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Valošek J, Cohen-Adad J. Reproducible Spinal Cord Quantitative MRI Analysis with the Spinal Cord Toolbox. Magn Reson Med Sci 2024; 23:307-315. [PMID: 38479843 DOI: 10.2463/mrms.rev.2023-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
The spinal cord plays a pivotal role in the central nervous system, providing communication between the brain and the body and containing critical motor and sensory networks. Recent advancements in spinal cord MRI data acquisition and image analysis have shown a potential to improve the diagnostics, prognosis, and management of a variety of pathological conditions. In this review, we first discuss the significance of standardized spinal cord MRI acquisition protocol in multi-center and multi-manufacturer studies. Then, we cover open-access spinal cord MRI datasets, which are important for reproducible science and validation of new methods. Finally, we elaborate on the recent advances in spinal cord MRI data analysis techniques implemented in the open-source software package Spinal Cord Toolbox (SCT).
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Affiliation(s)
- Jan Valošek
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
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Freund P, Boller V, Emmenegger TM, Akbar M, Hupp M, Pfender N, Wheeler-Kingshott CAMG, Cohen-Adad J, Fehlings MG, Curt A, Seif M. Quantifying neurodegeneration of the cervical cord and brain in degenerative cervical myelopathy: A multicentre study using quantitative magnetic resonance imaging. Eur J Neurol 2024:e16297. [PMID: 38713645 DOI: 10.1111/ene.16297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND PURPOSE Simultaneous assessment of neurodegeneration in both the cervical cord and brain across multiple centres can enhance the effectiveness of clinical trials. Thus, this study aims to simultaneously assess microstructural changes in the cervical cord and brain above the stenosis in degenerative cervical myelopathy (DCM) using quantitative magnetic resonance imaging (MRI) in a multicentre study. METHODS We applied voxelwise analysis with a probabilistic brain/spinal cord template embedded in statistical parametric mappin (SPM-BSC) to process multi parametric mapping (MPM) including effective transverse relaxation rate (R2*), longitudinal relaxation rate (R1), and magnetization transfer (MT), which are indirectly sensitive to iron and myelin content. Regression analysis was conducted to establish associations between neurodegeneration and clinical impairment. Thirty-eight DCM patients (mean age ± SD = 58.45 ± 11.47 years) and 38 healthy controls (mean age ± SD = 41.18 ± 12.75 years) were recruited at University Hospital Balgrist, Switzerland and Toronto Western Hospital, Canada. RESULTS Remote atrophy was observed in the cervical cord (p = 0.002) and in the left thalamus (0.026) of the DCM group. R1 was decreased in the periaqueductal grey matter (p = 0.014), thalamus (p = 0.001), corpus callosum (p = 0.0001), and cranial corticospinal tract (p = 0.03). R2* was increased in the primary somatosensory cortices (p = 0.008). Sensory impairments were associated with increased iron-sensitive R2* in the thalamus and periaqueductal grey matter in DCM. CONCLUSIONS Simultaneous assessment of the spinal cord and brain revealed DCM-induced demyelination, iron deposition, and atrophy. The extent of remote neurodegeneration was associated with sensory impairment, highlighting the intricate and expansive nature of microstructural neurodegeneration in DCM, reaching beyond the stenosis level.
