] [Indexed: 11/25/2022] Open
Abstract
Magnetic resonance imaging (MRI) of the human spinal cord at 7T has been demonstrated by a handful of research sites worldwide, and the spinal cord remains one of the areas in which higher fields and resolution could have high impact. The small diameter of the cord (∼1 cm) necessitates high spatial resolution to minimize partial volume effects between gray and white matter, and so MRI of the cord can greatly benefit from increased signal-to-noise ratio and contrasts at ultra-high field (UHF). Herein we review the current state of UHF spinal cord imaging. Technical challenges to successful UHF spinal cord MRI include radiofrequency (B1) nonuniformities and a general lack of optimized radiofrequency coils, amplified physiological noise, and an absence of methods for robust B0 shimming along the cord to mitigate image distortions and signal losses. Numerous solutions to address these challenges have been and are continuing to be explored, and include novel approaches for signal excitation and acquisition, dynamic shimming and specialized shim coils, and acquisitions with increased coverage or optimal slice angulations.
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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.
| | - S Johanna Vannesjo
- Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Samantha By
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - John C Gore
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Seth A Smith
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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316
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Polimeni JR, Renvall V, Zaretskaya N, Fischl B. Analysis strategies for high-resolution UHF-fMRI data. Neuroimage 2018; 168:296-320. [PMID: 28461062 PMCID: PMC5664177 DOI: 10.1016/j.neuroimage.2017.04.053] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 12/22/2022] Open
Abstract
Functional MRI (fMRI) benefits from both increased sensitivity and specificity with increasing magnetic field strength, making it a key application for Ultra-High Field (UHF) MRI scanners. Most UHF-fMRI studies utilize the dramatic increases in sensitivity and specificity to acquire high-resolution data reaching sub-millimeter scales, which enable new classes of experiments to probe the functional organization of the human brain. This review article surveys advanced data analysis strategies developed for high-resolution fMRI at UHF. These include strategies designed to mitigate distortion and artifacts associated with higher fields in ways that attempt to preserve spatial resolution of the fMRI data, as well as recently introduced analysis techniques that are enabled by these extremely high-resolution data. Particular focus is placed on anatomically-informed analyses, including cortical surface-based analysis, which are powerful techniques that can guide each step of the analysis from preprocessing to statistical analysis to interpretation and visualization. New intracortical analysis techniques for laminar and columnar fMRI are also reviewed and discussed. Prospects for single-subject individualized analyses are also presented and discussed. Altogether, there are both specific challenges and opportunities presented by UHF-fMRI, and the use of proper analysis strategies can help these valuable data reach their full potential.
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Affiliation(s)
- Jonathan R Polimeni
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, United States; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, United States.
| | - Ville Renvall
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, United States; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Natalia Zaretskaya
- Centre for Integrative Neuroscience, Department of Psychology, University of Tübingen, Tübingen, Germany; Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Bruce Fischl
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, United States; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, United States
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317
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Schmierer K, McDowell A, Petrova N, Carassiti D, Thomas DL, Miquel ME. Quantifying multiple sclerosis pathology in post mortem spinal cord using MRI. Neuroimage 2018; 182:251-258. [PMID: 29373838 DOI: 10.1016/j.neuroimage.2018.01.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/04/2018] [Accepted: 01/21/2018] [Indexed: 11/26/2022] Open
Abstract
Multiple sclerosis (MS) is a common inflammatory, demyelinating and degenerative disease of the central nervous system. The majority of people with MS present with symptoms due to spinal cord damage, and in more advanced MS a clinical syndrome resembling that of progressive myelopathy is not uncommon. Significant efforts have been undertaken to predict MS-related disability based on short-term observations, for example, the spinal cord cross-sectional area measured using MRI. The histo-pathological correlates of spinal cord MRI changes in MS are incompletely understood, however a surge of interest in tissue microstructure has recently led to new approaches to improve the precision with which MRI indices relate to underlying tissue features, such as myelin content, neurite density and orientation, among others. Quantitative MRI techniques including T1 and T2, magnetisation transfer (MT) and a number of diffusion-derived indices have all been successfully applied to post mortem MS spinal cord. Combining advanced quantification of histological features with quantitative - particularly diffusion-based - MRI techniques provide a new platform for high-quality MR/pathology data generation. To more accurately quantify grey matter pathology in the MS spinal cord, a key driver of physical disability in advanced MS, remains an important challenge of microstructural imaging.
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Affiliation(s)
- K Schmierer
- Queen Mary University of London, Barts and The London School of Medicine & Dentistry, Blizard Institute (Neuroscience), London, UK; Barts Health NHS Trust, Clinical Board Medicine (Neuroscience), The Royal London Hospital, London, UK.
| | - A McDowell
- UCL Great Ormond Street Institute of Child Health, Developmental Imaging and Biophysics Section, London, UK
| | - N Petrova
- Queen Mary University of London, Barts and The London School of Medicine & Dentistry, Blizard Institute (Neuroscience), London, UK
| | - D Carassiti
- Queen Mary University of London, Barts and The London School of Medicine & Dentistry, Blizard Institute (Neuroscience), London, UK
| | - D L Thomas
- UCL Institute of Neurology, Leonard Wolfson Experimental Neurology Centre, Department of Brain Repair and Rehabilitation, Queen Square, London, UK
| | - M E Miquel
- Barts Health NHS Trust, Clinical Physics, London, UK
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318
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Topfer R, Foias A, Stikov N, Cohen-Adad J. Real-time correction of respiration-induced distortions in the human spinal cord using a 24-channel shim array. Magn Reson Med 2018; 80:935-946. [DOI: 10.1002/mrm.27089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 12/22/2017] [Accepted: 12/24/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Ryan Topfer
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal; Montreal Quebec Canada
| | - Alexandru Foias
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal; Montreal Quebec Canada
| | - Nikola Stikov
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal; Montreal Quebec Canada
- Montreal Heart Institute, Université de Montréal; Montreal Quebec Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal; Montreal Quebec Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal; Montreal Quebec Canada
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319
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Massire A, Rasoanandrianina H, Taso M, Guye M, Ranjeva JP, Feiweier T, Callot V. Feasibility of single-shot multi-level multi-angle diffusion tensor imaging of the human cervical spinal cord at 7T. Magn Reson Med 2018; 80:947-957. [DOI: 10.1002/mrm.27087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/07/2017] [Accepted: 12/26/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Aurélien Massire
- Aix-Marseille Univ, CNRS, AP-HM, CRMBM, Hôpital de la Timone; CEMEREM Marseille France
- iLab-Spine - Laboratoire international associé - Imagerie et Biomécanique du rachis, France; Canada
| | - Henitsoa Rasoanandrianina
- Aix-Marseille Univ, CNRS, AP-HM, CRMBM, Hôpital de la Timone; CEMEREM Marseille France
- iLab-Spine - Laboratoire international associé - Imagerie et Biomécanique du rachis, France; Canada
| | - Manuel Taso
- Aix-Marseille Univ, CNRS, AP-HM, CRMBM, Hôpital de la Timone; CEMEREM Marseille France
- iLab-Spine - Laboratoire international associé - Imagerie et Biomécanique du rachis, France; Canada
- Division of MRI Research, Department of Radiology; Beth Israel Deaconess Medical Center & Harvard Medical School; Boston Massachusetts USA
| | - Maxime Guye
- Aix-Marseille Univ, CNRS, AP-HM, CRMBM, Hôpital de la Timone; CEMEREM Marseille France
| | - Jean-Philippe Ranjeva
- Aix-Marseille Univ, CNRS, AP-HM, CRMBM, Hôpital de la Timone; CEMEREM Marseille France
- iLab-Spine - Laboratoire international associé - Imagerie et Biomécanique du rachis, France; Canada
| | | | - Virginie Callot
- Aix-Marseille Univ, CNRS, AP-HM, CRMBM, Hôpital de la Timone; CEMEREM Marseille France
- iLab-Spine - Laboratoire international associé - Imagerie et Biomécanique du rachis, France; Canada
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320
