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Térémetz M, Hamdoun S, Colle F, Gerardin E, Desvilles C, Carment L, Charron S, Cuenca M, Calvet D, Baron JC, Turc G, Maier MA, Rosso C, Mas JL, Lindberg PG. Efficacy of interactive manual dexterity training after stroke: a pilot single-blinded randomized controlled trial. J Neuroeng Rehabil 2023; 20:93. [PMID: 37464404 PMCID: PMC10355015 DOI: 10.1186/s12984-023-01213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To compare the efficacy of Dextrain Manipulandum™ training of dexterity components such as force control and independent finger movements, to dose-matched conventional therapy (CT) post-stroke. METHODS A prospective, single-blind, pilot randomized clinical trial was conducted. Chronic-phase post-stroke patients with mild-to-moderate dexterity impairment (Box and Block Test (BBT) > 1) received 12 sessions of Dextrain or CT. Blinded measures were obtained before and after training and at 3-months follow-up. Primary outcome was BBT-change (after-before training). Secondary outcomes included changes in motor impairments, activity limitations and dexterity components. Corticospinal excitability and short intracortical inhibition (SICI) were measured using transcranial magnetic stimulation. RESULTS BBT-change after training did not differ between the Dextrain (N = 21) vs CT group (N = 21) (median [IQR] = 5[2-7] vs 4[2-7], respectively; P = 0.36). Gains in BBT were maintained at the 3-month post-training follow-up, with a non-significant trend for enhanced BBT-change in the Dextrain group (median [IQR] = 3[- 1-7.0], P = 0.06). Several secondary outcomes showed significantly larger changes in the Dextrain group: finger tracking precision (mean ± SD = 0.3 ± 0.3N vs - 0.1 ± 0.33N; P < 0.0018), independent finger movements (34.7 ± 25.1 ms vs 7.7 ± 18.5 ms, P = 0.02) and maximal finger tapping speed (8.4 ± 7.1 vs 4.5 ± 4.9, P = 0.045). At follow-up, Dextrain group showed significantly greater improvement in Motor Activity Log (median/IQR = 0.7/0.2-0.8 vs 0.2/0.1-0.6, P = 0.05). Across both groups SICI increased in patients with greater BBT-change (Rho = 0.80, P = 0.006). Comparing Dextrain subgroups with maximal grip force higher/lower than median (61.2%), BBT-change was significantly larger in patients with low vs high grip force (7.5 ± 5.6 vs 2.9 ± 2.8; respectively, P = 0.015). CONCLUSIONS Although immediate improvements in gross dexterity post-stroke did not significantly differ between Dextrain training and CT, our findings suggest that Dextrain enhances recovery of several dexterity components and reported hand-use, particularly when motor impairment is moderate (low initial grip force). Findings need to be confirmed in a larger trial. Trial registration ClinicalTrials.gov NCT03934073 (retrospectively registered).
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Affiliation(s)
- Maxime Térémetz
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Sonia Hamdoun
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Médecine Physique et de Réadaptation, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
| | - Florence Colle
- SSR Neurologique, Hôpitaux de Saint-Maurice, 12/14 Rue du Val d'Osne, 94410, Saint-Maurice, France
| | - Eloïse Gerardin
- Neurology Department, Stroke Unit, UCLouvain/CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Claire Desvilles
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Loïc Carment
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Sylvain Charron
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
| | - Macarena Cuenca
- Centre de Recherche Clinique, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
| | - David Calvet
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Jean-Claude Baron
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Guillaume Turc
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Marc A Maier
- Université Paris Cité, CNRS, Integrative Neuroscience and Cognition Center, 75006, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau et de la Moelle Épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Jean-Louis Mas
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France
- Service de Neurologie, Groupe Hospitalier Universitaire Paris, Psychiatrie et Neurosciences, 1 Rue Cabanis, 75014, Paris, France
- FHU NeuroVasc, Paris, France
| | - Påvel G Lindberg
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Cité, 102-108 Rue de La Santé, 75014, Paris, France.