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Affiliation(s)
- Patrick Freund
- Spinal Cord Injury Centre, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Viveka Boller
- Spinal Cord Injury Centre, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Tim M Emmenegger
- Spinal Cord Injury Centre, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Muhammad Akbar
- Spine Program Division of Neurosurgery, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Markus Hupp
- Spinal Cord Injury Centre, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Nikolai Pfender
- Spinal Cord Injury Centre, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Claudia Angela Michela Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Digital Neuroscience Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada
- Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, Quebec, Canada
| | - Michael G Fehlings
- Spine Program Division of Neurosurgery, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Armin Curt
- Spinal Cord Injury Centre, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Maryam Seif
- Spinal Cord Injury Centre, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Emmenegger TM, Pfyffer D, Curt A, Schading-Sassenhausen S, Hupp M, Ashburner J, Friston K, Weiskopf N, Thompson A, Freund P. Longitudinal motor system changes from acute to chronic spinal cord injury. Eur J Neurol 2024; 31:e16196. [PMID: 38258488 DOI: 10.1111/ene.16196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND AND PURPOSE In acute spinal cord injury (SCI), magnetic resonance imaging (MRI) reveals tissue bridges and neurodegeneration for 2 years. This 5-year study aims to track initial lesion changes, subsequent neurodegeneration, and their impact on recovery. METHODS This prospective longitudinal study enrolled acute SCI patients and healthy controls who were assessed clinically-and by MRI-regularly from 3 days postinjury up to 60 months. We employed histologically cross-validated quantitative MRI sequences sensitive to volume, myelin, and iron changes, thereby reflecting indirectly processes of neurodegeneration and neuroinflammation. General linear models tracked lesion and remote changes in volume, myelin- and iron-sensitive magnetic resonance indices over 5 years. Associations between lesion, degeneration, and recovery (using the Spinal Cord Independence Measure [SCIM] questionnaire and the International Standards for Neurological Classification of Spinal Cord Injury total motor score) were assessed. RESULTS Patients' motor scores improved by an average of 12.86 (95% confidence interval [CI] = 6.70-19.00) points, and SCIM by 26.08 (95% CI = 17.00-35.20) points. Within 3-28 days post-SCI, lesion size decreased by more than two-thirds (3 days: 302.52 ± 185.80 mm2 , 28 days: 76.77 ± 88.62 mm2 ), revealing tissue bridges. Cervical cord and corticospinal tract volumes transiently increased in SCI patients by 5% and 3%, respectively, accompanied by cervical myelin decreases and iron increases. Over time, progressive atrophy was observed in both regions, which was linked to early lesion dynamics. Tissue bridges, reduced swelling, and myelin content decreases were predictive of long-term motor score recovery and improved SCIM score. CONCLUSIONS Studying acute changes and their impact on longer follow-up provides insights into SCI trajectory, highlighting the importance of acute intervention while indicating the potential to influence outcomes in the later stages.
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Affiliation(s)
- Tim M Emmenegger
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Dario Pfyffer
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Armin Curt
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Markus Hupp
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - John Ashburner
- Wellcome Trust Centre for Neuroimaging, Queen Square Institute of Neurology, University College London, London, UK
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, Queen Square Institute of Neurology, University College London, London, UK
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Felix Bloch Institute for Solid State Physics, Faculty of Physics and Earth Sciences, Leipzig University, Leipzig, Germany
| | - Alan Thompson
- Queen Square Multiple Sclerosis Centre, Institute of Neurology, University College London, London, UK
| | - Patrick Freund
- Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Wellcome Trust Centre for Neuroimaging, Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Pareto D, Corral JF, Garcia-Vidal A, Alberich M, Auger C, Rio J, Mongay N, Sastre-Garriga J, Rovira À. Assessing the Equivalence of Brain-Derived Measures from Two 3D T1-Weighted Acquisitions: One Covering the Brain and One Covering the Brain and Spinal Cord. AJNR Am J Neuroradiol 2023; 44:569-573. [PMID: 37080719 PMCID: PMC10171373 DOI: 10.3174/ajnr.a7843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/01/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND PURPOSE In MS, it is common to acquire brain and spinal cord MR imaging sequences separately to assess the extent of the disease. The goal of this study was to see how replacing the traditional brain T1-weighted images (brain-T1) with an acquisition that included both the brain and the cervical spinal cord (cns-T1) affected brain- and spinal cord-derived measures. MATERIALS AND METHODS Thirty-six healthy controls (HC) and 42 patients with MS were included. Of those, 18 HC and 35 patients with MS had baseline and follow-up at 1 year acquired on a 3T magnet. Two 3D T1-weighted images (brain-T1 and cns-T1) were acquired at each time point. Regional cortical thickness and volumes were determined with FastSurfer, and the percentage brain volume change per year was obtained with SIENA. The spinal cord area was estimated with the Spinal Cord Toolbox. Intraclass correlation coefficients (ICC) were calculated to check for consistency of measures obtained from brain-T1 and cns-T1. RESULTS Cortical thickness measures showed an ICC >0.75 in 94% of regions in healthy controls and 80% in patients with MS. Estimated regional volumes had an ICC >0.88, and the percentage brain volume change had an ICC >0.79 for both groups. The spinal cord area measures had an ICC of 0.68 in healthy controls and 0.92 in patients with MS. CONCLUSIONS Brain measurements obtained from 3D cns-T1 are highly equivalent to those obtained from a brain-T1, suggesting that it could be feasible to replace the brain-T1 with cns-T1.