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Lévy S, Guertin MC, Khatibi A, Mezer A, Martinu K, Chen JI, Stikov N, Rainville P, Cohen-Adad J. Test-retest reliability of myelin imaging in the human spinal cord: Measurement errors versus region- and aging-induced variations. PLoS One 2018; 13:e0189944. [PMID: 29293550 PMCID: PMC5749716 DOI: 10.1371/journal.pone.0189944] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 12/05/2017] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To implement a statistical framework for assessing the precision of several quantitative MRI metrics sensitive to myelin in the human spinal cord: T1, Magnetization Transfer Ratio (MTR), saturation imposed by an off-resonance pulse (MTsat) and Macromolecular Tissue Volume (MTV). METHODS Thirty-three healthy subjects within two age groups (young, elderly) were scanned at 3T. Among them, 16 underwent the protocol twice to assess repeatability. Statistical reliability indexes such as the Minimal Detectable Change (MDC) were compared across metrics quantified within different cervical levels and white matter (WM) sub-regions. The differences between pathways and age groups were quantified and interpreted in context of the test-retest repeatability of the measurements. RESULTS The MDC was respectively 105.7ms, 2.77%, 0.37% and 4.08% for T1, MTR, MTsat and MTV when quantified over all WM, while the standard-deviation across subjects was 70.5ms, 1.34%, 0.20% and 2.44%. Even though particular WM regions did exhibit significant differences, these differences were on the same order as test-retest errors. No significant difference was found between age groups for all metrics. CONCLUSION While T1-based metrics (T1 and MTV) exhibited better reliability than MT-based measurements (MTR and MTsat), the observed differences between subjects or WM regions were comparable to (and often smaller than) the MDC. This makes it difficult to determine if observed changes are due to variations in myelin content, or simply due to measurement error. Measurement error remains a challenge in spinal cord myelin imaging, but this study provides statistical guidelines to standardize the field and make it possible to conduct large-scale multi-center studies.
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Affiliation(s)
- Simon Lévy
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center (MHICC), Montreal Heart Institute, Montreal, QC, Canada
| | - Ali Khatibi
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
- Psychology Department, Bilkent University, Ankara, Turkey
- Interdisciplinary program in Neuroscience, Bilkent University, Ankara, Turkey
- National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey
| | - Aviv Mezer
- The Edmond and Lily Safra Center for Brain Sciences (ELSC), The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kristina Martinu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Jen-I Chen
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Nikola Stikov
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Montreal Heart Institute, Montreal, QC, Canada
| | - Pierre Rainville
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
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321
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PAM50: Unbiased multimodal template of the brainstem and spinal cord aligned with the ICBM152 space. Neuroimage 2018; 165:170-179. [DOI: 10.1016/j.neuroimage.2017.10.041] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/16/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022] Open
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322
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Budde MD, Skinner NP, Muftuler LT, Schmit BD, Kurpad SN. Optimizing Filter-Probe Diffusion Weighting in the Rat Spinal Cord for Human Translation. Front Neurosci 2017; 11:706. [PMID: 29311786 PMCID: PMC5742102 DOI: 10.3389/fnins.2017.00706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/01/2017] [Indexed: 12/15/2022] Open
Abstract
Diffusion tensor imaging (DTI) is a promising biomarker of spinal cord injury (SCI). In the acute aftermath, DTI in SCI animal models consistently demonstrates high sensitivity and prognostic performance, yet translation of DTI to acute human SCI has been limited. In addition to technical challenges, interpretation of the resulting metrics is ambiguous, with contributions in the acute setting from both axonal injury and edema. Novel diffusion MRI acquisition strategies such as double diffusion encoding (DDE) have recently enabled detection of features not available with DTI or similar methods. In this work, we perform a systematic optimization of DDE using simulations and an in vivo rat model of SCI and subsequently implement the protocol to the healthy human spinal cord. First, two complementary DDE approaches were evaluated using an orientationally invariant or a filter-probe diffusion encoding approach. While the two methods were similar in their ability to detect acute SCI, the filter-probe DDE approach had greater predictive power for functional outcomes. Next, the filter-probe DDE was compared to an analogous single diffusion encoding (SDE) approach, with the results indicating that in the spinal cord, SDE provides similar contrast with improved signal to noise. In the SCI rat model, the filter-probe SDE scheme was coupled with a reduced field of view (rFOV) excitation, and the results demonstrate high quality maps of the spinal cord without contamination from edema and cerebrospinal fluid, thereby providing high sensitivity to injury severity. The optimized protocol was demonstrated in the healthy human spinal cord using the commercially-available diffusion MRI sequence with modifications only to the diffusion encoding directions. Maps of axial diffusivity devoid of CSF partial volume effects were obtained in a clinically feasible imaging time with a straightforward analysis and variability comparable to axial diffusivity derived from DTI. Overall, the results and optimizations describe a protocol that mitigates several difficulties with DTI of the spinal cord. Detection of acute axonal damage in the injured or diseased spinal cord will benefit the optimized filter-probe diffusion MRI protocol outlined here.
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Affiliation(s)
- Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Nathan P Skinner
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States.,Medical Scientist Training Program, Medical College of Wisconsin, Milwaukee, WI, United States
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
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323
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Gros C, De Leener B, Dupont SM, Martin AR, Fehlings MG, Bakshi R, Tummala S, Auclair V, McLaren DG, Callot V, Cohen-Adad J, Sdika M. Automatic spinal cord localization, robust to MRI contrasts using global curve optimization. Med Image Anal 2017; 44:215-227. [PMID: 29288983 DOI: 10.1016/j.media.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/29/2017] [Accepted: 12/02/2017] [Indexed: 12/14/2022]
Abstract
During the last two decades, MRI has been increasingly used for providing valuable quantitative information about spinal cord morphometry, such as quantification of the spinal cord atrophy in various diseases. However, despite the significant improvement of MR sequences adapted to the spinal cord, automatic image processing tools for spinal cord MRI data are not yet as developed as for the brain. There is nonetheless great interest in fully automatic and fast processing methods to be able to propose quantitative analysis pipelines on large datasets without user bias. The first step of most of these analysis pipelines is to detect the spinal cord, which is challenging to achieve automatically across the broad range of MRI contrasts, field of view, resolutions and pathologies. In this paper, a fully automated, robust and fast method for detecting the spinal cord centerline on MRI volumes is introduced. The algorithm uses a global optimization scheme that attempts to strike a balance between a probabilistic localization map of the spinal cord center point and the overall spatial consistency of the spinal cord centerline (i.e. the rostro-caudal continuity of the spinal cord). Additionally, a new post-processing feature, which aims to automatically split brain and spine regions is introduced, to be able to detect a consistent spinal cord centerline, independently from the field of view. We present data on the validation of the proposed algorithm, known as "OptiC", from a large dataset involving 20 centers, 4 contrasts (T2-weighted n = 287, T1-weighted n = 120, T2∗-weighted n = 307, diffusion-weighted n = 90), 501 subjects including 173 patients with a variety of neurologic diseases. Validation involved the gold-standard centerline coverage, the mean square error between the true and predicted centerlines and the ability to accurately separate brain and spine regions. Overall, OptiC was able to cover 98.77% of the gold-standard centerline, with a mean square error of 1.02 mm. OptiC achieved superior results compared to a state-of-the-art spinal cord localization technique based on the Hough transform, especially on pathological cases with an averaged mean square error of 1.08 mm vs. 13.16 mm (Wilcoxon signed-rank test p-value < .01). Images containing brain regions were identified with a 99% precision, on which brain and spine regions were separated with a distance error of 9.37 mm compared to ground-truth. Validation results on a challenging dataset suggest that OptiC could reliably be used for subsequent quantitative analyses tasks, opening the door to more robust analysis on pathological cases.