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2
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Zhang JK, Jayasekera D, Song C, Greenberg JK, Javeed S, Dibble CF, Blum J, Sun P, Song SK, Ray WZ. Diffusion Basis Spectrum Imaging Provides Insights Into Cervical Spondylotic Myelopathy Pathology. Neurosurgery 2023; 92:102-109. [PMID: 36519861 PMCID: PMC10158908 DOI: 10.1227/neu.0000000000002183] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diffusion basis spectrum imaging (DBSI) is a noninvasive quantitative imaging modality that may improve understanding of cervical spondylotic myelopathy (CSM) pathology through detailed evaluations of spinal cord microstructural compartments. OBJECTIVE To determine the utility of DBSI as a biomarker of CSM disease severity. METHODS A single-center prospective cohort study enrolled 50 patients with CSM and 20 controls from 2018 to 2020. All patients underwent clinical evaluation and diffusion-weighted MRI, followed by diffusion tensor imaging and DBSI analyses. Diffusion-weighted MRI metrics assessed white matter integrity by fractional anisotropy, axial diffusivity, radial diffusivity, and fiber fraction. In addition, DBSI further evaluates extra-axonal changes by isotropic restricted and nonrestricted fraction. Including an intra-axonal diffusion compartment, DBSI improves estimations of axonal injury through intra-axonal axial diffusivity. Patients were categorized into mild, moderate, and severe CSM using modified Japanese Orthopedic Association classifications. Imaging parameters were compared among patient groups using independent samples t tests and ANOVA. RESULTS Twenty controls, 27 mild (modified Japanese Orthopedic Association 15-17), 12 moderate (12-14), and 11 severe (0-11) patients with CSM were enrolled. Diffusion tensor imaging and DBSI fractional anisotropy, axial diffusivity, and radial diffusivity were significantly different between control and patients with CSM ( P < .05). DBSI fiber fraction, restricted fraction, and nonrestricted fraction were significantly different between groups ( P < .01). DBSI intra-axonal axial diffusivity was lower in mild compared with moderate (mean difference [95% CI]: 1.1 [0.3-2.1], P < .01) and severe (1.9 [1.3-2.4], P < .001) CSM. CONCLUSION DBSI offers granular data on white matter tract integrity in CSM that provide novel insights into disease pathology, supporting its potential utility as a biomarker of CSM disease progression.
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Affiliation(s)
- Justin K. Zhang
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Dinal Jayasekera
- Department of Biomedical Engineering, Washington University in St. Louis McKelvey School of Engineering, Saint Louis, Missouri, USA
| | - Chunyu Song
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob K. Greenberg
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Saad Javeed
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Christopher F. Dibble
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Jacob Blum
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peng Sun
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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3
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Liang S, Yang F, Zhang Y, Zhao H, Wang X. Changes and clinical correlation of diffusion tensor imaging parameters of compressed spinal cord and nerve root in patients with cervical spondylosis. BMC Med Imaging 2022; 22:107. [PMID: 35659198 PMCID: PMC9166510 DOI: 10.1186/s12880-022-00835-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) was used to quantitatively study the characteristics of the related spinal cord and nerve root compression parameters in patients with cervical spondylosis (CS), and diffusion tensor tractography (DTT) was used to visualize the spinal cord and nerve root and analyze their relevance to clinical evaluation. METHODS A total of 67 patients with CS and 30 healthy volunteers received 3.0 T magnetic resonance imaging. Cervical DTI and DTT were performed in all the participants, where the b value of DTI was set at 800 s/mm2. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the spinal cord and cervical nerve roots were measured by using DTI. Patients with CS were scored according to the modified Japanese Orthopedic Association (mJOA) score. RESULTS In all the participants, the spinal cord and cervical nerve roots were clearly visible by DTT. Compared to the healthy volunteers, the FA values were significantly decreased and ADC values were significantly increased in patients with CS. mJOA score was significantly correlated with the DTI index (ADC and FA) values. Receiver operator characteristic curve analysis revealed that FA and ADC could identify mild, moderate, and severe CS. CONCLUSIONS DTI parameters of cervical spinal cord and nerve root compression are associated with the clinical evaluation of patients with CS and may be helpful in assessing the severity of CS.
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Affiliation(s)
- Shuo Liang
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Feng Yang
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China.
| | - Yang Zhang
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China.
| | - Huiyu Zhao
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Xinyue Wang
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
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4
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Zhu F, Wang Y, Kong X, Liu Y, Zeng L, Jing X, Yao S, Chen K, Yang L, Guo X. Assessment of acute traumatic cervical spinal cord injury using conventional magnetic resonance imaging in combination with diffusion tensor imaging-tractography: a retrospective comparative study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1700-1709. [PMID: 35639157 DOI: 10.1007/s00586-022-07207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/10/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The application of conventional magnetic resonance imaging (MRI) in combination with diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) to diagnose acute traumatic cervical SCI has not been studied. This study explores the role of MRI with DTI-DTT in the diagnosis of acute traumatic cervical spinal cord injury (SCI). METHODS Thirty patients with acute traumatic cervical SCI underwent conventional MRI and DTI-DTT. Conventional MRI was used to detect the intramedullary lesion length (IMLL) and intramedullary hemorrhage length (IMHL). DTI was used to detect the spinal cord's fractional anisotropy (FA) and apparent diffusion coefficient value, and DTT detected the imaginary white matter fiber volume and the connection rates of fiber tractography (CRFT). Patients' neurological outcome was determined using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades. RESULTS Patients were divided into group A (without AIS grade conversion) and group B (with AIS grade conversion). The IMLL and IMHL of group A were significantly higher than those of group B. The FA and CRFT of group A were significantly lower than those of group B. The final AIS grade was negatively correlated with the IMLL and IMHL, and positively correlated with the FA and CRFT. According to imaging features based on conventional MRI and DTI-DTT, we propose a novel classification and diagnostic procedure. CONCLUSIONS The combination of conventional MRI with DTI-DTT is a valid diagnostic approach for SCI. Lower IMLL and IMHL, and higher FA value and CRFT are linked to better neurological outcomes.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China.,Department of Orthopaedics, Xinqiao Hospital, Army Military University, Chongqing, China
| | - Yulong Wang
- Department of Orthopedics, Wuhan No. 1 Hospital, Wuhan Integrated TCM & Western Medicine Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuan Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lian Zeng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China
| | - Xirui Jing
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China
| | - Sheng Yao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China
| | - Kaifang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaodong Guo
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1227 Jiefang Avenue, Wuhan, China.
