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Cook SR, Vasamreddy K, Combes A, Vandekar S, Visagie M, Houston D, Wald L, Kumar A, McGrath M, McKnight CD, Bagnato F, Smith SA, O'Grady KP. Biological variation in cervical spinal cord MRI morphometry in healthy individuals and people with multiple sclerosis. J Neuroimaging 2024. [PMID: 38858847 DOI: 10.1111/jon.13219] [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: 02/06/2024] [Revised: 05/06/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND AND PURPOSE Conclusions from prior literature regarding the impact of sex, age, and height on spinal cord (SC) MRI morphometrics are conflicting, while the effect of body weight on SC morphometrics has been found to be nonsignificant. The purpose of this case-control study is to assess the associations between cervical SC MRI morphometric parameters and age, sex, height, and weight to establish their potential role as confounding variables in a clinical study of people with multiple sclerosis (MS) compared to a cohort of healthy volunteers. METHODS Sixty-nine healthy volunteers and 31 people with MS underwent cervical SC MRI at 3 Tesla field strength. Images were centered at the C3/C4 intervertebral disc and processed using Spinal Cord Toolbox v.4.0.2. Mixed-effects linear regression models were used to evaluate the effects of biological variables and disease status on morphometric parameters. RESULTS Sex, age, and height had significant effects on cord and gray matter (GM) cross-sectional area (CSA) as well as the GM:cord CSA ratio. There were no significant effects of body weight on morphometric parameters. The effect of MS disease duration on cord CSA in the C4 level was significant when controlling for all other variables. CONCLUSIONS Studies of disease-related changes in SC morphometry should control for sex, age, and height to account for physiological variation.
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Affiliation(s)
- Sarah R Cook
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Yale College, Yale University, New Haven, Connecticut, USA
| | - Kritin Vasamreddy
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anna Combes
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mereze Visagie
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Delaney Houston
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lily Wald
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashwin Kumar
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Megan McGrath
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Colin D McKnight
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Francesca Bagnato
- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurology, VA Hospital, TN Valley Healthcare Center, Nashville, Tennessee, USA
| | - Seth A Smith
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Kristin P O'Grady
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
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Al-shaari H, J F, R M, CJ H. A systematic review of repeatability and reproducibility studies of diffusion tensor imaging of cervical spinal cord. Br J Radiol 2023; 96:20221019. [PMID: 37751162 PMCID: PMC10607424 DOI: 10.1259/bjr.20221019] [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: 10/31/2022] [Revised: 07/12/2023] [Accepted: 08/10/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES Diffusion tensor imaging (DTI) techniques are being studied as a possible diagnostic and predictive tool for the evaluation of cervical spinal cord disease. This systematic review aims to evaluate the previous DTI studies that specifically investigated the repeatability and reproducibility of DTI in the cervical spinal cord. METHODS AND MATERIALS A search in the PubMed, Scopus, Web of Science and Ovid electronic databases was conducted for articles published between January 1990 and February 2022 that related to the repeatability and reproducibility of DTI in evaluating the cervical spinal cord using one of the following measurements: the intraclass correlation coefficient (ICC) and/or the coefficient of variation (CV), and/or Bland-Altman (BA) differences analysis methods. DTI studies that presented full statistical analysis of repeatability and/or reproducibility tests of the cervical spinal cord in peer-reviewed full-text publications published in journals were included. Articles that included at least one of the keywords within the titles or abstracts were identified. Additional full-text papers were found by searching the citations and reference lists of related articles. This review has followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Risk of bias was evaluated with 13 criteria weighted toward methodological quality of reported studies using the QuADS assessment criteria. This assessment only included full-text articles written in English. RESULTS A total of 11 studies were included and assessed for different characteristics, including sample size,(3-34) re-test time interval (<1 h to >3 months), test-retest reproducibility scores and acquisition method. Six studies used ICC which ranged from poor (ICC<0.37) to excellent reproducibility (ICC 0.91-0.99). Four studies reported an overall CV lower than 40% for all DTI metrics. Three studies reported the Bland-Altman (BA) differences and reported a minimum percentage showing no strong differences between repeated measurements. Quantitative analysis was not undertaken due to heterogeneity of methods. Repeatability and reproducibility measures were generally found to be good. CONCLUSION This study revealed that the application of DTI and its related measures in a clinical setting in the assessment of cervical spinal cord changes is feasible and reproducible. However, cervical spinal cord DTI suffers from some existing limitations that prevent it from being routinely used in research and clinical settings. ADVANCES IN KNOWLEDGE DTI with its parametric maps provide broad evaluation of the tissue structure of axonal white matter and are being studied as a possible diagnostic and predictive tool for the assessment of cervical spinal cord (CSC) disease.
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Affiliation(s)
| | - Fulford J
- Medical Imaging Department, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Meertens R
- Medical Imaging Department, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Heales CJ
- Medical Imaging Department, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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Kesenheimer EM, Wendebourg MJ, Weigel M, Weidensteiner C, Haas T, Richter L, Sander L, Horvath A, Barakovic M, Cattin P, Granziera C, Bieri O, Schlaeger R. Normalization of Spinal Cord Total Cross-Sectional and Gray Matter Areas as Quantified With Radially Sampled Averaged Magnetization Inversion Recovery Acquisitions. Front Neurol 2021; 12:637198. [PMID: 33841307 PMCID: PMC8027254 DOI: 10.3389/fneur.2021.637198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background: MR imaging of the spinal cord (SC) gray matter (GM) at the cervical and lumbar enlargements' level may be particularly informative in lower motor neuron disorders, e. g., spinal muscular atrophy, but also in other neurodegenerative or autoimmune diseases affecting the SC. Radially sampled averaged magnetization inversion recovery acquisition (rAMIRA) is a novel approach to perform SC imaging in clinical settings with favorable contrast and is well-suited for SC GM quantitation. However, before applying rAMIRA in clinical studies, it is important to understand (i) the sources of inter-subject variability of total SC cross-sectional areas (TCA) and GM area (GMA) measurements in healthy subjects and (ii) their relation to age and sex to facilitate the detection of pathology-associated changes. In this study, we aimed to develop normalization strategies for rAMIRA-derived SC metrics using skull and spine-based metrics to reduce anatomical variability. Methods: Sixty-one healthy subjects (age range 11–93 years, 37.7% women) were investigated with axial two-dimensional rAMIRA imaging at 3T MRI. Cervical and thoracic levels including the level of the cervical (C4/C5) and lumbar enlargements (Tmax) were examined. SC T2-weighted sagittal images and high-resolution 3D whole-brain T1-weighted images were acquired. TCA and GMAs were quantified. Anatomical variables with associations of |r| > 0.30 in univariate association with SC areas, and age and sex were used to construct normalization models using backward selection with TCAC4/C5 as outcome. The effect of the normalization was assessed by % relative standard deviation (RSD) reductions. Results: Mean inter-individual variability and the SD of the SC area metrics were considerable: TCAC4/5: 8.1%/9.0; TCATmax: 8.9%/6.5; GMAC4/C5: 8.6%/2.2; GMATmax: 12.2%/3.8. Normalization based on sex, brain WM volume, and spinal canal area resulted in RSD reductions of 23.7% for TCAs and 12.0% for GM areas at C4/C5. Normalizations based on the area of spinal canal alone resulted in RSD reductions of 10.2% for TCAs and 9.6% for GM areas at C4/C5, respectively. Discussion: Anatomic inter-individual variability of SC areas is substantial. This study identified effective normalization models for inter-subject variability reduction in TCA and SC GMA in healthy subjects based on rAMIRA imaging.