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Affiliation(s)
- Charley Gros
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Benjamin De Leener
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Sara M Dupont
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Allan R Martin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Subhash Tummala
- Laboratory for Neuroimaging Research, Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | | | | | - Virginie Callot
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hôpital de la Timone, Pôle d'imagerie médicale, CEMEREM, Marseille, France
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
| | - Michaël Sdika
- Univ. Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69100, Lyon, France.
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324
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Rasoanandrianina H, Grapperon AM, Taso M, Girard OM, Duhamel G, Guye M, Ranjeva JP, Attarian S, Verschueren A, Callot V. Region-specific impairment of the cervical spinal cord (SC) in amyotrophic lateral sclerosis: A preliminary study using SC templates and quantitative MRI (diffusion tensor imaging/inhomogeneous magnetization transfer). NMR IN BIOMEDICINE 2017; 30:e3801. [PMID: 28926131 DOI: 10.1002/nbm.3801] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/24/2017] [Accepted: 08/07/2017] [Indexed: 06/07/2023]
Abstract
In this preliminary study, our objective was to investigate the potential of high-resolution anatomical imaging, diffusion tensor imaging (DTI) and conventional/inhomogeneous magnetization transfer imaging [magnetization transfer (MT)/inhomogeneous magnetization transfer (ihMT)] at 3 T, analyzed with template-extracted regions of interest, to measure the atrophy and structural changes of white (WM) and gray (GM) matter spinal cord (SC) occurring in patients with amyotrophic lateral sclerosis (ALS). Ten patients with ALS and 20 age-matched healthy controls were recruited. SC GM and WM areas were automatically segmented using dedicated templates. Atrophy indices were evaluated from T2 *-weighted images at each vertebral level from cervical C1 to C6. DTI and ihMT metrics were quantified within the corticospinal tract (CST), posterior sensory tract (PST) and anterior GM (aGM) horns at the C2 and C5 levels. Clinical disabilities of patients with ALS were evaluated using the Revised ALS Functional Rating Scale, upper motor neuron (UMN) and Medical Research Council scorings, and correlated with MR metrics. Compared with healthy controls, GM and WM atrophy was observed in patients with ALS, especially at lower cervical levels, where a strong correlation was also observed between GM atrophy and the UMN score (R = -0.75, p = 0.05 at C6). Interestingly, a significant decrease in ihMT ratio was found in all regions of interest (p < 0.0008), fractional anisotropy (FA) and MT ratios decreased significantly in CST, especially at C5 (p < 0.005), and λ// (axial diffusivity) decreased significantly in CST (p = 0.0004) and PST (p = 0.003) at C2. Strong correlations between MRI metrics and clinical scores were also found (0.47 < |R| < 0.87, p < 0.05). Altogether, these preliminary results suggest that high-resolution anatomical imaging and ihMT imaging, in addition to DTI, are valuable for the characterization of SC tissue impairment in ALS. In this study, in addition to an important SC WM demyelination, we also observed, for the first time in ALS, impairments of cervical aGM.
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Affiliation(s)
- Henitsoa Rasoanandrianina
- Aix-Marseille Université, CNRS, APHM, CRMBM, Hôpital de la Timone, CEMEREM, Marseille, France
- iLab-Spine International Associated Laboratory, Marseille-Montreal, France-Canada
- Aix-Marseille Université, IFSTTAR, LBA UMR T 24, Marseille, France
| | - Aude-Marie Grapperon
- Centre de Référence des Maladies neuro-musculaires et de la SLA, Hopital de La Timone, Marseille, France
| | - Manuel Taso
- Aix-Marseille Université, CNRS, APHM, CRMBM, Hôpital de la Timone, CEMEREM, Marseille, France
- iLab-Spine International Associated Laboratory, Marseille-Montreal, France-Canada
- Aix-Marseille Université, IFSTTAR, LBA UMR T 24, Marseille, France
| | - Olivier M Girard
- Aix-Marseille Université, CNRS, APHM, CRMBM, Hôpital de la Timone, CEMEREM, Marseille, France
| | - Guillaume Duhamel
- Aix-Marseille Université, CNRS, APHM, CRMBM, Hôpital de la Timone, CEMEREM, Marseille, France
| | - Maxime Guye
- Aix-Marseille Université, CNRS, APHM, CRMBM, Hôpital de la Timone, CEMEREM, Marseille, France
| | - Jean-Philippe Ranjeva
- Aix-Marseille Université, CNRS, APHM, CRMBM, Hôpital de la Timone, CEMEREM, Marseille, France
| | - Shahram Attarian
- Centre de Référence des Maladies neuro-musculaires et de la SLA, Hopital de La Timone, Marseille, France
- Aix Marseille Université, INSERM, GMGF, Marseille, France
| | - Annie Verschueren
- Centre de Référence des Maladies neuro-musculaires et de la SLA, Hopital de La Timone, Marseille, France
| | - Virginie Callot
- Aix-Marseille Université, CNRS, APHM, CRMBM, Hôpital de la Timone, CEMEREM, Marseille, France
- iLab-Spine International Associated Laboratory, Marseille-Montreal, France-Canada
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325
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Paquin MÊ, El Mendili MM, Gros C, Dupont SM, Cohen-Adad J, Pradat PF. Spinal Cord Gray Matter Atrophy in Amyotrophic Lateral Sclerosis. AJNR Am J Neuroradiol 2017; 39:184-192. [PMID: 29122760 DOI: 10.3174/ajnr.a5427] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/17/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is an emerging need for biomarkers to better categorize clinical phenotypes and predict progression in amyotrophic lateral sclerosis. This study aimed to quantify cervical spinal gray matter atrophy in amyotrophic lateral sclerosis and investigate its association with clinical disability at baseline and after 1 year. MATERIALS AND METHODS Twenty-nine patients with amyotrophic lateral sclerosis and 22 healthy controls were scanned with 3T MR imaging. Standard functional scale was recorded at the time of MR imaging and after 1 year. MR imaging data were processed automatically to measure the spinal cord, gray matter, and white matter cross-sectional areas. A statistical analysis assessed the difference in cross-sectional areas between patients with amyotrophic lateral sclerosis and controls, correlations between spinal cord and gray matter atrophy to clinical disability at baseline and at 1 year, and prediction of clinical disability at 1 year. RESULTS Gray matter atrophy was more sensitive to discriminate patients with amyotrophic lateral sclerosis from controls (P = .004) compared with spinal cord atrophy (P = .02). Gray matter and spinal cord cross-sectional areas showed good correlations with clinical scores at baseline (R = 0.56 for gray matter and R = 0.55 for spinal cord; P < .01). Prediction at 1 year with clinical scores (R2 = 0.54) was improved when including a combination of gray matter and white matter cross-sectional areas (R2 = 0.74). CONCLUSIONS Although improvements over spinal cord cross-sectional areas were modest, this study suggests the potential use of gray matter cross-sectional areas as an MR imaging structural biomarker to monitor the evolution of amyotrophic lateral sclerosis.