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5
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Valošek J, Bednařík P, Keřkovský M, Hluštík P, Bednařík J, Svatkova A. Quantitative MR Markers in Non-Myelopathic Spinal Cord Compression: A Narrative Review. J Clin Med 2022; 11:2301. [PMID: 35566426 PMCID: PMC9105390 DOI: 10.3390/jcm11092301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
Degenerative spinal cord compression is a frequent pathological condition with increasing prevalence throughout aging. Initial non-myelopathic cervical spinal cord compression (NMDC) might progress over time into potentially irreversible degenerative cervical myelopathy (DCM). While quantitative MRI (qMRI) techniques demonstrated the ability to depict intrinsic tissue properties, longitudinal in-vivo biomarkers to identify NMDC patients who will eventually develop DCM are still missing. Thus, we aim to review the ability of qMRI techniques (such as diffusion MRI, diffusion tensor imaging (DTI), magnetization transfer (MT) imaging, and magnetic resonance spectroscopy (1H-MRS)) to serve as prognostic markers in NMDC. While DTI in NMDC patients consistently detected lower fractional anisotropy and higher mean diffusivity at compressed levels, caused by demyelination and axonal injury, MT and 1H-MRS, along with advanced and tract-specific diffusion MRI, recently revealed microstructural alterations, also rostrally pointing to Wallerian degeneration. Recent studies also disclosed a significant relationship between microstructural damage and functional deficits, as assessed by qMRI and electrophysiology, respectively. Thus, tract-specific qMRI, in combination with electrophysiology, critically extends our understanding of the underlying pathophysiology of degenerative spinal cord compression and may provide predictive markers of DCM development for accurate patient management. However, the prognostic value must be validated in longitudinal studies.
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Affiliation(s)
- Jan Valošek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (J.V.); (P.H.)
- Department of Radiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
- Department of Biomedical Engineering, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Petr Bednařík
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark;
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Miloš Keřkovský
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (J.B.)
- Department of Radiology and Nuclear Medicine, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Petr Hluštík
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (J.V.); (P.H.)
- Department of Neurology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Josef Bednařík
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (J.B.)
- Department of Neurology, University Hospital Brno, 625 00 Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, 625 00 Brno, Czech Republic
| | - Alena Svatkova
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark;
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, 1090 Vienna, Austria
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6
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Davies BM, Mowforth O, Gharooni AA, Tetreault L, Nouri A, Dhillon RS, Bednarik J, Martin AR, Young A, Takahashi H, Boerger TF, Newcombe VFJ, Zipser CM, Freund P, Koljonen PA, Rodrigues-Pinto R, Rahimi-Movaghar V, Wilson JR, Kurpad SN, Fehlings MG, Kwon BK, Harrop JS, Guest JD, Curt A, Kotter MRN. A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time. Global Spine J 2022; 12:78S-96S. [PMID: 35174728 PMCID: PMC8859710 DOI: 10.1177/21925682211057546] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Literature Review (Narrative). OBJECTIVE To propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5. METHODS Degenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual's susceptibility, including the proposal of a new framework. RESULTS Present pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an individual's vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time. CONCLUSION Understanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease.