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Affiliation(s)
- Eva M Kesenheimer
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Maria Janina Wendebourg
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.,Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Claudia Weidensteiner
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Tanja Haas
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Laura Richter
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Laura Sander
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Antal Horvath
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Philippe Cattin
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Regina Schlaeger
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
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Biomechanical comparison of spinal cord compression types occurring in Degenerative Cervical Myelopathy. Clin Biomech (Bristol, Avon) 2021; 81:105174. [PMID: 33279293 DOI: 10.1016/j.clinbiomech.2020.105174] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Degenerative Cervical Myelopathy results from spine degenerations narrowing the spinal canal and inducing cord compressions. Prognosis is challenging. This study aimed at simulating typical spinal cord compressions observed in patients with a realistic model to better understand pathogenesis for later prediction of patients' evolution. METHODS A 30% reduction in cord cross-sectional area at C5-C6 was defined as myelopathy threshold based on Degenerative Cervical Myelopathy features from literature and MRI measurements in 20 patients. Four main compression types were extracted from MRIs and simulated with a comprehensive three-dimensional finite element spine model. Median diffuse, median focal and lateral types were modelled as disk herniation while circumferential type additionally involved ligamentum flavum hypertrophy. All stresses were quantified along inferior-superior axis, compression development and across atlas-defined spinal cord regions. FINDINGS Anterior gray and white matter globally received the highest stress while lateral pathways were the least affected. Median diffuse compression induced the highest stresses. Circumferential type focused stresses in posterior gray matter. Along inferior-superior axis, those two types showed a peak of constraints at compression site while median focal and lateral types showed lower values but extending further. INTERPRETATION Median diffuse type would be the most detrimental based on stress amplitude. Anterior regions would be the most at risk, except for circumferential type where posterior regions would be equally affected. In addition to applying constraints, ischemia could be a significant component explaining the early demyelination reported in lateral pathways. Moving towards patient-specific simulations, biomechanical models could become strong predictors for degenerative changes.
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5
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Abstract
Human brain atlases have been evolving tremendously, propelled recently by brain big projects, and driven by sophisticated imaging techniques, advanced brain mapping methods, vast data, analytical strategies, and powerful computing. We overview here this evolution in four categories: content, applications, functionality, and availability, in contrast to other works limited mostly to content. Four atlas generations are distinguished: early cortical maps, print stereotactic atlases, early digital atlases, and advanced brain atlas platforms, and 5 avenues in electronic atlases spanning the last two generations. Content-wise, new electronic atlases are categorized into eight groups considering their scope, parcellation, modality, plurality, scale, ethnicity, abnormality, and a mixture of them. Atlas content developments in these groups are heading in 23 various directions. Application-wise, we overview atlases in neuroeducation, research, and clinics, including stereotactic and functional neurosurgery, neuroradiology, neurology, and stroke. Functionality-wise, tools and functionalities are addressed for atlas creation, navigation, individualization, enabling operations, and application-specific. Availability is discussed in media and platforms, ranging from mobile solutions to leading-edge supercomputers, with three accessibility levels. The major application-wise shift has been from research to clinical practice, particularly in stereotactic and functional neurosurgery, although clinical applications are still lagging behind the atlas content progress. Atlas functionality also has been relatively neglected until recently, as the management of brain data explosion requires powerful tools. We suggest that the future human brain atlas-related research and development activities shall be founded on and benefit from a standard framework containing the core virtual brain model cum the brain atlas platform general architecture.
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Affiliation(s)
- Wieslaw L Nowinski
- John Paul II Center for Virtual Anatomy and Surgical Simulation, University of Cardinal Stefan Wyszynski, Woycickiego 1/3, Block 12, room 1220, 01-938, Warsaw, Poland.
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6
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Tinnermann A, Büchel C, Cohen-Adad J. Cortico-spinal imaging to study pain. Neuroimage 2020; 224:117439. [PMID: 33039624 DOI: 10.1016/j.neuroimage.2020.117439] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/21/2020] [Accepted: 10/01/2020] [Indexed: 12/15/2022] Open
Abstract
Functional magnetic resonance imaging of the brain has helped to reveal mechanisms of pain perception in health and disease. Recently, imaging approaches have been developed that allow recording neural activity simultaneously in the brain and in the spinal cord. These approaches offer the possibility to examine pain perception in the entire central pain system and in addition, to investigate cortico-spinal interactions during pain processing. Although cortico-spinal imaging is a promising technique, it bears challenges concerning data acquisition and data analysis strategies. In this review, we discuss studies that applied simultaneous imaging of the brain and spinal cord to explore central pain processing. Furthermore, we describe different MR-related acquisition techniques, summarize advantages and disadvantages of approaches that have been implemented so far and present software that has been specifically developed for the analysis of spinal fMRI data to address challenges of spinal data analysis.
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Affiliation(s)
- Alexandra Tinnermann
- Department for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Max Planck School of Cognition, Leipzig, Germany.
| | - Christian Büchel
- Department for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Max Planck School of Cognition, Leipzig, Germany
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, Quebec, Canada.
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Smeriglio P, Langard P, Querin G, Biferi MG. The Identification of Novel Biomarkers Is Required to Improve Adult SMA Patient Stratification, Diagnosis and Treatment. J Pers Med 2020; 10:jpm10030075. [PMID: 32751151 PMCID: PMC7564782 DOI: 10.3390/jpm10030075] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Spinal muscular atrophy (SMA) is currently classified into five different subtypes, from the most severe (type 0) to the mildest (type 4) depending on age at onset, best motor function achieved, and copy number of the SMN2 gene. The two recent approved treatments for SMA patients revolutionized their life quality and perspectives. However, upon treatment with Nusinersen, the most widely administered therapy up to date, a high degree of variability in therapeutic response was observed in adult SMA patients. These data, together with the lack of natural history information and the wide spectrum of disease phenotypes, suggest that further efforts are needed to develop precision medicine approaches for all SMA patients. Here, we compile the current methods for functional evaluation of adult SMA patients treated with Nusinersen. We also present an overview of the known molecular changes underpinning disease heterogeneity. We finally highlight the need for novel techniques, i.e., -omics approaches, to capture phenotypic differences and to understand the biological signature in order to revise the disease classification and device personalized treatments.
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Affiliation(s)
- Piera Smeriglio
- Centre of Research in Myology, Institute of Myology, Sorbonne Université, INSERM, 75013 Paris, France; (P.L.); (G.Q.)
- Correspondence: (P.S.); (M.G.B.)
| | - Paul Langard
- Centre of Research in Myology, Institute of Myology, Sorbonne Université, INSERM, 75013 Paris, France; (P.L.); (G.Q.)
| | - Giorgia Querin
- Centre of Research in Myology, Institute of Myology, Sorbonne Université, INSERM, 75013 Paris, France; (P.L.); (G.Q.)
- Association Institut de Myologie, Plateforme Essais Cliniques Adultes, 75013 Paris, France
- APHP, Service de Neuromyologie, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Maria Grazia Biferi
- Centre of Research in Myology, Institute of Myology, Sorbonne Université, INSERM, 75013 Paris, France; (P.L.); (G.Q.)
- Correspondence: (P.S.); (M.G.B.)
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8
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Anterior fissure, central canal, posterior septum and more: New insights into the cervical spinal cord gray and white matter regional organization using T1 mapping at 7T. Neuroimage 2020; 205:116275. [DOI: 10.1016/j.neuroimage.2019.116275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/16/2019] [Accepted: 10/10/2019] [Indexed: 12/12/2022] Open
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Papinutto N, Asteggiano C, Bischof A, Gundel TJ, Caverzasi E, Stern WA, Bastianello S, Hauser SL, Henry RG. Intersubject Variability and Normalization Strategies for Spinal Cord Total Cross-Sectional and Gray Matter Areas. J Neuroimaging 2019; 30:110-118. [PMID: 31571307 DOI: 10.1111/jon.12666] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/02/2019] [Accepted: 09/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE The quantification of spinal cord (SC) atrophy by MRI has assumed an important role in assessment of neuroinflammatory/neurodegenerative diseases and traumatic SC injury. Recent technical advances make possible the quantification of gray matter (GM) and white matter tissues in clinical settings. However, the goal of a reliable diagnostic, prognostic or predictive marker is still elusive, in part due to large intersubject variability of SC areas. Here, we investigated the sources of this variability and explored effective strategies to reduce it. METHODS One hundred twenty-nine healthy subjects (mean age: 41.0 ± 15.9) underwent MRI on a Siemens 3T Skyra scanner. Two-dimensional PSIR at the C2-C3 vertebral level and a sagittal 1 mm3 3D T1-weighted brain acquisition extended to the upper cervical cord were acquired. Total cross-sectional area and GM area were measured at C2-C3, as well as measures of the vertebra, spinal canal and the skull. Correlations between the different metrics were explored using Pearson product-moment coefficients. The most promising metrics were used to normalize cord areas using multiple regression analyses. RESULTS The most effective normalization metrics were the V-scale (from SienaX) and the product of the C2-C3 spinal canal diameters. Normalization methods based on these metrics reduced the intersubject variability of cord areas of up to 17.74%. The measured cord areas had a statistically significant sex difference, while the effect of age was moderate. CONCLUSIONS The present work explored in a large cohort of healthy subjects the source of intersubject variability of SC areas and proposes effective normalization methods for its reduction.