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Affiliation(s)
- D Pareto
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J F Corral
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - A Garcia-Vidal
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - M Alberich
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Auger
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - J Rio
- Department of Neurology and Neuroimmunology (J.R., N.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Mongay
- Department of Neurology and Neuroimmunology (J.R., N.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Sastre-Garriga
- Department of Neurology and Neuroimmunology (J.R., N.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - À Rovira
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Mohanty R, Allabun S, Solanki SS, Pani SK, Alqahtani MS, Abbas M, Soufiene BO. NAMSTCD: A Novel Augmented Model for Spinal Cord Segmentation and Tumor Classification Using Deep Nets. Diagnostics (Basel) 2023; 13:diagnostics13081417. [PMID: 37189520 DOI: 10.3390/diagnostics13081417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
Spinal cord segmentation is the process of identifying and delineating the boundaries of the spinal cord in medical images such as magnetic resonance imaging (MRI) or computed tomography (CT) scans. This process is important for many medical applications, including the diagnosis, treatment planning, and monitoring of spinal cord injuries and diseases. The segmentation process involves using image processing techniques to identify the spinal cord in the medical image and differentiate it from other structures, such as the vertebrae, cerebrospinal fluid, and tumors. There are several approaches to spinal cord segmentation, including manual segmentation by a trained expert, semi-automated segmentation using software tools that require some user input, and fully automated segmentation using deep learning algorithms. Researchers have proposed a wide range of system models for segmentation and tumor classification in spinal cord scans, but the majority of these models are designed for a specific segment of the spine. As a result, their performance is limited when applied to the entire lead, limiting their deployment scalability. This paper proposes a novel augmented model for spinal cord segmentation and tumor classification using deep nets to overcome this limitation. The model initially segments all five spinal cord regions and stores them as separate datasets. These datasets are manually tagged with cancer status and stage based on observations from multiple radiologist experts. Multiple Mask Regional Convolutional Neural Networks (MRCNNs) were trained on various datasets for region segmentation. The results of these segmentations were combined using a combination of VGGNet 19, YoLo V2, ResNet 101, and GoogLeNet models. These models were selected via performance validation on each segment. It was observed that VGGNet-19 was capable of classifying the thoracic and cervical regions, while YoLo V2 was able to efficiently classify the lumbar region, ResNet 101 exhibited better accuracy for sacral-region classification, and GoogLeNet was able to classify the coccygeal region with high performance accuracy. Due to use of specialized CNN models for different spinal cord segments, the proposed model was able to achieve a 14.5% better segmentation efficiency, 98.9% tumor classification accuracy, and a 15.6% higher speed performance when averaged over the entire dataset and compared with various state-of-the art models. This performance was observed to be better, due to which it can be used for various clinical deployments. Moreover, this performance was observed to be consistent across multiple tumor types and spinal cord regions, which makes the model highly scalable for a wide variety of spinal cord tumor classification scenarios.