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Affiliation(s)
| | - Oliver Mowforth
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | | | - Lindsay Tetreault
- New York University, Langone Health, Graduate Medical Education, Department of Neurology, New York, NY, USA
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Genève, Switzerland
| | - Rana S. Dhillon
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Allan R. Martin
- Department of Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Adam Young
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Hitoshi Takahashi
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Virginia FJ Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Carl Moritz Zipser
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick Freund
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - James D. Guest
- Department of Neurosurgery and the Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Armin Curt
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
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7
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Valošek J, Labounek R, Horák T, Horáková M, Bednařík P, Keřkovský M, Kočica J, Rohan T, Lenglet C, Cohen-Adad J, Hluštík P, Vlčková E, Kadaňka Z, Bednařík J, Svatkova A. Diffusion magnetic resonance imaging reveals tract-specific microstructural correlates of electrophysiological impairments in non-myelopathic and myelopathic spinal cord compression. Eur J Neurol 2021; 28:3784-3797. [PMID: 34288268 PMCID: PMC8530898 DOI: 10.1111/ene.15027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Non-myelopathic degenerative cervical spinal cord compression (NMDC) frequently occurs throughout aging and may progress to potentially irreversible degenerative cervical myelopathy (DCM). Whereas standard clinical magnetic resonance imaging (MRI) and electrophysiological measures assess compression severity and neurological dysfunction, respectively, underlying microstructural deficits still have to be established in NMDC and DCM patients. The study aims to establish tract-specific diffusion MRI markers of electrophysiological deficits to predict the progression of asymptomatic NMDC to symptomatic DCM. METHODS High-resolution 3 T diffusion MRI was acquired for 103 NMDC and 21 DCM patients compared to 60 healthy controls to reveal diffusion alterations and relationships between tract-specific diffusion metrics and corresponding electrophysiological measures and compression severity. Relationship between the degree of DCM disability, assessed by the modified Japanese Orthopaedic Association scale, and tract-specific microstructural changes in DCM patients was also explored. RESULTS The study identified diffusion-derived abnormalities in the gray matter, dorsal and lateral tracts congruent with trans-synaptic degeneration and demyelination in chronic degenerative spinal cord compression with more profound alterations in DCM than NMDC. Diffusion metrics were affected in the C3-6 area as well as above the compression level at C3 with more profound rostral deficits in DCM than NMDC. Alterations in lateral motor and dorsal sensory tracts correlated with motor and sensory evoked potentials, respectively, whereas electromyography outcomes corresponded with gray matter microstructure. DCM disability corresponded with microstructure alteration in lateral columns. CONCLUSIONS Outcomes imply the necessity of high-resolution tract-specific diffusion MRI for monitoring degenerative spinal pathology in longitudinal studies.
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Affiliation(s)
- Jan Valošek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia.,Department of Biomedical Engineering, University Hospital, Olomouc, Czechia
| | - René Labounek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia.,Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tomáš Horák
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Magda Horáková
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petr Bednařík
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Miloš Keřkovský
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Jan Kočica
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tomáš Rohan
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Christophe Lenglet
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada.,Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, Quebec, Canada.,Mila - Quebec AI Institute, Montreal, Quebec, Canada
| | - Petr Hluštík
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia
| | - Eva Vlčková
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Zdeněk Kadaňka
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Josef Bednařík
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Alena Svatkova
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
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8
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Juliano AF, Policeni B, Agarwal V, Burns J, Bykowski J, Harvey HB, Hoang JK, Hunt CH, Kennedy TA, Moonis G, Pannell JS, Parsons MS, Powers WJ, Rosenow JM, Schroeder JW, Slavin K, Whitehead MT, Corey AS. ACR Appropriateness Criteria® Ataxia. J Am Coll Radiol 2019; 16:S44-S56. [PMID: 31054758 DOI: 10.1016/j.jacr.2019.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 01/14/2023]
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9
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Predictive value of flexion and extension diffusion tensor imaging in the early stage of cervical myelopathy. Neuroradiology 2018; 60:1181-1191. [PMID: 30232516 DOI: 10.1007/s00234-018-2097-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/06/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Diffusion tensor imaging (DTI) in flexion (F) and extension (E) may serve as a sensitive diagnostic tool in early symptoms of myelopathy. The aim of this study was to compare values of water diffusion parameters on dynamic cervical DTI in early stage of myelopathy. METHODS Study enrolled 10 patients with an early stage of cervical myelopathy, in grade I/II of Nurick classification. All subjects were scanned with flexion-extension 3T MRI. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), RD (radial diffusivity), AD (axial diffusivity) and TRACEW (trace diffusion) were measured at C2, compression level (CL) and C7. Parameters were compared between 3 levels and F and E positions. RESULTS Flexion DTI revealed significant difference only for TRACEW between C2 and C7 (105.8 ± 18.9 vs. 83.7 ± 14, respectively; p = 0.0029). Extension DTI showed differences for ADC between CL and C7 (1378.9 ± 381.8 vs. 1227.2 ± 269.2; p = 0.001), reduced FA from 664.6 ± 56.3 at C2 down to 553.1 ± 75.5 (p = 0.001) at CL and 584.7 ± 40.7 at C7 (p = 0.002). Differences of RD in E were significant through all levels and reached 612.9 ± 105.1, 955.3 ± 319.4 and 802.1 ± 194.1 at C2, CL and C7, respectively. TRACEW lowered from 92.3 ± 14.4 at C2 to 66.9 ± 21.1 at CL (p = 0.0001) and 64.4 ± 15.5 at C7 (p = 0.0002). Comparison of DTI between F and E showed differences for all parameters except AD. RD was significantly higher in E at CL (p = 0.003) and C7 (0.013), but TRACEW increased in F at CL by 27.4% (p = 0.001) and at C7 by 23.1% (p = 0.013). FA was reduced at CL in E (p = 0.027) and similarly ADC in F (p = 0.048). CONCLUSION Dynamic DTI of the cervical spine is feasible and can detect subtle spinal cord damage of functional relevance in cervical myelopathy. A marked increase of RD and decrease of FA and TRACEW values in extension were found to be indicative for an early structural cord injury in myelopathy.