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Affiliation(s)
- M-Ê Paquin
- From the Faculté de Médecine (M.-Ê.P.).,NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal (M.-Ê.P., C.G., S.M.D., J.C.-A.), Montreal, Quebec, Canada
| | - M M El Mendili
- Sorbonne Universités (M.M.E.M., P.-F.P.) UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.,Department of Neurology (M.M.E.M.), Icahn School of Medicine, Mount Sinai, New York, New York
| | - C Gros
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal (M.-Ê.P., C.G., S.M.D., J.C.-A.), Montreal, Quebec, Canada
| | - S M Dupont
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal (M.-Ê.P., C.G., S.M.D., J.C.-A.), Montreal, Quebec, Canada
| | - J Cohen-Adad
- Functional Neuroimaging Unit, CRIUGM (J.C.-A.), Université de Montréal, Montreal, Quebec, Canada .,NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal (M.-Ê.P., C.G., S.M.D., J.C.-A.), Montreal, Quebec, Canada
| | - P-F Pradat
- Sorbonne Universités (M.M.E.M., P.-F.P.) UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.,Département des Maladies du Système Nerveux (P.-F.P.), Centre Référent Maladie Rare SLA, Hôpital de la Pitié-Salpêtrière, Paris, France
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326
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Azodi S, Nair G, Enose-Akahata Y, Charlip E, Vellucci A, Cortese I, Dwyer J, Billioux BJ, Thomas C, Ohayon J, Reich DS, Jacobson S. Imaging spinal cord atrophy in progressive myelopathies: HTLV-I-associated neurological disease (HAM/TSP) and multiple sclerosis (MS). Ann Neurol 2017; 82:719-728. [PMID: 29024167 DOI: 10.1002/ana.25072] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/08/2017] [Accepted: 10/05/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previous work measures spinal cord thinning in chronic progressive myelopathies, including human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and multiple sclerosis (MS). Quantitative measurements of spinal cord atrophy are important in fully characterizing these and other spinal cord diseases. We aimed to investigate patterns of spinal cord atrophy and correlations with clinical markers. METHODS Spinal cord cross-sectional area was measured in individuals (24 healthy controls [HCs], 17 asymptomatic carriers of HTLV-1 (AC), 47 HAM/TSP, 74 relapsing-remitting MS [RRMS], 17 secondary progressive MS [SPMS], and 40 primary progressive MS [PPMS]) from C1 to T10. Clinical disability scores, viral markers, and immunological parameters were obtained for patients and correlated with representative spinal cord cross-sectional area regions at the C2 to C3, C4 to C5, and T4 to T9 levels. In 2 HAM/TSP patients, spinal cord cross-sectional area was measured over 3 years. RESULTS All spinal cord regions are thinner in HAM/TSP (56 mm2 [standard deviation, 10], 59 [10], 23 [5]) than in HC (76 [7], 83 [8], 38 [4]) and AC (71 [7], 78 [9], 36 [7]). SPMS (62 [9], 66 [9], 32 [6]) and PPMS (65 [11], 68 [10], 35 [7]) have thinner cervical cords than HC and RRMS (73 [9], 77 [10], 37 [6]). Clinical disability scores (Expanded Disability Status Scale [p = 0.009] and Instituto de Pesquisas de Cananeia [p = 0.03]) and CD8+ T-cell frequency (p = 0.04) correlate with T4 to T9 spinal cord cross-sectional area in HAM/TSP. Higher cerebrospinal fluid HTLV-1 proviral load (p = 0.01) was associated with thinner spinal cord cross-sectional area. Both HAM/TSP patients followed longitudinally showed thoracic thinning followed by cervical thinning. INTERPRETATION Group average spinal cord cross-sectional area in HAM/TSP and progressive MS show spinal cord atrophy. We further hypothesize in HAM/TSP that is possible that neuroglial loss from a thoracic inflammatory process results in anterograde and retrograde degeneration of axons, leading to the temporal progression of thoracic to cervical atrophy described here. Ann Neurol 2017;82:719-728.
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Affiliation(s)
- Shila Azodi
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Govind Nair
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Yoshimi Enose-Akahata
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Emily Charlip
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Ashley Vellucci
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Irene Cortese
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Jenifer Dwyer
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - B Jeanne Billioux
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Chevaz Thomas
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Joan Ohayon
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
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327
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Weber KA, Sentis AI, Bernadel-Huey ON, Chen Y, Wang X, Parrish TB, Mackey S. Thermal Stimulation Alters Cervical Spinal Cord Functional Connectivity in Humans. Neuroscience 2017; 369:40-50. [PMID: 29101078 DOI: 10.1016/j.neuroscience.2017.10.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 11/28/2022]
Abstract
The spinal cord has an active role in the modulation and transmission of the neural signals traveling between the body and the brain. Recent advancements in functional magnetic resonance imaging (fMRI) have made the in vivo examination of spinal cord function in humans now possible. This technology has been recently extended to the investigation of resting state functional networks in the spinal cord, leading to the identification of distinct patterns of spinal cord functional connectivity. In this study, we expand on the previous work and further investigate resting state cervical spinal cord functional connectivity in healthy participants (n = 15) using high resolution imaging coupled with both seed-based functional connectivity analyses and graph theory-based metrics. Within spinal cord segment functional connectivity was present between the left and right ventral horns (bilateral motor network), left and right dorsal horns (bilateral sensory network), and the ipsilateral ventral and dorsal horns (unilateral sensory-motor network). Functional connectivity between the spinal cord segments was less apparent with the connectivity centered at the region of interest and spanning <20 mm along the superior-inferior axis. In a subset of participants (n = 10), the cervical spinal cord functional network was demonstrated to be state-dependent as thermal stimulation of the right ventrolateral forearm resulted in significant disruption of the bilateral sensory network, increased network global efficiency, and decreased network modularity.
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Affiliation(s)
- Kenneth A Weber
- Systems Neuroscience and Pain Lab, Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Palo Alto 94304, CA, USA.
| | - Amy I Sentis
- Systems Neuroscience and Pain Lab, Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Palo Alto 94304, CA, USA
| | - Olivia N Bernadel-Huey
- Systems Neuroscience and Pain Lab, Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Palo Alto 94304, CA, USA
| | - Yufen Chen
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
| | - Xue Wang
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
| | - Todd B Parrish
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
| | - Sean Mackey
- Systems Neuroscience and Pain Lab, Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Palo Alto 94304, CA, USA
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328
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Smith AC, Weber KA, O'Dell DR, Parrish TB, Wasielewski M, Elliott JM. Lateral Corticospinal Tract Damage Correlates With Motor Output in Incomplete Spinal Cord Injury. Arch Phys Med Rehabil 2017; 99:660-666. [PMID: 29107041 DOI: 10.1016/j.apmr.2017.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/21/2017] [Accepted: 10/01/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the relationship between spinal cord damage and specific motor function in participants with incomplete spinal cord injury (iSCI). DESIGN Single-blinded, cross-sectional study design. SETTING University setting research laboratory. PARTICIPANTS Individuals with chronic cervical iSCI (N=14; 1 woman, 13 men; average age ± SD, 43±12y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Axial T2-weighted magnetic resonance imaging (MRI) of spinal cord damage was performed in 14 participants with iSCI. Each participant's damage was processed for total damage quantification, lateral corticospinal tract (LCST) and gracile fasciculus (GF) analysis. Plantarflexion and knee extension were quantified using an isokinetic dynamometer. Walking ability was assessed using a 6-minute walk test. RESULTS Total damage was correlated with plantarflexion, knee extension, and distance walked in 6 minutes. Right LCST damage was correlated with right plantarflexion and right knee extension, while left LCST damage was correlated with left-sided measures. Right and left GF damage was not correlated with the motor output measures. CONCLUSIONS MRI measures of spinal cord damage were correlated to motor function, and this measure appears to have spatial specificity to descending tracts, which may offer prognostic value after SCI.