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Affiliation(s)
- Ricky Mohanty
- School of Information System, ASBM University, Bhubaneswar 754012, Odisha, India
| | - Sarah Allabun
- Department of Medical Education, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Sandeep Singh Solanki
- Department of Electronics and Communication Engineering, Birla Institute of Technology, Mesra 835215, Jharkhand, India
| | | | - Mohammed S Alqahtani
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
- BioImaging Unit, Space Research Centre, University of Leicester, Michael Atiyah Building, Leicester LE1 7RH, UK
| | - Mohamed Abbas
- Electrical Engineering Department, College of Engineering, King Khalid University, Abha 61421, Saudi Arabia
| | - Ben Othman Soufiene
- PRINCE Laboratory Research, ISITcom, Hammam Sousse, University of Sousse, Sousse 4000, Tunisia
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Trolle C, Goldberg E, Linnman C. Spinal cord atrophy after spinal cord injury - A systematic review and meta-analysis. Neuroimage Clin 2023; 38:103372. [PMID: 36931004 PMCID: PMC10026037 DOI: 10.1016/j.nicl.2023.103372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/12/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023]
Abstract
Cervical spinal cord atrophy occurs after spinal cord injury. The atrophy and how level of injury affects atrophy differs between studies. A systematic review and metaanalysis were done after systematic searches of PubMed, CINAHL, APA PsycInfo and Web of Science. English language original studies analyzing MRI cervical spinal cord cross-sectional area in adults with spinal cord injury were included. Atrophy and correlation between injury level and atrophy were estimated with random-effects models, standardized mean differences, and 95% confidence intervals. 24 studies were identified. 13/24 studies had low risk of bias. Cord atrophy meta-analysis of 18 articles corresponded to a standardized mean difference of -1.48 (95% CI -1.78 to -1.19) with moderate to large interstudy heterogeneity. Logarithmic time since injury influenced heterogeneity. Longitudinal atrophy was best described by a logarithmic model, indicating that rate of spinal atrophy decreases over time. Meta-correlation of eight studies indicated more severe atrophy in more rostral injuries (0.41, 95% CI 0.20-0.59). Larger and preferably longitudinal studies, data sharing, and standardized protocols are warranted.
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Affiliation(s)
- Carl Trolle
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Department of Medical Sciences, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden.
| | - Estee Goldberg
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Clas Linnman
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
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Seif M, Leutritz T, Schading S, Emmengger T, Curt A, Weiskopf N, Freund P. Reliability of multi-parameter mapping (MPM) in the cervical cord: A multi-center multi-vendor quantitative MRI study. Neuroimage 2022; 264:119751. [PMID: 36384206 DOI: 10.1016/j.neuroimage.2022.119751] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 11/14/2022] Open
Abstract
MRI based multicenter studies which target neurological pathologies affecting the spinal cord and brain - including spinal cord injury (SCI) - require standardized acquisition protocols and image processing methods. We have optimized and applied a multi-parameter mapping (MPM) protocol that simultaneously covers the brain and the cervical cord within a traveling heads study across six clinical centers (Leutritz et al., 2020). The MPM protocol includes quantitative maps (magnetization transfer saturation (MT), proton density (PD), longitudinal (R1), and effective transverse (R2*) relaxation rates) sensitive to myelination, water content, iron concentration, and morphometric measures, such as cross-sectional cord area. Previously, we assessed the repeatability and reproducibility of the brain MPM data acquired in the five healthy participants who underwent two scan-rescans (Leutritz et al., 2020). This study focuses on the cervical cord MPM data derived from the same acquisitions to determine its repeatability and reproducibility in the cervical cord. MPM matrices of the cervical cord were generated and processed using the hMRI and the spinal cord toolbox. To determine reliability of the cervical MPM data, the intra-site (i.e., scan-rescan) coefficient of variation (CoV), inter-site CoV, and bias within region of interests (C1, C2 and C3 levels) were determined. The range of the mean intra- and inter-site CoV of MT, R1 and PD was between 2.5% and 12%, and between 1.1% and 4.0% for the morphometric measures. In conclusion, the cervical MPM data showed a high repeatability and reproducibility for key imaging biomarkers and hence can be employed as a standardized tool in multi-center studies, including clinical trials.