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10
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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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11
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Dong F, Wu Y, Song P, Qian Y, Wang Y, Xu L, Yin M, Zhang R, Tao H, Ge P, Liu C, Zhang H, Zhu J, Shen C, Yu Y. A preliminary study of 3.0-T magnetic resonance diffusion tensor imaging in cervical spondylotic myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1839-1845. [DOI: 10.1007/s00586-018-5579-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/05/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
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12
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Liu CB, Yang DG, Meng QR, Li DP, Yang ML, Sun W, Zhang WH, Cai C, Du LJ, Li J, Gao F, Yu Y, Zhang X, Zuo ZT, Li JJ. Dynamic correlation of diffusion tensor imaging and neurological function scores in beagles with spinal cord injury. Neural Regen Res 2018; 13:877-886. [PMID: 29863019 PMCID: PMC5998642 DOI: 10.4103/1673-5374.232485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Exploring the relationship between different structure of the spinal cord and functional assessment after spinal cord injury is important. Quantitative diffusion tensor imaging can provide information about the microstructure of nerve tissue and can quantify the pathological damage of spinal cord white matter and gray matter. In this study, a custom-designed spinal cord contusion-impactor was used to damage the T10 spinal cord of beagles. Diffusion tensor imaging was used to observe changes in the whole spinal cord, white matter, and gray matter, and the Texas Spinal Cord Injury Score was used to assess changes in neurological function at 3 hours, 24 hours, 6 weeks, and 12 weeks after injury. With time, fractional anisotropy values after spinal cord injury showed a downward trend, and the apparent diffusion coefficient, mean diffusivity, and radial diffusivity first decreased and then increased. The apparent diffusion-coefficient value was highly associated with the Texas Spinal Cord Injury Score for the whole spinal cord (R = 0.919, P = 0.027), white matter (R = 0.932, P = 0.021), and gray matter (R = 0.882, P = 0.048). Additionally, the other parameters had almost no correlation with the score (P > 0.05). In conclusion, the highest and most significant correlation between diffusion parameters and neurological function was the apparent diffusion-coefficient value for white matter, indicating that it could be used to predict the recovery of neurological function accurately after spinal cord injury.
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Affiliation(s)
- Chang-Bin Liu
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - De-Gang Yang
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Qian-Ru Meng
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Da-Peng Li
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Ming-Liang Yang
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Wei Sun
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Wen-Hao Zhang
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Chang Cai
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Liang-Jie Du
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Jun Li
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Feng Gao
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Yan Yu
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Xin Zhang
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Zhen-Tao Zuo
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences; The Innovation Center of Excellence on Brain Science, Chinese Academy of Sciences; Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
| | - Jian-Jun Li
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
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13
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Wu W, Niu Y, Kong X, Liu D, Long X, Shu S, Su X, Wang B, Liu X, Ma Y, Wang L. Application of diffusion tensor imaging in quantitatively monitoring chronic constriction injury of rabbit sciatic nerves: correlation with histological and functional changes. Br J Radiol 2017; 91:20170414. [PMID: 29166135 DOI: 10.1259/bjr.20170414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate the potential of diffusion tensor imaging (DTI) in quantitatively monitoring chronic constriction injuri (CCI) of sciatic nerves and to analyse the association of DTI parameters with nerve histology and limb function. METHODS CCI was created on sciatic nerves in the right hind legs of 20 rabbits with the left as control. DTI parameters-fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD) and radial diffusivity (RD)-and limb function were longitudinally evaluated. Pathology analysis was performed on day 3 (d3), week 1 (w1), 2, 4, 6, 8 and 10. RESULTS FA of the constricted nerves decreased on d3 (0.316 ± 0.044) and increased from w1 to w10 (0.331 ± 0.018, 0.354 ± 0.044, 0.375 ± 0.015, 0.394 ± 0.020, 0.42 ± 0.03 and 0.464 ± 0.039). ADC increased on d3 until w2 (1.502 ± 0.126, 1.462 ± 0.058 and 1.473 ± 0.124 × 10-3 mm2 s-1) and decreased to normal from w4 to w10 (1.356 ± 0.129, 1.375 ± 0.107, 1.290 ± 0.064 and 1.298 ± 0.026 × 10-3 mm2 s-1). AD decreased and stayed low from d3 to w10 (2.042 ± 0.160, 2.005 ± 0.095, 2.057 ± 0.124, 1.952 ± 0.213, 1.988 ± 0.180, 1.947 ± 0.106 and 2.097 ± 0.114). RD increased on d3 (1.233 ± 0.152) and declined from w1 to w10 (1.19 ± 0.06, 1.181 ± 0.14, 1.071 ± 0.102, 1.068 ± 0.084, 0.961 ± 0.063 and 0.923 ± 0.058). FA, ADC and RD correlated significantly with limb functional scores (all Ps < 0.0001) and their changes were associated with histological changes. CONCLUSION FA, ADC and RD are promising to monitor CCI. AD may be a stable indicator for injury. Histological changes, oedema, axon loss and demyelination, and fibrosis, accompanied the changes of these parameters. Advances in knowledge: DTI parameters can detect and monitor acute and chronic changes after nerve compression.