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Affiliation(s)
- Nico Papinutto
- Department of Neurology, University of California, San Francisco, CA
| | - Carlo Asteggiano
- Department of Neurology, University of California, San Francisco, CA.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Antje Bischof
- Department of Neurology, University of California, San Francisco, CA
| | - Tristan J Gundel
- Department of Neurology, University of California, San Francisco, CA
| | - Eduardo Caverzasi
- Department of Neurology, University of California, San Francisco, CA.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - William A Stern
- Department of Neurology, University of California, San Francisco, CA
| | - Stefano Bastianello
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stephen L Hauser
- Department of Neurology, University of California, San Francisco, CA
| | - Roland G Henry
- Department of Neurology, University of California, San Francisco, CA
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10
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Kaushal M, Shabani S, Budde M, Kurpad S. Diffusion Tensor Imaging in Acute Spinal Cord Injury: A Review of Animal and Human Studies. J Neurotrauma 2019; 36:2279-2286. [PMID: 30950317 DOI: 10.1089/neu.2019.6379] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Diffusion tensor imaging (DTI), based on the property of preferential diffusion of water molecules in biological tissue, is seeing increasing clinical application in the pathologies of the central nervous system. Spinal cord injury (SCI) is one such area where the use of DTI allows for the evaluation of changes to microstructure of the spinal cord not detected on routine conventional magnetic resonance imaging. The insights obtained from pre-clinical models of SCI indicate correlation of quantitative DTI indices with histology and function, which points to the potential of DTI as a non-invasive, viable biomarker for integrity of white matter tracts in the spinal cord. In this review, we describe DTI alterations in the acute phase of SCI in both animal models and human subjects and explore the underlying pathophysiology behind these changes.
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Affiliation(s)
- Mayank Kaushal
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shekar Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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11
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El Mendili MM, Querin G, Bede P, Pradat PF. Spinal Cord Imaging in Amyotrophic Lateral Sclerosis: Historical Concepts-Novel Techniques. Front Neurol 2019; 10:350. [PMID: 31031688 PMCID: PMC6474186 DOI: 10.3389/fneur.2019.00350] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/21/2019] [Indexed: 01/13/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common adult onset motor neuron disease with no effective disease modifying therapies at present. Spinal cord degeneration is a hallmark feature of ALS, highlighted in the earliest descriptions of the disease by Lockhart Clarke and Jean-Martin Charcot. The anterior horns and corticospinal tracts are invariably affected in ALS, but up to recently it has been notoriously challenging to detect and characterize spinal pathology in vivo. With recent technological advances, spinal imaging now offers unique opportunities to appraise lower motor neuron degeneration, sensory involvement, metabolic alterations, and interneuron pathology in ALS. Quantitative spinal imaging in ALS has now been used in cross-sectional and longitudinal study designs, applied to presymptomatic mutation carriers, and utilized in machine learning applications. Despite its enormous clinical and academic potential, a number of physiological, technological, and methodological challenges limit the routine use of computational spinal imaging in ALS. In this review, we provide a comprehensive overview of emerging spinal cord imaging methods and discuss their advantages, drawbacks, and biomarker potential in clinical applications, clinical trial settings, monitoring, and prognostic roles.
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Affiliation(s)
- Mohamed Mounir El Mendili
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France
| | - Giorgia Querin
- Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France.,Department of Neurology, Pitié-Salpêtrière University Hospital (APHP), Paris, France
| | - Peter Bede
- Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France.,Department of Neurology, Pitié-Salpêtrière University Hospital (APHP), Paris, France.,Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Pierre-François Pradat
- Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France.,Department of Neurology, Pitié-Salpêtrière University Hospital (APHP), Paris, France
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12
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Islam H, Law CSW, Weber KA, Mackey SC, Glover GH. Dynamic per slice shimming for simultaneous brain and spinal cord fMRI. Magn Reson Med 2019; 81:825-838. [PMID: 30284730 PMCID: PMC6649677 DOI: 10.1002/mrm.27388] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/10/2018] [Accepted: 05/13/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Simultaneous brain and spinal cord functional MRI is emerging as a new tool to study the central nervous system but is challenging. Poor B0 homogeneity and small size of the spinal cord are principal obstacles to this nascent technology. Here we extend a dynamic shimming approach, first posed by Finsterbusch, by shimming per slice for both the brain and spinal cord. METHODS We shim dynamically by a simple and fast optimization of linear field gradients and frequency offset separately for each slice in order to minimize off-resonance for both the brain and spinal cord. Simultaneous acquisition of brain and spinal cord fMRI is achieved with high spatial resolution in the spinal cord by means of an echo-planar RF pulse for reduced FOV. Brain slice acquisition is full FOV. RESULTS T2*-weighted images of brain and spinal cord are acquired with high clarity and minimal observable image artifacts. Fist-clenching fMRI experiments reveal task-consistent activation in motor cortices, cerebellum, and C6-T1 spinal segments. CONCLUSIONS High quality functional results are obtained for a sensory-motor task. Consistent activation in both the brain and spinal cord is observed at individual levels, not only at group level. Because reduced FOV excitation is applicable to any spinal cord section, future continuation of these methods holds great potential.
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Affiliation(s)
- Haisam Islam
- Department of Bioengineering, Stanford University, Stanford, California
| | - Christine S. W. Law
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Kenneth A. Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Sean C. Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Gary H. Glover
- Department of Radiology, Stanford University, Stanford, California
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13
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Powers JM, Ioachim G, Stroman PW. Ten Key Insights into the Use of Spinal Cord fMRI. Brain Sci 2018; 8:E173. [PMID: 30201938 PMCID: PMC6162663 DOI: 10.3390/brainsci8090173] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 01/27/2023] Open
Abstract
A comprehensive review of the literature-to-date on functional magnetic resonance imaging (fMRI) of the spinal cord is presented. Spinal fMRI has been shown, over more than two decades of work, to be a reliable tool for detecting neural activity. We discuss 10 key points regarding the history, development, methods, and applications of spinal fMRI. Animal models have served a key purpose for the development of spinal fMRI protocols and for experimental spinal cord injury studies. Applications of spinal fMRI span from animal models across healthy and patient populations in humans using both task-based and resting-state paradigms. The literature also demonstrates clear trends in study design and acquisition methods, as the majority of studies follow a task-based, block design paradigm, and utilize variations of single-shot fast spin-echo imaging methods. We, therefore, discuss the similarities and differences of these to resting-state fMRI and gradient-echo EPI protocols. Although it is newly emerging, complex connectivity and network analysis is not only possible, but has also been shown to be reliable and reproducible in the spinal cord for both task-based and resting-state studies. Despite the technical challenges associated with spinal fMRI, this review identifies reliable solutions that have been developed to overcome these challenges.
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Affiliation(s)
- Jocelyn M Powers
- Centre for Neuroscience Studies, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Gabriela Ioachim
- Centre for Neuroscience Studies, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Patrick W Stroman
- Centre for Neuroscience Studies, Queen's University, Kingston, ON K7L 3N6, Canada.
- Department of Biomedical Sciences, Queen's University, Kingston, ON K7L 3N6, Canada.
- Department of Physics, Queen's University, Kingston, ON K7L 3N6, Canada.
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14
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Sinnecker T, Granziera C, Wuerfel J, Schlaeger R. Future Brain and Spinal Cord Volumetric Imaging in the Clinic for Monitoring Treatment Response in MS. Curr Treat Options Neurol 2018; 20:17. [PMID: 29679165 DOI: 10.1007/s11940-018-0504-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Volumetric analysis of brain imaging has emerged as a standard approach used in clinical research, e.g., in the field of multiple sclerosis (MS), but its application in individual disease course monitoring is still hampered by biological and technical limitations. This review summarizes novel developments in volumetric imaging on the road towards clinical application to eventually monitor treatment response in patients with MS. RECENT FINDINGS In addition to the assessment of whole-brain volume changes, recent work was focused on the volumetry of specific compartments and substructures of the central nervous system (CNS) in MS. This included volumetric imaging of the deep brain structures and of the spinal cord white and gray matter. Volume changes of the latter indeed independently correlate with clinical outcome measures especially in progressive MS. Ultrahigh field MRI and quantitative MRI added to this trend by providing a better visualization of small compartments on highly resolving MR images as well as microstructural information. New developments in volumetric imaging have the potential to improve sensitivity as well as specificity in detecting and hence monitoring disease-related CNS volume changes in MS.