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Affiliation(s)
- Maryam Seif
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Tobias Leutritz
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Simon Schading
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland
| | - Tim Emmengger
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Faculty of Physics and Earth Sciences, Felix Bloch Institute for Solid State Physics, Leipzig University, Leipzig, Germany
| | - Patrick Freund
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, London, UK
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Combes AJ, Clarke MA, O'Grady KP, Schilling KG, Smith SA. Advanced spinal cord MRI in multiple sclerosis: Current techniques and future directions. Neuroimage Clin 2022; 36:103244. [PMID: 36306717 PMCID: PMC9668663 DOI: 10.1016/j.nicl.2022.103244] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/02/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
Spinal cord magnetic resonance imaging (MRI) has a central role in multiple sclerosis (MS) clinical practice for diagnosis and disease monitoring. Advanced MRI sequences capable of visualizing and quantifying tissue macro- and microstructure and reflecting different pathological disease processes have been used in MS research; however, the spinal cord remains under-explored, partly due to technical obstacles inherent to imaging this structure. We propose that the study of the spinal cord merits equal ambition in overcoming technical challenges, and that there is much information to be exploited to make valuable contributions to our understanding of MS. We present a narrative review on the latest progress in advanced spinal cord MRI in MS, covering in the first part structural, functional, metabolic and vascular imaging methods. We focus on recent studies of MS and those making significant technical steps, noting the challenges that remain to be addressed and what stands to be gained from such advances. Throughout we also refer to other works that presend more in-depth review on specific themes. In the second part, we present several topics that, in our view, hold particular potential. The need for better imaging of gray matter is discussed. We stress the importance of developing imaging beyond the cervical spinal cord, and explore the use of ultra-high field MRI. Finally, some recommendations are given for future research, from study design to newer developments in analysis, and the need for harmonization of sequences and methods within the field. This review is aimed at researchers and clinicians with an interest in gaining an overview of the current state of advanced MRI research in this field and what is primed to be the future of spinal cord imaging in MS research.
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Affiliation(s)
- Anna J.E. Combes
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. South, Nashville, TN 37232, United States,Corresponding author at: 1161 21st Ave S, MCN AA1105, Nashville, TN 37232, USA.
| | - Margareta A. Clarke
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States
| | - Kristin P. O'Grady
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. South, Nashville, TN 37232, United States,Department of Biomedical Engineering, Vanderbilt University, 2301 Vanderbilt Place, PMB 351826, Nashville, TN 37235-1826, United States
| | - Kurt G. Schilling
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. South, Nashville, TN 37232, United States
| | - Seth A. Smith
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, AA-1105, Nashville, TN 37232-2310, United States,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. South, Nashville, TN 37232, United States,Department of Biomedical Engineering, Vanderbilt University, 2301 Vanderbilt Place, PMB 351826, Nashville, TN 37235-1826, United States
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Azzarito M, Kyathanahally SP, Balbastre Y, Seif M, Blaiotta C, Callaghan MF, Ashburner J, Freund P. Simultaneous voxel-wise analysis of brain and spinal cord morphometry and microstructure within the SPM framework. Hum Brain Mapp 2020; 42:220-232. [PMID: 32991031 PMCID: PMC7721239 DOI: 10.1002/hbm.25218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 08/05/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022] Open
Abstract
To validate a simultaneous analysis tool for the brain and cervical cord embedded in the statistical parametric mapping (SPM) framework, we compared trauma-induced macro- and microstructural changes in spinal cord injury (SCI) patients to controls. The findings were compared with results obtained from existing processing tools that assess the brain and spinal cord separately. A probabilistic brain-spinal cord template (BSC) was generated using a generative semi-supervised modelling approach. The template was incorporated into the pre-processing pipeline of voxel-based morphometry and voxel-based quantification analyses in SPM. This approach was validated on T1-weighted scans and multiparameter maps, by assessing trauma-induced changes in SCI patients relative to controls and comparing the findings with the outcome from existing analytical tools. Consistency of the MRI measures was assessed using intraclass correlation coefficients (ICC). The SPM approach using the BSC template revealed trauma-induced changes across the sensorimotor system in the cord and brain in SCI patients. These changes were confirmed with established approaches covering brain or cord, separately. The ICC in the brain was high within regions of interest, such as the sensorimotor cortices, corticospinal tracts and thalamus. The simultaneous voxel-wise analysis of brain and cervical spinal cord was performed in a unique SPM-based framework incorporating pre-processing and statistical analysis in the same environment. Validation based on a SCI cohort demonstrated that the new processing approach based on the brain and cord is comparable to available processing tools, while offering the advantage of performing the analysis simultaneously across the neuraxis.
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Affiliation(s)
- Michela Azzarito
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sreenath P Kyathanahally
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yaël Balbastre
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Maryam Seif
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudia Blaiotta
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Martina F Callaghan
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - John Ashburner
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Patrick Freund
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, UK
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