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Affiliation(s)
- Wenjun Wu
- 1 Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Yanfeng Niu
- 2 Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Xiangquan Kong
- 1 Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Dingxi Liu
- 1 Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Xi Long
- 1 Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Shenglei Shu
- 1 Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Xiaoyun Su
- 1 Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Bing Wang
- 1 Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Xiaoming Liu
- 1 Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Yamei Ma
- 1 Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Lixia Wang
- 1 Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
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Yang YM, Yoo WK, Yoo JH, Kwak YH, Oh JK, Song JS, Kim SW. The functional relevance of diffusion tensor imaging in comparison to conventional MRI in patients with cervical compressive myelopathy. Skeletal Radiol 2017; 46:1477-1486. [PMID: 28714054 DOI: 10.1007/s00256-017-2713-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/21/2017] [Accepted: 07/03/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the functional relevance of diffusion tensor imaging (DTI) metrics and conventional MRI (signal intensity change in T2, compression ratio) by measuring the correlation of these parameters with clinical outcome measured by the modified Japanese Orthopedic Association (mJOA) score. MATERIALS AND METHODS A total of 20 cervical myelopathy (CM) patients participated in this prospective cohort study. The severities of CM were assessed using the mJOA score. Conventional MRIs (T2-weighted images) measuring the signal changes of spinal cords and the degree of compression at the lesion level and DTI metrics [fractional anisotropy (FA), apparent diffusion coefficient (ADC)] at each lesion and below each lesion (C7/T1) level were acquired using a 3-T Achieva MRI. These parameters were correlated with the mJOA scores to determine the functional relevance. RESULTS Ninety percent of CM patients showed signal changes and 30 % of patients noted a more than 40% canal compression ratio in conventional MRIs at the lesion level; however, these findings were not correlated with the mJOA score (p < 0.05). In contrast, FA values on DTI showed high sensitivity to CM (100%), which was well correlated with the mJOA score (p = 0.034, r = 0.475) below the lesion level (C7/T1). CONCLUSIONS This study showed a meaningful symptomatic correlation between mJOA scores and FA values below the lesion levels in CM patients. It could give us more understanding of the pathological changes in spinal cords matched with various clinical findings in CM patients than the results from conventional MRI.
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Affiliation(s)
- Young-Mi Yang
- Spine Center, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang-si, South Korea
- Hallym Institute for Translational Genomics & Bioinformatics, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang-si, South Korea
| | - Je Hyun Yoo
- Department of Orthopaedic surgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang-si, South Korea
| | - Yoon Hae Kwak
- Department of Orthopaedic surgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang-si, South Korea
| | - Jae-Keun Oh
- Spine Center, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea
| | - Ji-Sun Song
- Spine Center, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea
| | - Seok Woo Kim
- Spine Center, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, South Korea.
- Department of Orthopaedic surgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang-si, South Korea.