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Affiliation(s)
- Tim Sinnecker
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Medical Image Analysis Center Basel AG, Basel, Switzerland
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center Basel AG, Basel, Switzerland
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Ultrahigh Field Facility, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Regina Schlaeger
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
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15
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Calabrese E, Adil SM, Cofer G, Perone CS, Cohen-Adad J, Lad SP, Johnson GA. Postmortem diffusion MRI of the entire human spinal cord at microscopic resolution. Neuroimage Clin 2018; 18:963-971. [PMID: 29876281 PMCID: PMC5988447 DOI: 10.1016/j.nicl.2018.03.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/15/2018] [Accepted: 03/21/2018] [Indexed: 11/20/2022]
Abstract
The human spinal cord is a central nervous system structure that plays an important role in normal motor and sensory function, and can be affected by many debilitating neurologic diseases. Due to its clinical importance, the spinal cord is frequently the subject of imaging research. Common methods for visualizing spinal cord anatomy and pathology include histology and magnetic resonance imaging (MRI), both of which have unique benefits and drawbacks. Postmortem microscopic resolution MRI of fixed specimens, sometimes referred to as magnetic resonance microscopy (MRM), combines many of the benefits inherent to both techniques. However, the elongated shape of the human spinal cord, along with hardware and scan time limitations, have restricted previous microscopic resolution MRI studies (both in vivo and ex vivo) to small sections of the cord. Here we present the first MRM dataset of the entire postmortem human spinal cord. These data include 50 μm isotropic resolution anatomic image data and 100 μm isotropic resolution diffusion data, made possible by a 280 h long multi-segment acquisition and automated image segment composition. We demonstrate the use of these data for spinal cord lesion detection, automated volumetric gray matter segmentation, and quantitative spinal cord morphometry including estimates of cross sectional dimensions and gray matter fraction throughout the length of the cord.
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Affiliation(s)
- Evan Calabrese
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA; Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA.
| | - Syed M Adil
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Gary Cofer
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
| | - Christian S Perone
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - G Allan Johnson
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
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16
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PAM50: Unbiased multimodal template of the brainstem and spinal cord aligned with the ICBM152 space. Neuroimage 2018; 165:170-179. [DOI: 10.1016/j.neuroimage.2017.10.041] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/16/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022] Open
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17
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Ruiz-España S, Domingo J, Díaz-Parra A, Dura E, D'Ocón-Alcañiz V, Arana E, Moratal D. Automatic segmentation of the spine by means of a probabilistic atlas with a special focus on ribs suppression. Med Phys 2017. [DOI: 10.1002/mp.12431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Silvia Ruiz-España
- Center for Biomaterials and Tissue Engineering; Universitat Politècnica de València; 46022 Valencia Spain
| | - Juan Domingo
- Department of Informatics; Universitat de València; 46100 Burjasot Spain
| | - Antonio Díaz-Parra
- Center for Biomaterials and Tissue Engineering; Universitat Politècnica de València; 46022 Valencia Spain
| | - Esther Dura
- Department of Informatics; Universitat de València; 46100 Burjasot Spain
| | - Víctor D'Ocón-Alcañiz
- Center for Biomaterials and Tissue Engineering; Universitat Politècnica de València; 46022 Valencia Spain
| | - Estanislao Arana
- Radiology Department; Fundación Instituto Valenciano de Oncología; 46009 Valencia Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering; Universitat Politècnica de València; 46022 Valencia Spain
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18
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Cohen-Adad J. Functional Magnetic Resonance Imaging of the Spinal Cord: Current Status and Future Developments. Semin Ultrasound CT MR 2017; 38:176-186. [DOI: 10.1053/j.sult.2016.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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19
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Eippert F, Kong Y, Winkler AM, Andersson JL, Finsterbusch J, Büchel C, Brooks JCW, Tracey I. Investigating resting-state functional connectivity in the cervical spinal cord at 3T. Neuroimage 2016; 147:589-601. [PMID: 28027960 PMCID: PMC5315056 DOI: 10.1016/j.neuroimage.2016.12.072] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/20/2016] [Accepted: 12/23/2016] [Indexed: 12/12/2022] Open
Abstract
The study of spontaneous fluctuations in the blood-oxygen-level-dependent (BOLD) signal has recently been extended from the brain to the spinal cord. Two ultra-high field functional magnetic resonance imaging (fMRI) studies in humans have provided evidence for reproducible resting-state connectivity between the dorsal horns as well as between the ventral horns, and a study in non-human primates has shown that these resting-state signals are impacted by spinal cord injury. As these studies were carried out at ultra-high field strengths using region-of-interest (ROI) based analyses, we investigated whether such resting-state signals could also be observed at the clinically more prevalent field strength of 3 T. In a reanalysis of a sample of 20 healthy human participants who underwent a resting-state fMRI acquisition of the cervical spinal cord, we were able to observe significant dorsal horn connectivity as well as ventral horn connectivity, but no consistent effects for connectivity between dorsal and ventral horns, thus replicating the human 7 T results. These effects were not only observable when averaging along the acquired length of the spinal cord, but also when we examined each of the acquired spinal segments separately, which showed similar patterns of connectivity. Finally, we investigated the robustness of these resting-state signals against variations in the analysis pipeline by varying the type of ROI creation, temporal filtering, nuisance regression and connectivity metric. We observed that – apart from the effects of band-pass filtering – ventral horn connectivity showed excellent robustness, whereas dorsal horn connectivity showed moderate robustness. Together, our results provide evidence that spinal cord resting-state connectivity is a robust and spatially consistent phenomenon that could be a valuable tool for investigating the effects of pathology, disease progression, and treatment response in neurological conditions with a spinal component, such as spinal cord injury.
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Affiliation(s)
- Falk Eippert
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Yazhuo Kong
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Magnetic Resonance Imaging Research Centre, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Anderson M Winkler
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jesper L Andersson
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jürgen Finsterbusch
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Irene Tracey
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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20
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Massire A, Taso M, Besson P, Guye M, Ranjeva JP, Callot V. High-resolution multi-parametric quantitative magnetic resonance imaging of the human cervical spinal cord at 7T. Neuroimage 2016; 143:58-69. [DOI: 10.1016/j.neuroimage.2016.08.055] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 11/17/2022] Open
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21
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De Leener B, Lévy S, Dupont SM, Fonov VS, Stikov N, Louis Collins D, Callot V, Cohen-Adad J. SCT: Spinal Cord Toolbox, an open-source software for processing spinal cord MRI data. Neuroimage 2016; 145:24-43. [PMID: 27720818 DOI: 10.1016/j.neuroimage.2016.10.009] [Citation(s) in RCA: 337] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 11/17/2022] Open
Abstract
For the past 25 years, the field of neuroimaging has witnessed the development of several software packages for processing multi-parametric magnetic resonance imaging (mpMRI) to study the brain. These software packages are now routinely used by researchers and clinicians, and have contributed to important breakthroughs for the understanding of brain anatomy and function. However, no software package exists to process mpMRI data of the spinal cord. Despite the numerous clinical needs for such advanced mpMRI protocols (multiple sclerosis, spinal cord injury, cervical spondylotic myelopathy, etc.), researchers have been developing specific tools that, while necessary, do not provide an integrative framework that is compatible with most usages and that is capable of reaching the community at large. This hinders cross-validation and the possibility to perform multi-center studies. In this study we introduce the Spinal Cord Toolbox (SCT), a comprehensive software dedicated to the processing of spinal cord MRI data. SCT builds on previously-validated methods and includes state-of-the-art MRI templates and atlases of the spinal cord, algorithms to segment and register new data to the templates, and motion correction methods for diffusion and functional time series. SCT is tailored towards standardization and automation of the processing pipeline, versatility, modularity, and it follows guidelines of software development and distribution. Preliminary applications of SCT cover a variety of studies, from cross-sectional area measures in large databases of patients, to the precise quantification of mpMRI metrics in specific spinal pathways. We anticipate that SCT will bring together the spinal cord neuroimaging community by establishing standard templates and analysis procedures.
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Affiliation(s)
- Benjamin De Leener
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Simon Lévy
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
| | - Sara M Dupont
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Vladimir S Fonov
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Nikola Stikov
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Montreal Heart Institute, Montreal, QC, Canada
| | - D Louis Collins
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Virginie Callot
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France; AP-HM, Hopital de la Timone, Pôle d'imagerie médicale, CEMEREM, Marseille, France
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada.