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Affiliation(s)
- Andrew C Smith
- Regis University School of Physical Therapy, Denver, CO; Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL.
| | - Kenneth A Weber
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA
| | | | - Todd B Parrish
- Department of Radiology, Northwestern University, Chicago, IL
| | - Marie Wasielewski
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL
| | - James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL
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329
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Peterson DJ, Rutman AM, Hippe DS, Jarvik JG, Chokshi FH, Reyes MR, Bombardier CH, Mossa-Basha M. Test-Retest and Interreader Reproducibility of Semiautomated Atlas-Based Analysis of Diffusion Tensor Imaging Data in Acute Cervical Spine Trauma in Adult Patients. AJNR Am J Neuroradiol 2017; 38:2015-2020. [PMID: 28818826 DOI: 10.3174/ajnr.a5334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 06/05/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DTI is a tool for microstructural spinal cord injury evaluation. This study evaluated the reproducibility of a semiautomated segmentation algorithm of spinal cord DTI. MATERIALS AND METHODS Forty-two consecutive patients undergoing acute trauma cervical spine MR imaging underwent 2 axial DTI scans in addition to their clinical scan. The datasets were put through a semiautomated probabilistic segmentation algorithm that selected white matter, gray matter, and 24 individual white matter tracts. Regional and white matter tract volume, fractional anisotropy, and mean diffusivity values were calculated. Two readers performed the nonautomated steps to evaluate interreader reproducibility. The coefficient of variation and intraclass correlation coefficient were used to assess test-retest and interreader reproducibility. RESULTS Of 42 patients, 30 had useable data. Test-retest reproducibility of fractional anisotropy was high for white matter as a whole (coefficient of variation, 3.8%; intraclass correlation coefficient, 0.93). Test-retest coefficient-of-variation ranged from 8.0%-18.2% and intraclass correlation coefficients from 0.47-0.80 across individual white matter tracts. Mean diffusivity metrics also had high test-retest reproducibility (white matter: coefficient-of-variation, 5.6%; intraclass correlation coefficient, 0.86) with coefficients of variation from 11.6%-18.3% and intraclass correlation coefficients from 0.57-0.74 across individual tracts, with better agreement for larger tracts. The coefficients of variation of fractional anisotropy and mean diffusivity both had significant negative relationships with white matter volume (26%-27% decrease for each doubling of white matter volume, P < .01). CONCLUSIONS DTI spinal cord segmentation is reproducible in the setting of acute spine trauma, specifically for larger white matter tracts and total white or gray matter.
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Affiliation(s)
- D J Peterson
- From the Departments of Radiology (D.J.P., A.M.R., D.S.H., J.G.J., M.M.-B.)
| | - A M Rutman
- From the Departments of Radiology (D.J.P., A.M.R., D.S.H., J.G.J., M.M.-B.)
| | - D S Hippe
- From the Departments of Radiology (D.J.P., A.M.R., D.S.H., J.G.J., M.M.-B.)
| | - J G Jarvik
- From the Departments of Radiology (D.J.P., A.M.R., D.S.H., J.G.J., M.M.-B.)
| | - F H Chokshi
- Department of Radiology (F.H.C.), Emory University, Atlanta, Georgia
| | - M R Reyes
- Rehabilitation Medicine (M.R.R., C.H.B.), University of Washington, Seattle, Washington
| | - C H Bombardier
- Rehabilitation Medicine (M.R.R., C.H.B.), University of Washington, Seattle, Washington
| | - M Mossa-Basha
- From the Departments of Radiology (D.J.P., A.M.R., D.S.H., J.G.J., M.M.-B.)
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330
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Liu H, MacMillan EL, Jutzeler CR, Ljungberg E, MacKay AL, Kolind SH, Mädler B, Li DKB, Dvorak MF, Curt A, Laule C, Kramer JLK. Assessing structure and function of myelin in cervical spondylotic myelopathy: Evidence of demyelination. Neurology 2017; 89:602-610. [PMID: 28701500 PMCID: PMC5562959 DOI: 10.1212/wnl.0000000000004197] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 05/12/2017] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To assess the extent of demyelination in cervical spondylotic myelopathy (CSM) using myelin water imaging (MWI) and electrophysiologic techniques. METHODS Somatosensory evoked potentials (SSEPs) and MWI were acquired in 14 patients with CSM and 18 age-matched healthy controls. MWI was performed on a 3.0T whole body magnetic resonance scanner. Myelin water fraction (MWF) was extracted for the dorsal columns and whole cord. SSEPs and MWF were also compared with conventional MRI outcomes, including T2 signal intensity, compression ratio, maximum spinal cord compression (MSCC), and maximum canal compromise (MCC). RESULTS Group analysis showed marked differences in T2 signal intensity, compression ratio, MSCC, and MCC between healthy controls and patients with CSM. There were no group differences in MWF and SSEP latencies. However, patients with CSM with pathologic SSEPs exhibited reduction in MWF (p < 0.05). MWF was also correlated with SSEP latencies. CONCLUSION Our findings provide evidence of decreased myelin content in the spinal cord associated with impaired spinal cord conduction in patients with CSM. While conventional MRI are of great value to define the extent of cord compression, they show a limited correlation with functional deficits (i.e., delayed SSEPs). MWI provides independent and complementary readouts to spinal cord compression, with a high specificity to detect impaired conduction.
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Affiliation(s)
- Hanwen Liu
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany.
| | - Erin L MacMillan
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Catherine R Jutzeler
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Emil Ljungberg
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Alex L MacKay
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Shannon H Kolind
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Burkhard Mädler
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - David K B Li
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Marcel F Dvorak
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Armin Curt
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Cornelia Laule
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - John L K Kramer
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
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331
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Rutman AM, Peterson DJ, Cohen WA, Mossa-Basha M. Diffusion Tensor Imaging of the Spinal Cord: Clinical Value, Investigational Applications, and Technical Limitations. Curr Probl Diagn Radiol 2017; 47:257-269. [PMID: 28869104 DOI: 10.1067/j.cpradiol.2017.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022]
Abstract
Although diffusion-weighted imaging (DWI) has become a mainstay in modern brain imaging, it remains less utilized in the evaluation of the spinal cord. Many studies have shown promise in using DWI and diffusion-tensor imaging (DTI) for evaluation of the spinal cord; however, application has been stalled by technical obstacles and artifacts, and questions remain regarding its clinical utility on an individual examination level. This review discusses the background, concepts, and technical aspects of DWI and DTI, specifically for imaging of the spinal cord. The clinical and investigational applications of spinal cord DTI, as well as the practical difficulties and limitations of DWI and DTI for the evaluation of the spinal cord are examined.