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15
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Martín Noguerol T, Barousse R, Socolovsky M, Luna A. Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries. Quant Imaging Med Surg 2017; 7:398-421. [PMID: 28932698 DOI: 10.21037/qims.2017.08.01] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Traumatic conditions of peripheral nerves and plexus have been classically evaluated by morphological imaging techniques and electrophysiological tests. New magnetic resonance imaging (MRI) studies based on 3D fat-suppressed techniques are providing high accuracy for peripheral nerve injury evaluation from a qualitative point of view. However, these techniques do not provide quantitative information. Diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) are functional MRI techniques that are able to evaluate and quantify the movement of water molecules within different biological structures. These techniques have been successfully applied in other anatomical areas, especially in the assessment of central nervous system, and now are being imported, with promising results for peripheral nerve and plexus evaluation. DWI and DTI allow performing a qualitative and quantitative peripheral nerve analysis, providing valuable pathophysiological information about functional integrity of these structures. In the field of trauma and peripheral nerve or plexus injury, several derived parameters from DWI and DTI studies such as apparent diffusion coefficient (ADC) or fractional anisotropy (FA) among others, can be used as potential biomarkers of neural damage providing information about fiber organization, axonal flow or myelin integrity. A proper knowledge of physical basis of these techniques and their limitations is important for an optimal interpretation of the imaging findings and derived data. In this paper, a comprehensive review of the potential applications of DWI and DTI neurographic studies is performed with a focus on traumatic conditions, including main nerve entrapment syndromes in both peripheral nerves and brachial or lumbar plexus.
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Affiliation(s)
| | - Rafael Barousse
- Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina
| | - Mariano Socolovsky
- Peripheral Nerve and Plexus Surgery Unit, Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Antonio Luna
- MRI Unit, Neuroradiology Section, Clínica Las Nieves, SERCOSA, Health Time, Jaén, Spain.,Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
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16
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Wang K, Wang WT, Wang J, Chen Z, Song QX, Chen SY, Hao Q, He DW, Shen HX. Compared study of routine magnetic resonance imaging and diffusion tensor tractography on the predictive value of diagnosis and prognosis in acute cervical spinal cord injury. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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17
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Kuhn FP, Feydy A, Launay N, Lefevre-Colau MM, Poiraudeau S, Laporte S, Maier MA, Lindberg P. Kinetic DTI of the cervical spine: diffusivity changes in healthy subjects. Neuroradiology 2016; 58:929-35. [PMID: 27278377 DOI: 10.1007/s00234-016-1709-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The study aims to assess the influence of neck extension on water diffusivity within the cervical spinal cord. METHODS IRB approved the study in 22 healthy volunteers. All subjects underwent anatomical MR and diffusion tensor imaging (DTI) at 1.5 T. The cervical cord was imaged in neutral (standard) position and extension. Segmental vertebral rotations were analyzed on sagittal T2-weighted images using the SpineView® software. Spinal cord diffusivity was measured in cross-sectional regions of interests at multiple levels (C1-C5). RESULTS As a result of non-adapted coil geometry for spinal extension, 10 subjects had to be excluded. Image quality of the remaining 12 subjects was good without any deteriorating artifacts. Quantitative measurements of vertebral rotation angles and diffusion parameters showed good intra-rater reliability (ICC = 0.84-0.99). DTI during neck extension revealed significantly decreased fractional anisotropy (FA) and increased radial diffusivity (RD) at the C3 level and increased apparent diffusion coefficients (ADC) at the C3 and C4 levels (p < 0.01 Bonferroni corrected). The C3/C4 level corresponded to the maximal absolute change in segmental vertebral rotation between the two positions. The increase in RD correlated positively with the degree of global extension, i.e., the summed vertebral rotation angle between C1 and C5 (R = 0.77, p = 0.006). CONCLUSION Our preliminary results suggest that DTI can quantify changes in water diffusivity during cervical spine extension. The maximal differences in segmental vertebral rotation corresponded to the levels with significant changes in diffusivity (C3/C4). Consequently, kinetic DTI measurements may open new perspectives in the assessment of neural tissue under biomechanical constraints.
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Affiliation(s)
- Félix P Kuhn
- Service de Radiologie B, APHP, Centre Hospitalier Universitaire Cochin, Faculté de Médecine, Université Paris Descartes, 27 rue du Fbg St Jacques, 75679, Paris, France.