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22
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Dupont SM, De Leener B, Taso M, Le Troter A, Nadeau S, Stikov N, Callot V, Cohen-Adad J. Fully-integrated framework for the segmentation and registration of the spinal cord white and gray matter. Neuroimage 2016; 150:358-372. [PMID: 27663988 DOI: 10.1016/j.neuroimage.2016.09.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/23/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022] Open
Abstract
The spinal cord white and gray matter can be affected by various pathologies such as multiple sclerosis, amyotrophic lateral sclerosis or trauma. Being able to precisely segment the white and gray matter could help with MR image analysis and hence be useful in further understanding these pathologies, and helping with diagnosis/prognosis and drug development. Up to date, white/gray matter segmentation has mostly been done manually, which is time consuming, induces a bias related to the rater and prevents large-scale multi-center studies. Recently, few methods have been proposed to automatically segment the spinal cord white and gray matter. However, no single method exists that combines the following criteria: (i) fully automatic, (ii) works on various MRI contrasts, (iii) robust towards pathology and (iv) freely available and open source. In this study we propose a multi-atlas based method for the segmentation of the spinal cord white and gray matter that addresses the previous limitations. Moreover, to study the spinal cord morphology, atlas-based approaches are increasingly used. These approaches rely on the registration of a spinal cord template to an MR image, however the registration usually doesn't take into account the spinal cord internal structure and thus lacks accuracy. In this study, we propose a new template registration framework that integrates the white and gray matter segmentation to account for the specific gray matter shape of each individual subject. Validation of segmentation was performed in 24 healthy subjects using T2*-weighted images, in 8 healthy subjects using diffusion weighted images (exhibiting inverted white-to-gray matter contrast compared to T2*-weighted), and in 5 patients with spinal cord injury. The template registration was validated in 24 subjects using T2*-weighted data. Results of automatic segmentation on T2*-weighted images was in close correspondence with the manual segmentation (Dice coefficient in the white/gray matter of 0.91/0.71 respectively). Similarly, good results were obtained in data with inverted contrast (diffusion-weighted image) and in patients. When compared to the classical template registration framework, the proposed framework that accounts for gray matter shape significantly improved the quality of the registration (comparing Dice coefficient in gray matter: p=9.5×10-6). While further validation is needed to show the benefits of the new registration framework in large cohorts and in a variety of patients, this study provides a fully-integrated tool for quantitative assessment of white/gray matter morphometry and template-based analysis. All the proposed methods are implemented in the Spinal Cord Toolbox (SCT), an open-source software for processing spinal cord multi-parametric MRI data.
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Affiliation(s)
- Sara M Dupont
- NeuroPoly Lab, Polytechnique Montreal, Montreal, QC, Canada
| | | | - Manuel Taso
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France; AP-HM, Hopital de la Timone, Pôle d'imagerie médicale, CEMEREM, Marseille, France
| | - Arnaud Le Troter
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France; AP-HM, Hopital de la Timone, Pôle d'imagerie médicale, CEMEREM, Marseille, France
| | - Sylvie Nadeau
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation, Institut de réadaptation Gingras-Lindsay-de-Montréal- CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada; School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
| | - Nikola Stikov
- NeuroPoly Lab, Polytechnique Montreal, Montreal, QC, Canada; Montreal Heart Institute, Montreal, QC, Canada
| | - Virginie Callot
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France; AP-HM, Hopital de la Timone, Pôle d'imagerie médicale, CEMEREM, Marseille, France
| | - Julien Cohen-Adad
- NeuroPoly Lab, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada.
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Taso M, Girard OM, Duhamel G, Le Troter A, Feiweier T, Guye M, Ranjeva JP, Callot V. Tract-specific and age-related variations of the spinal cord microstructure: a multi-parametric MRI study using diffusion tensor imaging (DTI) and inhomogeneous magnetization transfer (ihMT). NMR IN BIOMEDICINE 2016; 29:817-832. [PMID: 27100385 DOI: 10.1002/nbm.3530] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/17/2016] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
Being able to finely characterize the spinal cord (SC) microstructure and its alterations is a key point when investigating neural damage mechanisms encountered in different central nervous system (CNS) pathologies, such as multiple sclerosis, amyotrophic lateral sclerosis or myelopathy. Based on novel methods, including inhomogeneous magnetization transfer (ihMT) and dedicated SC probabilistic atlas post-processing, the present study focuses on the in vivo characterization of the healthy SC tissue in terms of regional microstructure differences between (i) upper and lower cervical vertebral levels and (ii) sensory and motor tracts, as well as differences attributed to normal aging. Forty-eight healthy volunteers aged from 20 to 70 years old were included in the study and scanned at 3 T using axial high-resolution T2 *-w imaging, diffusion tensor imaging (DTI) and ihMT, at two vertebral levels (C2 and C5). A processing pipeline with minimal user intervention, SC segmentation and spatial normalization into a reference space was implemented in order to assess quantitative morphological and structural parameters (cross-sectional areas, scalar DTI and MT/ihMT metrics) in specific white and gray matter regions of interest. The multi-parametric MRI metrics collected allowed upper and lower cervical levels to be distinguished, with higher ihMT ratio (ihMTR), higher axial diffusivity (λ∥ ) and lower radial diffusivity (λ⊥ ) at C2 compared with C5. Significant differences were also observed between white matter fascicles, with higher ihMTR and lower λ∥ in motor tracts compared with posterior sensory tracts. Finally, aging was found to be associated with significant metric alterations (decreased ihMTR and λ∥ ). The methodology proposed here, which can be easily transferred to the clinic, provides new insights for SC characterization. It bears great potential to study focal and diffuse SC damage in neurodegenerative and demyelinating diseases. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Manuel Taso
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
- Aix-Marseille Université, IFSTTAR, Laboratoire de Biomécanique Appliquée (LBA), UMR T 24, Marseille, France
- Laboratoire International Associé iLab-Spine - Imagerie et Biomécanique du Rachis, Marseille, France/Montréal, Canada
| | - Olivier M Girard
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
| | - Guillaume Duhamel
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
| | - Arnaud Le Troter
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
| | | | - Maxime Guye
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
| | - Jean-Philippe Ranjeva
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
- Laboratoire International Associé iLab-Spine - Imagerie et Biomécanique du Rachis, Marseille, France/Montréal, Canada
| | - Virginie Callot
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Marseille, France
- AP-HM, Hôpital de la Timone, Pôle d'imagerie médicale, Centre d'Exploration Métabolique par Résonance Magnétique (CEMEREM), Marseille, France
- Laboratoire International Associé iLab-Spine - Imagerie et Biomécanique du Rachis, Marseille, France/Montréal, Canada
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El Mendili MM, Lenglet T, Stojkovic T, Behin A, Guimarães-Costa R, Salachas F, Meininger V, Bruneteau G, Le Forestier N, Laforêt P, Lehéricy S, Benali H, Pradat PF. Cervical Spinal Cord Atrophy Profile in Adult SMN1-Linked SMA. PLoS One 2016; 11:e0152439. [PMID: 27089520 PMCID: PMC4835076 DOI: 10.1371/journal.pone.0152439] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/14/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The mechanisms underlying the topography of motor deficits in spinal muscular atrophy (SMA) remain unknown. We investigated the profile of spinal cord atrophy (SCA) in SMN1-linked SMA, and its correlation with the topography of muscle weakness. MATERIALS AND METHODS Eighteen SMN1-linked SMA patients type III/V and 18 age/gender-matched healthy volunteers were included. Patients were scored on manual muscle testing and functional scales. Spinal cord was imaged using 3T MRI system. Radial distance (RD) and cord cross-sectional area (CSA) measurements in SMA patients were compared to those in controls and correlated with strength and disability scores. RESULTS CSA measurements revealed a significant cord atrophy gradient mainly located between C3 and C6 vertebral levels with a SCA rate ranging from 5.4% to 23% in SMA patients compared to controls. RD was significantly lower in SMA patients compared to controls in the anterior-posterior direction with a maximum along C4 and C5 vertebral levels (p-values < 10-5). There were no correlations between atrophy measurements, strength and disability scores. CONCLUSIONS Spinal cord atrophy in adult SMN1-linked SMA predominates in the segments innervating the proximal muscles. Additional factors such as neuromuscular junction or intrinsic skeletal muscle defects may play a role in more complex mechanisms underlying weakness in these patients.