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Affiliation(s)
- Aaron M Rutman
- Department of Radiology, University of Washington, Seattle, WA.
| | | | - Wendy A Cohen
- Department of Radiology, University of Washington, Seattle, WA
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332
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Grabher P, Mohammadi S, David G, Freund P. Neurodegeneration in the Spinal Ventral Horn Prior to Motor Impairment in Cervical Spondylotic Myelopathy. J Neurotrauma 2017; 34:2329-2334. [PMID: 28462691 DOI: 10.1089/neu.2017.4980] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Remote gray matter pathology has been suggested rostral to the compression site in cervical spondylotic myelopathy (CSM). We therefore assessed neurodegeneration in the gray matter ventral and dorsal horns. Twenty patients with CSM and 18 healthy subjects underwent a high-resolution structural and diffusion magnetic resonance imaging protocol at vertebra C2/C3. Patients received comprehensive clinical assessments. T2*-weighted data provided cross-sectional area measurements of gray matter ventral and dorsal horns to identify atrophy. At the identical location, mean diffusivity (MD) and fractional anisotropy (FA) determined the microstructural integrity. Finally, the relationships between neurodegeneration occurring in the gray and white matter and clinical impairment were investigated. Patients suffered from mild-to-moderate CSM with mainly sensory impairment. In the ventral horns, cross-sectional area was not reduced (p = 0.863) but MD was increased (p = 0.045). The magnitude of MD changes within the ventral horn was associated with white matter diffusivity changes (MD: p = 0.013; FA: p = 0.028) within the lateral corticospinal tract. In contrast, dorsal horn cross-sectional area was reduced by 16.0% (p < 0.001) without alterations in diffusivity indices, compared with controls. No associations between the magnitude of ventral and dorsal horn neurodegeneration and clinical impairment were evident. Focal cord gray matter pathology is evident remote to the compression site in vivo in CSM patients. Microstructural changes in the ventral horns (i.e., motoneurons) related to corticospinal tract integrity in the absence of atrophy and marked motor impairment. Dorsal horn atrophy corresponded to main clinical representation of sensory impairment. Thus, neuroimaging biomarkers of cord gray matter integrity reveal focal neurodegeneration prior to marked clinical impairment and thus could serve as predictors of ensuing impairment in CSM patients.
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Affiliation(s)
- Patrick Grabher
- 1 Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Siawoosh Mohammadi
- 2 Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf , Hamburg, Germany .,3 Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London , London, United Kingdom .,4 Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig, Germany
| | - Gergely David
- 1 Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Patrick Freund
- 1 Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich , Zurich, Switzerland .,3 Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London , London, United Kingdom .,4 Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig, Germany .,5 Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London , London, United Kingdom
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333
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Combes AJ, Matthews L, Lee JS, Li DK, Carruthers R, Traboulsee AL, Barker GJ, Palace J, Kolind S. Cervical cord myelin water imaging shows degenerative changes over one year in multiple sclerosis but not neuromyelitis optica spectrum disorder. NEUROIMAGE-CLINICAL 2017; 16:17-22. [PMID: 28725551 PMCID: PMC5503831 DOI: 10.1016/j.nicl.2017.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/08/2017] [Accepted: 06/13/2017] [Indexed: 12/12/2022]
Abstract
Spinal cord pathology is a feature of both neuromyelitis optica spectrum disorder (NMOSD) and relapsing-remitting multiple sclerosis (MS). While subclinical disease activity has been described in MS using quantitative magnetic resonance imaging measures, current evidence suggests that neurodegeneration is absent between relapses in NMOSD, although most evidence comes from brain studies. We aimed to assess cross-sectional differences and longitudinal changes in myelin integrity in relapse-free MS and NMOSD subjects over one year. 15 NMOSD, 15 MS subjects, and 17 healthy controls were scanned at 3 T using a cervical cord mcDESPOT protocol. A subset of 8 NMOSD, 11 MS subjects and 14 controls completed follow-up. Measures of the myelin water fraction (fM) within lesioned and non-lesioned cord segments were collected. At baseline, fM in lesioned and non-lesioned segments was significantly reduced in MS (lesioned: p = 0.002; non-lesioned: p = 0.03) and NMOSD (lesioned: p = 0.0007; non-lesioned: p = 0.002) compared to controls. Longitudinally, fM decreased within non-lesioned cord segments in the MS group (− 7.3%, p = 0.02), but not in NMOSD (+ 5.8%, p = 0.1), while change in lesioned segments fM did not differ from controls' in either patient group. These results suggest that degenerative changes outside of lesioned areas can be observed over a short time frame in MS, but not NMOSD, and support the use of longitudinal myelin water imaging for the assessment of pathological changes in the cervical cord in demyelinating diseases. MS and NMOSD subjects underwent longitudinal cervical cord myelin water imaging. Reduced myelin water fraction in MS and NMOSD normal-appearing and lesioned areas Decrease in myelin in normal-appearing tissue over 1 year in MS, but not NMOSD Further evidence that disease progression is absent between relapses in NMOSD.
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Affiliation(s)
- Anna J.E. Combes
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Corresponding author at: Centre for Neuroimaging Sciences, P089, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Lucy Matthews
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jimmy S. Lee
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David K.B. Li
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert Carruthers
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Anthony L. Traboulsee
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Gareth J. Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Shannon Kolind
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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334
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Martin AR, De Leener B, Cohen-Adad J, Cadotte DW, Kalsi-Ryan S, Lange SF, Tetreault L, Nouri A, Crawley A, Mikulis DJ, Ginsberg H, Fehlings MG. Clinically Feasible Microstructural MRI to Quantify Cervical Spinal Cord Tissue Injury Using DTI, MT, and T2*-Weighted Imaging: Assessment of Normative Data and Reliability. AJNR Am J Neuroradiol 2017; 38:1257-1265. [PMID: 28428213 DOI: 10.3174/ajnr.a5163] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/28/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DTI, magnetization transfer, T2*-weighted imaging, and cross-sectional area can quantify aspects of spinal cord microstructure. However, clinical adoption remains elusive due to complex acquisitions, cumbersome analysis, limited reliability, and wide ranges of normal values. We propose a simple multiparametric protocol with automated analysis and report normative data, analysis of confounding variables, and reliability. MATERIALS AND METHODS Forty healthy subjects underwent T2WI, DTI, magnetization transfer, and T2*WI at 3T in <35 minutes using standard hardware and pulse sequences. Cross-sectional area, fractional anisotropy, magnetization transfer ratio, and T2*WI WM/GM signal intensity ratio were calculated. Relationships between MR imaging metrics and age, sex, height, weight, cervical cord length, and rostrocaudal level were analyzed. Test-retest coefficient of variation measured reliability in 24 DTI, 17 magnetization transfer, and 16 T2*WI datasets. DTI with and without cardiac triggering was compared in 10 subjects. RESULTS T2*WI WM/GM showed lower intersubject coefficient of variation (3.5%) compared with magnetization transfer ratio (5.8%), fractional anisotropy (6.0%), and cross-sectional area (12.2%). Linear correction of cross-sectional area with cervical cord length, fractional anisotropy with age, and magnetization transfer ratio with age and height led to decreased coefficients of variation (4.8%, 5.4%, and 10.2%, respectively). Acceptable reliability was achieved for all metrics/levels (test-retest coefficient of variation < 5%), with T2*WI WM/GM comparing favorably with fractional anisotropy and magnetization transfer ratio. DTI with and without cardiac triggering showed no significant differences for fractional anisotropy and test-retest coefficient of variation. CONCLUSIONS Reliable multiparametric assessment of spinal cord microstructure is possible by using clinically suitable methods. These results establish normalization procedures and pave the way for clinical studies, with the potential for improving diagnostics, objectively monitoring disease progression, and predicting outcomes in spinal pathologies.