| | - Antoine Feydy
- Service de Radiologie B, APHP, Centre Hospitalier Universitaire Cochin, Faculté de Médecine, Université Paris Descartes, 27 rue du Fbg St Jacques, 75679, Paris, France.,INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidémiologie clinique appliquées aux maladies ostéo-articulaires (Ecamo), Université Paris Descartes, Paris, France
| | - Nathalie Launay
- Service de Radiologie B, APHP, Centre Hospitalier Universitaire Cochin, Faculté de Médecine, Université Paris Descartes, 27 rue du Fbg St Jacques, 75679, Paris, France
| | - Marie-Martine Lefevre-Colau
- INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidémiologie clinique appliquées aux maladies ostéo-articulaires (Ecamo), Université Paris Descartes, Paris, France.,Service de Médecine Physique & de Réadaptation, APHP, Centre Hospitalier Universitaire Cochin, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Serge Poiraudeau
- INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidémiologie clinique appliquées aux maladies ostéo-articulaires (Ecamo), Université Paris Descartes, Paris, France.,Service de Médecine Physique & de Réadaptation, APHP, Centre Hospitalier Universitaire Cochin, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Sébastien Laporte
- Laboratoire de Biomécanique, Ecole Nationale Supérieure d'Arts et Métiers, Paris, France
| | - Marc A Maier
- Centre de Psychiatrie et Neurosciences, INSERM U894, Paris, France.,FR3636 Neurosciences, CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pavel Lindberg
- Centre de Psychiatrie et Neurosciences, INSERM U894, Paris, France.,FR3636 Neurosciences, CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Santisteban L, Térémetz M, Bleton JP, Baron JC, Maier MA, Lindberg PG. Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review. PLoS One 2016; 11:e0154792. [PMID: 27152853 PMCID: PMC4859525 DOI: 10.1371/journal.pone.0154792] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/19/2016] [Indexed: 02/04/2023] Open
Abstract
Background Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians. Objective In this study we aimed to identify the most commonly used upper limb outcome measures in intervention studies after stroke and to describe domains covered according to ICF, how measures are combined, and how their use varies geographically and over time. Methods Pubmed, CinHAL, and PeDRO databases were searched for upper limb intervention studies in stroke according to PRISMA guidelines and477 studies were included. Results In studies 48different outcome measures were found. Only 15 of these outcome measures were used in more than 5% of the studies. The Fugl-Meyer Test (FMT)was the most commonly used measure (in 36% of studies). Commonly used measures covered ICF domains of body function and activity to varying extents. Most studies (72%) combined multiple outcome measures: the FMT was often combined with the Motor Activity Log (MAL), the Wolf Motor Function Test and the Action Research Arm Test, but infrequently combined with the Motor Assessment Scale or the Nine Hole Peg Test. Key components of manual dexterity such as selective finger movements were rarely measured. Frequency of use increased over a twelve-year period for the FMT and for assessments of kinematics, whereas other measures, such as the MAL and the Jebsen Taylor Hand Test showed decreased use over time. Use varied largely between countries showing low international consensus. Conclusions The results showed a large diversity of outcome measures used across studies. However, a growing number of studies used the FMT, a neurological test with good psychometric properties. For thorough assessment the FMT needs to be combined with functional measures. These findings illustrate the need for strategies to build international consensus on appropriate outcome measures for upper limb function after stroke.
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Affiliation(s)
- Leire Santisteban
- Service de Médecine Physique et de Réadaptation, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France
| | - Maxime Térémetz
- FR3636 CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-Pierre Bleton
- Unité James Parkinson, service de Neurologie, Fondation OPH Rothschild, Paris, France
- Centre de Psychiatrie et Neurosciences, Inserm U894, Paris, France
| | | | - Marc A. Maier
- FR3636 CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Påvel G. Lindberg
- FR3636 CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Centre de Psychiatrie et Neurosciences, Inserm U894, Paris, France
- * E-mail:
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Parekh MB, Gurjarpadhye AA, Manoukian MAC, Dubnika A, Rajadas J, Inayathullah M. Recent Developments in Diffusion Tensor Imaging of Brain. ACTA ACUST UNITED AC 2015; 1:1-12. [PMID: 27077135 DOI: 10.17140/roj-1-101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Magnetic resonance imaging (MRI) has come to be known as a unique radiological imaging modality because of its ability to perform tomographic imaging of body without the use of any harmful ionizing radiation. The radiologists use MRI to gain insight into the anatomy of organs, including the brain, while biomedical researchers explore the modality to gain better understanding of the brain structure and function. However, due to limited resolution and contrast, the conventional MRI fails to show the brain microstructure. Diffusion tensor imaging (DTI) harnesses the power of conventional MRI to deduce the diffusion dynamics of water molecules within the tissue and indirectly create a three-dimensional sketch of the brain anatomy. DTI enables visualization of brain tissue microstructure, which is extremely helpful in understanding various neuropathologies and neurodegenerative disorders. In this review, we briefly discuss the background and operating principles of DTI, followed by current trends in DTI applications for biomedical and clinical investigation of various brain diseases and disorders.
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Affiliation(s)
- Mansi Bharat Parekh
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Palo Alto, California, USA; Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Abhijit Achyut Gurjarpadhye
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Palo Alto, California, USA; Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Martin A C Manoukian
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Palo Alto, California, USA; University of California Davis School of Medicine, Sacramento, California, USA
| | - Arita Dubnika
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Palo Alto, California, USA; Riga Technical University, Faculty of Materials Science and Applied Chemistry, Institute of General Chemical Engineering, Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre, Riga, Latvia
| | - Jayakumar Rajadas
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Palo Alto, California, USA; Cardiovascular Pharmacology, Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Mohammed Inayathullah
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford University School of Medicine, Palo Alto, California, USA; Department of Radiology, Stanford University School of Medicine, Stanford, California, USA; Cardiovascular Pharmacology, Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
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