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Affiliation(s)
- Mohamed-Mounir El Mendili
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, France
| | - Timothée Lenglet
- APHP, Hôpital Pitié-Salpêtriere, Département des Maladies du Système Nerveux, Centre référent SLA, Paris, France
- APHP, Hôpital Pitié-Salpêtriere, Service d’Explorations Fonctionnelles, Paris, France
| | - Tanya Stojkovic
- APHP, Centre de Référence Maladies Neuromusculaires Paris-Est, Institut de Myologie, Paris, France
| | - Anthony Behin
- APHP, Centre de Référence Maladies Neuromusculaires Paris-Est, Institut de Myologie, Paris, France
| | - Raquel Guimarães-Costa
- APHP, Centre de Référence Maladies Neuromusculaires Paris-Est, Institut de Myologie, Paris, France
| | - François Salachas
- APHP, Hôpital Pitié-Salpêtriere, Département des Maladies du Système Nerveux, Centre référent SLA, Paris, France
| | - Vincent Meininger
- APHP, Hôpital Pitié-Salpêtriere, Département des Maladies du Système Nerveux, Centre référent SLA, Paris, France
| | - Gaelle Bruneteau
- APHP, Hôpital Pitié-Salpêtriere, Département des Maladies du Système Nerveux, Centre référent SLA, Paris, France
| | - Nadine Le Forestier
- APHP, Hôpital Pitié-Salpêtriere, Département des Maladies du Système Nerveux, Centre référent SLA, Paris, France
| | - Pascal Laforêt
- APHP, Centre de Référence Maladies Neuromusculaires Paris-Est, Institut de Myologie, Paris, France
| | - Stéphane Lehéricy
- APHP, Hôpital Pitié-Salpêtriere, Service de Neuroradiologie, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S975, Inserm U975, CNRS UMR7225, Centre de recherche de l’Institut du Cerveau et de la Moelle épinière–CRICM, Centre de Neuroimagerie de Recherche–CENIR, Paris, France
| | - Habib Benali
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, France
| | - Pierre-François Pradat
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, France
- APHP, Hôpital Pitié-Salpêtriere, Département des Maladies du Système Nerveux, Centre référent SLA, Paris, France
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Girard OM, Callot V, Prevost VH, Robert B, Taso M, Ribeiro G, Varma G, Rangwala N, Alsop DC, Duhamel G. Magnetization transfer from inhomogeneously broadened lines (ihMT): Improved imaging strategy for spinal cord applications. Magn Reson Med 2016; 77:581-591. [PMID: 26959278 DOI: 10.1002/mrm.26134] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/08/2015] [Accepted: 01/03/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE Inhomogeneous magnetization transfer (ihMT) shows great promise for specific imaging of myelinated tissues. Whereas the ihMT technique has been previously applied in brain applications, the current report presents a strategy for cervical spinal cord (SC) imaging free of cerebrospinal fluid (CSF) pulsatility artifacts. METHODS A pulsed ihMT preparation was combined with a single-shot HASTE readout. Electrocardiogram (ECG) synchronization was used to acquire all images during the quiescent phase of SC motion. However ihMT signal quantification errors may occur when a variable recovery delay is introduced in the sequence as a consequence of variable cardiac cycle. A semiautomatic retrospective correction algorithm, based on repetition time (TR) -matching, is proposed to correct for signal variations of long T1 -components (e.g., CSF). RESULTS The proposed strategy combining ECG synchronization and retrospective data pairing led to clean SC images free of CSF artifacts. Lower variability of the ihMT metrics were obtained with the correction algorithm, and allowed for shorter TR to be used, hence improving signal-to-noise ratio efficiency. CONCLUSION The proposed methodology enabled faster acquisitions, while offering robust ihMT quantification and exquisite SC image quality. This opens great perspectives for widening the in vivo characterization of SC physiopathology using MRI, such as studying white matter tracts microstructure or impairment in degenerative pathologies. Magn Reson Med 77:581-591, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Olivier M Girard
- Aix-Marseille Université, CRMBM, UMR 7339 CNRS - AMU, Marseille, France.,Pôle d'Imagerie Médicale, CEMEREM, AP-HM, Marseille, France
| | - Virginie Callot
- Aix-Marseille Université, CRMBM, UMR 7339 CNRS - AMU, Marseille, France.,Pôle d'Imagerie Médicale, CEMEREM, AP-HM, Marseille, France
| | - Valentin H Prevost
- Aix-Marseille Université, CRMBM, UMR 7339 CNRS - AMU, Marseille, France.,Pôle d'Imagerie Médicale, CEMEREM, AP-HM, Marseille, France
| | | | - Manuel Taso
- Aix-Marseille Université, CRMBM, UMR 7339 CNRS - AMU, Marseille, France.,Pôle d'Imagerie Médicale, CEMEREM, AP-HM, Marseille, France.,Aix-Marseille Université, IFSTTAR, LBA UMR T24, Marseille, France
| | - Guilherme Ribeiro
- Aix-Marseille Université, CRMBM, UMR 7339 CNRS - AMU, Marseille, France.,Pôle d'Imagerie Médicale, CEMEREM, AP-HM, Marseille, France
| | - Gopal Varma
- Department of Radiology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, USA
| | - Novena Rangwala
- Department of Radiology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, USA
| | - David C Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, USA
| | - Guillaume Duhamel
- Aix-Marseille Université, CRMBM, UMR 7339 CNRS - AMU, Marseille, France.,Pôle d'Imagerie Médicale, CEMEREM, AP-HM, Marseille, France
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De Leener B, Taso M, Cohen-Adad J, Callot V. Segmentation of the human spinal cord. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 29:125-53. [PMID: 26724926 DOI: 10.1007/s10334-015-0507-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 12/14/2022]
Abstract
Segmenting the spinal cord contour is a necessary step for quantifying spinal cord atrophy in various diseases. Delineating gray matter (GM) and white matter (WM) is also useful for quantifying GM atrophy or for extracting multiparametric MRI metrics into specific WM tracts. Spinal cord segmentation in clinical research is not as developed as brain segmentation, however with the substantial improvement of MR sequences adapted to spinal cord MR investigations, the field of spinal cord MR segmentation has advanced greatly within the last decade. Segmentation techniques with variable accuracy and degree of complexity have been developed and reported in the literature. In this paper, we review some of the existing methods for cord and WM/GM segmentation, including intensity-based, surface-based, and image-based methods. We also provide recommendations for validating spinal cord segmentation techniques, as it is important to understand the intrinsic characteristics of the methods and to evaluate their performance and limitations. Lastly, we illustrate some applications in the healthy and pathological spinal cord. One conclusion of this review is that robust and automatic segmentation is clinically relevant, as it would allow for longitudinal and group studies free from user bias as well as reproducible multicentric studies in large populations, thereby helping to further our understanding of the spinal cord pathophysiology and to develop new criteria for early detection of subclinical evolution for prognosis prediction and for patient management. Another conclusion is that at the present time, no single method adequately segments the cord and its substructure in all the cases encountered (abnormal intensities, loss of contrast, deformation of the cord, etc.). A combination of different approaches is thus advised for future developments, along with the introduction of probabilistic shape models. Maturation of standardized frameworks, multiplatform availability, inclusion in large suite and data sharing would also ultimately benefit to the community.
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Affiliation(s)
- Benjamin De Leener
- Neuroimaging Research Laboratory (NeuroPoly), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
| | - Manuel Taso
- Aix Marseille Université, IFSTTAR, LBA UMR_T 24, Marseille, France.,Aix Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France.,APHM, Hôpital de la Timone, Pôle d'imagerie médicale, CEMEREM, Marseille, France
| | - Julien Cohen-Adad
- Neuroimaging Research Laboratory (NeuroPoly), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
| | - Virginie Callot
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France. .,APHM, Hôpital de la Timone, Pôle d'imagerie médicale, CEMEREM, Marseille, France.
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27
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Dunås T, Wåhlin A, Ambarki K, Zarrinkoob L, Birgander R, Malm J, Eklund A. Automatic labeling of cerebral arteries in magnetic resonance angiography. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2015; 29:39-47. [PMID: 26646523 DOI: 10.1007/s10334-015-0512-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/04/2015] [Accepted: 11/10/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVES In order to introduce 4D flow magnetic resonance imaging (MRI) as a standard clinical instrument for studying the cerebrovascular system, new and faster postprocessing tools are necessary. The objective of this study was to construct and evaluate a method for automatic identification of individual cerebral arteries in a 4D flow MRI angiogram. MATERIALS AND METHODS Forty-six elderly individuals were investigated with 4D flow MRI. Fourteen main cerebral arteries were manually labeled and used to create a probabilistic atlas. An automatic atlas-based artery identification method (AAIM) was developed based on vascular-branch extraction and the atlas was used for identification. The method was evaluated by comparing automatic with manual identification in 4D flow MRI angiograms from 67 additional elderly individuals. RESULTS Overall accuracy was 93%, and internal carotid artery and middle cerebral artery labeling was 100% accurate. Smaller and more distal arteries had lower accuracy; for posterior communicating arteries and vertebral arteries, accuracy was 70 and 89%, respectively. CONCLUSION The AAIM enabled fast and fully automatic labeling of the main cerebral arteries. AAIM functionality provides the basis for creating an automatic and powerful method to analyze arterial cerebral blood flow in clinical routine.