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Affiliation(s)
- A R Martin
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - B De Leener
- Polytechnique Montreal (B.D.L., J.C.-A.), Montréal, Quebec, Canada
| | - J Cohen-Adad
- Polytechnique Montreal (B.D.L., J.C.-A.), Montréal, Quebec, Canada
- Functional Neuroimaging Unit (J.C.-A.), Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - D W Cadotte
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - S Kalsi-Ryan
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - S F Lange
- University of Groningen (S.F.L.), Groningen, the Netherlands
| | - L Tetreault
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - A Nouri
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - A Crawley
- Department of Medical Imaging (A.C., D.J.M.), University of Toronto and the University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - D J Mikulis
- Department of Medical Imaging (A.C., D.J.M.), University of Toronto and the University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - H Ginsberg
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - M G Fehlings
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
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335
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Prados F, Ashburner J, Blaiotta C, Brosch T, Carballido-Gamio J, Cardoso MJ, Conrad BN, Datta E, Dávid G, Leener BD, Dupont SM, Freund P, Wheeler-Kingshott CAMG, Grussu F, Henry R, Landman BA, Ljungberg E, Lyttle B, Ourselin S, Papinutto N, Saporito S, Schlaeger R, Smith SA, Summers P, Tam R, Yiannakas MC, Zhu A, Cohen-Adad J. Spinal cord grey matter segmentation challenge. Neuroimage 2017; 152:312-329. [PMID: 28286318 PMCID: PMC5440179 DOI: 10.1016/j.neuroimage.2017.03.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/27/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022] Open
Abstract
An important image processing step in spinal cord magnetic resonance imaging is the ability to reliably and accurately segment grey and white matter for tissue specific analysis. There are several semi- or fully-automated segmentation methods for cervical cord cross-sectional area measurement with an excellent performance close or equal to the manual segmentation. However, grey matter segmentation is still challenging due to small cross-sectional size and shape, and active research is being conducted by several groups around the world in this field. Therefore a grey matter spinal cord segmentation challenge was organised to test different capabilities of various methods using the same multi-centre and multi-vendor dataset acquired with distinct 3D gradient-echo sequences. This challenge aimed to characterize the state-of-the-art in the field as well as identifying new opportunities for future improvements. Six different spinal cord grey matter segmentation methods developed independently by various research groups across the world and their performance were compared to manual segmentation outcomes, the present gold-standard. All algorithms provided good overall results for detecting the grey matter butterfly, albeit with variable performance in certain quality-of-segmentation metrics. The data have been made publicly available and the challenge web site remains open to new submissions. No modifications were introduced to any of the presented methods as a result of this challenge for the purposes of this publication.
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Affiliation(s)
- Ferran Prados
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, Russell Square, London WC1B 5EH, UK.
| | - John Ashburner
- Wellcome Trust Centre for Neuroimaging, University College London, Queen Square, London WC1N 3BG, UK
| | - Claudia Blaiotta
- Wellcome Trust Centre for Neuroimaging, University College London, Queen Square, London WC1N 3BG, UK
| | - Tom Brosch
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada V6T 1Z4
| | | | - Manuel Jorge Cardoso
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK; Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Benjamin N Conrad
- Department of Electrical Engineering, Computer Science, Biomedical Engineering, Radiology and Radiological Sciences, Institute of Image Science at Vanderbilt University, Nashville, TN, USA
| | - Esha Datta
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gergely Dávid
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Sara M Dupont
- NeuroPoly Lab, Polytechnique Montreal, Montreal, QC, Canada
| | - Patrick Freund
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Switzerland
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, Russell Square, London WC1B 5EH, UK; Brain MRI 3T Centre, C. Mondino National Neurological Institute, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Italy
| | - Francesco Grussu
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, Russell Square, London WC1B 5EH, UK
| | - Roland Henry
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Bennett A Landman
- Department of Electrical Engineering, Computer Science, Biomedical Engineering, Radiology and Radiological Sciences, Institute of Image Science at Vanderbilt University, Nashville, TN, USA
| | - Emil Ljungberg
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 2B5
| | - Bailey Lyttle
- Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK; Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Nico Papinutto
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Regina Schlaeger
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Seth A Smith
- Department of Radiology and Radiological Sciences, Biomedical Engineering, Ophthalmology, Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Paul Summers
- Department of Radiology, European Institute of Oncology, University of Modena and Reggio Emilia, 41121, Modena, MO, Italy
| | - Roger Tam
- Department of Radiology, UBC MS/MRI Research Group, University of British Columbia, Vancouver, BC, Canada V6T 2B5
| | - Marios C Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, Russell Square, London WC1B 5EH, UK
| | - Alyssa Zhu
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Julien Cohen-Adad
- NeuroPoly Lab, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada.
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336
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Martin AR, De Leener B, Cohen-Adad J, Cadotte DW, Kalsi-Ryan S, Lange SF, Tetreault L, Nouri A, Crawley A, Mikulis DJ, Ginsberg H, Fehlings MG. A Novel MRI Biomarker of Spinal Cord White Matter Injury: T2*-Weighted White Matter to Gray Matter Signal Intensity Ratio. AJNR Am J Neuroradiol 2017; 38:1266-1273. [PMID: 28428212 DOI: 10.3174/ajnr.a5162] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/29/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE T2*-weighted imaging provides sharp contrast between spinal cord GM and WM, allowing their segmentation and cross-sectional area measurement. Injured WM demonstrates T2*WI hyperintensity but requires normalization for quantitative use. We introduce T2*WI WM/GM signal-intensity ratio and compare it against cross-sectional area, the DTI metric fractional anisotropy, and magnetization transfer ratio in degenerative cervical myelopathy. MATERIALS AND METHODS Fifty-eight patients with degenerative cervical myelopathy and 40 healthy subjects underwent 3T MR imaging, covering C1-C7. Metrics were automatically extracted at maximally compressed and uncompressed rostral/caudal levels. Normalized metrics were compared with t tests, area under the curve, and logistic regression. Relationships with clinical measures were analyzed by using Pearson correlation and multiple linear regression. RESULTS The maximally compressed level cross-sectional area demonstrated superior differences (P = 1 × 10-13), diagnostic accuracy (area under the curve = 0.890), and univariate correlation with the modified Japanese Orthopedic Association score (0.66). T2*WI WM/GM showed strong differences (rostral: P = 8 × 10-7; maximally compressed level: P = 1 × 10-11; caudal: P = 1 × 10-4), correlations (modified Japanese Orthopedic Association score; rostral: -0.52; maximally compressed level: -0.59; caudal: -0.36), and diagnostic accuracy (rostral: 0.775; maximally compressed level: 0.860; caudal: 0.721), outperforming fractional anisotropy and magnetization transfer ratio in most comparisons and cross-sectional area at rostral/caudal levels. Rostral T2*WI WM/GM showed the strongest correlations with focal motor (-0.45) and sensory (-0.49) deficits and was the strongest independent predictor of the modified Japanese Orthopedic Association score (P = .01) and diagnosis (P = .02) in multivariate models (R2 = 0.59, P = 8 × 10-13; area under the curve = 0.954, respectively). CONCLUSIONS T2*WI WM/GM shows promise as a novel biomarker of WM injury. It detects damage in compressed and uncompressed regions and contributes substantially to multivariate models for diagnosis and correlation with impairment. Our multiparametric approach overcomes limitations of individual measures, having the potential to improve diagnostics, monitor progression, and predict outcomes.