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Affiliation(s)
- Tora Dunås
- Department of Radiation Sciences, Umeå University, S-901 87, Umeå, Sweden.
| | - Anders Wåhlin
- Department of Radiation Sciences, Umeå University, S-901 87, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, S-901 87, Umeå, Sweden
| | - Khalid Ambarki
- Department of Radiation Sciences, Umeå University, S-901 87, Umeå, Sweden
- Centre for Biomedical Engineering and Physics, Umeå University, S-901 87, Umeå, Sweden
| | - Laleh Zarrinkoob
- Department of Clinical Neuroscience, Umeå University, S-901 87, Umeå, Sweden
| | - Richard Birgander
- Department of Radiation Sciences, Umeå University, S-901 87, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Neuroscience, Umeå University, S-901 87, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, S-901 87, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, S-901 87, Umeå, Sweden
- Centre for Biomedical Engineering and Physics, Umeå University, S-901 87, Umeå, Sweden
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28
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Henao J, Aubin CÉ, Labelle H, Arnoux PJ. Patient-specific finite element model of the spine and spinal cord to assess the neurological impact of scoliosis correction: preliminary application on two cases with and without intraoperative neurological complications. Comput Methods Biomech Biomed Engin 2015; 19:901-10. [DOI: 10.1080/10255842.2015.1075010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Taso M, Fradet L, Callot V, Arnoux PJ. Anteroposterior compression of the spinal cord leading to cervical myelopathy: a finite element analysis. Comput Methods Biomech Biomed Engin 2015; 18 Suppl 1:2070-1. [DOI: 10.1080/10255842.2015.1069625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M. Taso
- Aix-Marseille Université, IFSTTAR, LBA UMR T 24, Marseille, France
- CRMBM-CEMEREM, UMR 7339 Aix-Marseille Université, CNRS, Marseille, France
- International Associate Lab in Biomechanics of Spine Injury and Pathologies (BSIP), Marseille, France
| | - L. Fradet
- International Associate Lab in Biomechanics of Spine Injury and Pathologies (BSIP), Marseille, France
- Department of Mechanical Engineering, Ecole Polytechnique de Montréal, Montréal, Canada
| | - V. Callot
- CRMBM-CEMEREM, UMR 7339 Aix-Marseille Université, CNRS, Marseille, France
- International Associate Lab in Biomechanics of Spine Injury and Pathologies (BSIP), Marseille, France
| | - P. J. Arnoux
- Aix-Marseille Université, IFSTTAR, LBA UMR T 24, Marseille, France
- International Associate Lab in Biomechanics of Spine Injury and Pathologies (BSIP), Marseille, France
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Lévy S, Benhamou M, Naaman C, Rainville P, Callot V, Cohen-Adad J. White matter atlas of the human spinal cord with estimation of partial volume effect. Neuroimage 2015; 119:262-71. [PMID: 26099457 DOI: 10.1016/j.neuroimage.2015.06.040] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/24/2015] [Accepted: 06/13/2015] [Indexed: 12/14/2022] Open
Abstract
Template-based analysis has proven to be an efficient, objective and reproducible way of extracting relevant information from multi-parametric MRI data. Using common atlases, it is possible to quantify MRI metrics within specific regions without the need for manual segmentation. This method is therefore free from user-bias and amenable to group studies. While template-based analysis is common procedure for the brain, there is currently no atlas of the white matter (WM) spinal pathways. The goals of this study were: (i) to create an atlas of the white matter tracts compatible with the MNI-Poly-AMU template and (ii) to propose methods to quantify metrics within the atlas that account for partial volume effect. The WM atlas was generated by: (i) digitalizing an existing WM atlas from a well-known source (Gray's Anatomy), (ii) registering this atlas to the MNI-Poly-AMU template at the corresponding slice (C4 vertebral level), (iii) propagating the atlas throughout all slices of the template (C1 to T6) using regularized diffeomorphic transformations and (iv) computing partial volume values for each voxel and each tract. Several approaches were implemented and validated to quantify metrics within the atlas, including weighted-average and Gaussian mixture models. Proof-of-concept application was done in five subjects for quantifying magnetization transfer ratio (MTR) in each tract of the atlas. The resulting WM atlas showed consistent topological organization and smooth transitions along the rostro-caudal axis. The median MTR across tracts was 26.2. Significant differences were detected across tracts, vertebral levels and subjects, but not across laterality (right-left). Among the different tested approaches to extract metrics, the maximum a posteriori showed highest performance with respect to noise, inter-tract variability, tract size and partial volume effect. This new WM atlas of the human spinal cord overcomes the biases associated with manual delineation and partial volume effect. Combined with multi-parametric data, the atlas can be applied to study demyelination and degeneration in diseases such as multiple sclerosis and will facilitate the conduction of longitudinal and multi-center studies.
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Affiliation(s)
- S Lévy
- Neuroimaging Research Laboratory (NeuroPoly), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
| | - M Benhamou
- Neuroimaging Research Laboratory (NeuroPoly), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - C Naaman
- Neuroimaging Research Laboratory (NeuroPoly), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - P Rainville
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada; Department of Stomatology, Université de Montréal, Montreal, QC, Canada
| | - V Callot
- Aix-Marseille Université (AMU), CNRS, CRMBM UMR 7339, 13385 Marseille, France; APHM, Hôpital de la Timone, CEMEREM, 13005 Marseille, France
| | - J Cohen-Adad
- Neuroimaging Research Laboratory (NeuroPoly), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada.
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A reliable spatially normalized template of the human spinal cord--Applications to automated white matter/gray matter segmentation and tensor-based morphometry (TBM) mapping of gray matter alterations occurring with age. Neuroimage 2015; 117:20-8. [PMID: 26003856 DOI: 10.1016/j.neuroimage.2015.05.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/06/2015] [Accepted: 05/13/2015] [Indexed: 12/14/2022] Open
Abstract
Recently, a T2*-weighted template and probabilistic atlas of the white and gray matter (WM, GM) of the spinal cord (SC) have been reported. Such template can be used as tissue-priors for automated WM/GM segmentation but can also provide a common reference and normalized space for group studies. Here, a new template has been created (AMU40), and accuracy of automatic template-based WM/GM segmentation was quantified. The feasibility of tensor-based morphometry (TBM) for studying voxel-wise morphological differences of SC between young and elderly healthy volunteers was also investigated. Sixty-five healthy subjects were divided into young (n=40, age<40years old, mean age 28±5years old) and elderly (n=25, age>50years old, mean age 57±5years old) groups and scanned at 3T using an axial high-resolution T2*-weighted sequence. Inhomogeneity correction and affine intensity normalization of the SC and cerebrospinal fluid (CSF) signal intensities across slices were performed prior to both construction of the AMU40 template and WM/GM template-based segmentation. The segmentation was achieved using non-linear spatial normalization of T2*-w MR images to the AMU40 template. Validation of WM/GM segmentations was performed with a leave-one-out procedure by calculating DICE similarity coefficients between manual and automated WM/GM masks. SC morphological differences between young and elderly healthy volunteers were assessed using the same non-linear spatial normalization of the subjects' MRI to a common template, derivation of the Jacobian determinant maps from the warping fields, and a TBM analysis. Results demonstrated robust WM/GM automated segmentation, with mean DICE values greater than 0.8. Concerning the TBM analysis, an anterior GM atrophy was highlighted in elderly volunteers, demonstrating thereby, for the first time, the feasibility of studying local structural alterations in the SC using tensor-based morphometry. This holds great promise for studies of morphological impairment occurring in several central nervous system pathologies.