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Affiliation(s)
- A R Martin
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - B De Leener
- Polytechnique Montreal (B.D.L., J.C.-A.), Montreal, Quebec, Canada
| | - J Cohen-Adad
- Polytechnique Montreal (B.D.L., J.C.-A.), Montreal, Quebec, Canada.,Functional Neuroimaging Unit (J.C.-A.), Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - D W Cadotte
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - S Kalsi-Ryan
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - S F Lange
- University of Groningen (S.F.L.), Groningen, the Netherlands
| | - L Tetreault
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - A Nouri
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - A Crawley
- Department of Medical Imaging (A.C., D.J.M.), University of Toronto and the University Health Network, Toronto, Ontario, Canada
| | - D J Mikulis
- Department of Medical Imaging (A.C., D.J.M.), University of Toronto and the University Health Network, Toronto, Ontario, Canada
| | - H Ginsberg
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
| | - M G Fehlings
- From the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
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337
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De Leener B, Mangeat G, Dupont S, Martin AR, Callot V, Stikov N, Fehlings MG, Cohen-Adad J. Topologically preserving straightening of spinal cord MRI. J Magn Reson Imaging 2017; 46:1209-1219. [PMID: 28130805 DOI: 10.1002/jmri.25622] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/18/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To propose a robust and accurate method for straightening magnetic resonance (MR) images of the spinal cord, based on spinal cord segmentation, that preserves spinal cord topology and that works for any MRI contrast, in a context of spinal cord template-based analysis. MATERIALS AND METHODS The spinal cord curvature was computed using an iterative Non-Uniform Rational B-Spline (NURBS) approximation. Forward and inverse deformation fields for straightening were computed by solving analytically the straightening equations for each image voxel. Computational speed-up was accomplished by solving all voxel equation systems as one single system. Straightening accuracy (mean and maximum distance from straight line), computational time, and robustness to spinal cord length was evaluated using the proposed and the standard straightening method (label-based spline deformation) on 3T T2 - and T1 -weighted images from 57 healthy subjects and 33 patients with spinal cord compression due to degenerative cervical myelopathy (DCM). RESULTS The proposed algorithm was more accurate, more robust, and faster than the standard method (mean distance = 0.80 vs. 0.83 mm, maximum distance = 1.49 vs. 1.78 mm, time = 71 vs. 174 sec for the healthy population and mean distance = 0.65 vs. 0.68 mm, maximum distance = 1.28 vs. 1.55 mm, time = 32 vs. 60 sec for the DCM population). CONCLUSION A novel image straightening method that enables template-based analysis of quantitative spinal cord MRI data is introduced. This algorithm works for any MRI contrast and was validated on healthy and patient populations. The presented method is implemented in the Spinal Cord Toolbox, an open-source software for processing spinal cord MRI data. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1209-1219.
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Affiliation(s)
- Benjamin De Leener
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Gabriel Mangeat
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Sara Dupont
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Allan R Martin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Virginie Callot
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France.,AP-HM, Hopital de la Timone, Pôle d'imagerie médicale, CEMEREM, Marseille, France
| | - Nikola Stikov
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,Montreal Heart Institute, Montreal, QC, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
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338
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Duval T, Le Vy S, Stikov N, Campbell J, Mezer A, Witzel T, Keil B, Smith V, Wald LL, Klawiter E, Cohen-Adad J. g-Ratio weighted imaging of the human spinal cord in vivo. Neuroimage 2017; 145:11-23. [PMID: 27664830 PMCID: PMC5179300 DOI: 10.1016/j.neuroimage.2016.09.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 08/22/2016] [Accepted: 09/08/2016] [Indexed: 12/13/2022] Open
Abstract
The fiber g-ratio is defined as the ratio of the inner to the outer diameter of the myelin sheath. This ratio provides a measure of the myelin thickness that complements axon morphology (diameter and density) for assessment of demyelination in diseases such as multiple sclerosis. Previous work has shown that an aggregate g-ratio map can be computed using a formula that combines axon and myelin density measured with quantitative MRI. In this work, we computed g-ratio weighted maps in the cervical spinal cord of nine healthy subjects. We utilized the 300mT/m gradients from the CONNECTOM scanner to estimate the fraction of restricted water (fr) with high accuracy, using the CHARMED model. Myelin density was estimated using the lipid and macromolecular tissue volume (MTV) method, derived from normalized proton density (PD) mapping. The variability across spinal level, laterality and subject were assessed using a three-way ANOVA. The average g-ratio value obtained in the white matter was 0.76+/-0.03, consistent with previous histology work. Coefficients of variation of fr and MTV were respectively 4.3% and 13.7%. fr and myelin density were significantly different across spinal tracts (p=3×10-7 and 0.004 respectively) and were positively correlated in the white matter (r=0.42), suggesting shared microstructural information. The aggregate g-ratio did not show significant differences across tracts (p=0.6). This study suggests that fr and myelin density can be measured in vivo with high precision and that they can be combined to produce a g-ratio-weighted map robust to free water pool contamination from cerebrospinal fluid or veins. Potential applications include the study of early demyelination in multiple sclerosis, and the quantitative assessment of remyelination drugs.
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Affiliation(s)
- T Duval
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - S Le Vy
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montréal, QC, Canada
| | - N Stikov
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Montreal Heart Institute, Montreal, QC, Canada
| | - J Campbell
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - A Mezer
- Edmond and Lily Safra Center for Brain Sciences (ELSC), The Hebrew University of Jerusalem, Jerusalem, Israel
| | - T Witzel
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - B Keil
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - V Smith
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - L L Wald
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - E Klawiter
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - J Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montréal, QC, Canada.
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339
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Eippert F, Kong Y, Winkler AM, Andersson JL, Finsterbusch J, Büchel C, Brooks JCW, Tracey I. Investigating resting-state functional connectivity in the cervical spinal cord at 3T. Neuroimage 2016; 147:589-601. [PMID: 28027960 PMCID: PMC5315056 DOI: 10.1016/j.neuroimage.2016.12.072] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/20/2016] [Accepted: 12/23/2016] [Indexed: 12/12/2022] Open
Abstract
The study of spontaneous fluctuations in the blood-oxygen-level-dependent (BOLD) signal has recently been extended from the brain to the spinal cord. Two ultra-high field functional magnetic resonance imaging (fMRI) studies in humans have provided evidence for reproducible resting-state connectivity between the dorsal horns as well as between the ventral horns, and a study in non-human primates has shown that these resting-state signals are impacted by spinal cord injury. As these studies were carried out at ultra-high field strengths using region-of-interest (ROI) based analyses, we investigated whether such resting-state signals could also be observed at the clinically more prevalent field strength of 3 T. In a reanalysis of a sample of 20 healthy human participants who underwent a resting-state fMRI acquisition of the cervical spinal cord, we were able to observe significant dorsal horn connectivity as well as ventral horn connectivity, but no consistent effects for connectivity between dorsal and ventral horns, thus replicating the human 7 T results. These effects were not only observable when averaging along the acquired length of the spinal cord, but also when we examined each of the acquired spinal segments separately, which showed similar patterns of connectivity. Finally, we investigated the robustness of these resting-state signals against variations in the analysis pipeline by varying the type of ROI creation, temporal filtering, nuisance regression and connectivity metric. We observed that – apart from the effects of band-pass filtering – ventral horn connectivity showed excellent robustness, whereas dorsal horn connectivity showed moderate robustness. Together, our results provide evidence that spinal cord resting-state connectivity is a robust and spatially consistent phenomenon that could be a valuable tool for investigating the effects of pathology, disease progression, and treatment response in neurological conditions with a spinal component, such as spinal cord injury.
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Affiliation(s)
- Falk Eippert
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Yazhuo Kong
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Magnetic Resonance Imaging Research Centre, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Anderson M Winkler
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jesper L Andersson
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jürgen Finsterbusch
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Irene Tracey
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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