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El Mendili MM, Chen R, Tiret B, Villard N, Trunet S, Pélégrini-Issac M, Lehéricy S, Pradat PF, Benali H. Fast and accurate semi-automated segmentation method of spinal cord MR images at 3T applied to the construction of a cervical spinal cord template. PLoS One 2015; 10:e0122224. [PMID: 25816143 PMCID: PMC4376938 DOI: 10.1371/journal.pone.0122224] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 02/19/2015] [Indexed: 12/11/2022] Open
Abstract
Objective To design a fast and accurate semi-automated segmentation method for spinal cord 3T MR images and to construct a template of the cervical spinal cord. Materials and Methods A semi-automated double threshold-based method (DTbM) was proposed enabling both cross-sectional and volumetric measures from 3D T2-weighted turbo spin echo MR scans of the spinal cord at 3T. Eighty-two healthy subjects, 10 patients with amyotrophic lateral sclerosis, 10 with spinal muscular atrophy and 10 with spinal cord injuries were studied. DTbM was compared with active surface method (ASM), threshold-based method (TbM) and manual outlining (ground truth). Accuracy of segmentations was scored visually by a radiologist in cervical and thoracic cord regions. Accuracy was also quantified at the cervical and thoracic levels as well as at C2 vertebral level. To construct a cervical template from healthy subjects’ images (n=59), a standardization pipeline was designed leading to well-centered straight spinal cord images and accurate probability tissue map. Results Visual scoring showed better performance for DTbM than for ASM. Mean Dice similarity coefficient (DSC) was 95.71% for DTbM and 90.78% for ASM at the cervical level and 94.27% for DTbM and 89.93% for ASM at the thoracic level. Finally, at C2 vertebral level, mean DSC was 97.98% for DTbM compared with 98.02% for TbM and 96.76% for ASM. DTbM showed similar accuracy compared with TbM, but with the advantage of limited manual interaction. Conclusion A semi-automated segmentation method with limited manual intervention was introduced and validated on 3T images, enabling the construction of a cervical spinal cord template.
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Affiliation(s)
- Mohamed-Mounir El Mendili
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
- * E-mail:
| | - Raphaël Chen
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Brice Tiret
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Noémie Villard
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Stéphanie Trunet
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neuroradiologie, F-75013, Paris, Île de France, France
| | - Mélanie Pélégrini-Issac
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Stéphane Lehéricy
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neuroradiologie, F-75013, Paris, Île de France, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S975, Inserm U975, CNRS UMR7225, Centre de recherche de l’Institut du Cerveau et de la Moelle épinière—CRICM, Centre de Neuroimagerie de Recherche—CENIR, F-75013, Paris, Île de France, France
| | - Pierre-François Pradat
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Département des Maladies du Système Nerveux, F-75013, Paris, Île de France, France
| | - Habib Benali
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
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Age, gender and normalization covariates for spinal cord gray matter and total cross-sectional areas at cervical and thoracic levels: A 2D phase sensitive inversion recovery imaging study. PLoS One 2015; 10:e0118576. [PMID: 25781178 PMCID: PMC4363673 DOI: 10.1371/journal.pone.0118576] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/13/2015] [Indexed: 11/24/2022] Open
Abstract
The source of inter-subject variability and the influence of age and gender on morphometric characteristics of the spinal cord, such as the total cross-sectional area (TCA), the gray matter (GM) and white matter (WM) areas, currently remain under investigation. Understanding the effect of covariates such as age, gender, brain volumes, and skull- and vertebra-derived metrics on cervical and thoracic spinal cord TCA and GM areas in healthy subjects would be fundamental for exploring compartment specific changes in neurological diseases affecting the spinal cord. Using Magnetic Resonance Imaging at 3T we investigated 32 healthy subjects using a 2D phase sensitive inversion recovery sequence and we measured TCA, GM and WM areas at 4 cervical and thoracic levels of the spinal cord. We assessed age and gender relationships of cord measures and explored associations between cord measures and a) brain volumes and b) skull- and vertebra-derived metrics. Age and gender had a significant effect on TCA, WM and GM areas (with women and elderly having smaller values than men and younger people respectively), but not on the GM area/TCA ratio. The total intracranial volume and C3 vertebra dimensions showed the highest correlations with cord measures. When used in multi-regression models, they reduced cord areas group variability by approximately a third. Age and gender influences on cord measures and normalization strategies here presented might be of use in the study of compartment specific changes in various neurological diseases affecting the spinal cord.
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Farooq H, Genis H, Alarcon J, Vuong B, Jivraj J, Yang VXD, Cohen-Adad J, Fehlings MG, Cadotte DW. High-resolution imaging of the central nervous system: how novel imaging methods combined with navigation strategies will advance patient care. PROGRESS IN BRAIN RESEARCH 2015; 218:55-78. [PMID: 25890132 DOI: 10.1016/bs.pbr.2014.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This narrative review captures a subset of recent advances in imaging of the central nervous system. First, we focus on improvements in the spatial and temporal profile afforded by optical coherence tomography, fluorescence-guided surgery, and Coherent Anti-Stokes Raman Scattering Microscopy. Next, we highlight advances in the generation and uses of imaging-based atlases and discuss how this will be applied to specific clinical situations. To conclude, we discuss how these and other imaging tools will be combined with neuronavigation techniques to guide surgeons in the operating room. Collectively, this work aims to highlight emerging biomedical imaging strategies that hold potential to be a valuable tool for both clinicians and researchers in the years to come.
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Affiliation(s)
- Hamza Farooq
- Biophotonics and Bioengineering Laboratory, Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON, Canada
| | - Helen Genis
- Biophotonics and Bioengineering Laboratory, Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON, Canada
| | - Joseph Alarcon
- Biophotonics and Bioengineering Laboratory, Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON, Canada
| | - Barry Vuong
- Biophotonics and Bioengineering Laboratory, Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON, Canada
| | - Jamil Jivraj
- Biophotonics and Bioengineering Laboratory, Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON, Canada
| | - Victor X D Yang
- Biophotonics and Bioengineering Laboratory, Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON, Canada; Physical Science-Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Julien Cohen-Adad
- Institute of Biomedical Engineering, Ecole Polytechnique de Montréal, SensoriMotor Rehabilitation Research Team of the Canadian Institute of Health Research, Montreal, QC, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - David W Cadotte
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
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Ruiz-Espana S, Domingo J, Diaz-Parra A, Dura E, D'Ocon-Alcaniz V, Arana E, Moratal D. Automatic segmentation of the spine by means of a probabilistic atlas with a special focus on ribs suppression. Preliminary results. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:2014-2017. [PMID: 26736681 DOI: 10.1109/embc.2015.7318781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Spine is a structure commonly involved in several prevalent diseases. In clinical diagnosis, therapy, and surgical intervention, the identification and segmentation of the vertebral bodies are crucial steps. However, automatic and detailed segmentation of vertebrae is a challenging task, especially due to the proximity of the vertebrae to the corresponding ribs and other structures such as blood vessels. In this study, to overcome these problems, a probabilistic atlas of the spine, including cervical, thoracic and lumbar vertebrae has been built to introduce anatomical knowledge in the segmentation process, aiming to deal with overlapping gray levels and the proximity to other structures. From a set of 3D images manually segmented by a physician (training data), a 3D volume indicating the probability of each voxel of belonging to the spine has been developed, being necessary the generation of a probability map and its deformation to adapt to each patient. To validate the improvement of the segmentation using the atlas developed in the testing data, we computed the Hausdorff distance between the manually-segmented ground truth and an automatic segmentation and also between the ground truth and the automatic segmentation refined with the atlas. The results are promising, obtaining a higher improvement especially in the thoracic region, where the ribs can be found and appropriately eliminated.
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Papinutto N, Schlaeger R, Panara V, Caverzasi E, Ahn S, Johnson KJ, Zhu AH, Stern WA, Laub G, Hauser SL, Henry RG. 2D phase-sensitive inversion recovery imaging to measure in vivo spinal cord gray and white matter areas in clinically feasible acquisition times. J Magn Reson Imaging 2014; 42:698-708. [PMID: 25483607 DOI: 10.1002/jmri.24819] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/17/2014] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To present and assess a procedure for measurement of spinal cord total cross-sectional areas (TCA) and gray matter (GM) areas based on phase-sensitive inversion recovery imaging (PSIR). In vivo assessment of spinal cord GM and white matter (WM) could become pivotal to study various neurological diseases, but it is challenging because of insufficient GM/WM contrast provided by conventional magnetic resonance imaging (MRI). MATERIALS AND METHODS We acquired 2D PSIR images at 3T at each disc level of the spinal axis in 10 healthy subjects and measured TCA, cord diameters, WM and GM areas, and GM area/TCA ratios. Second, we investigated 32 healthy subjects at four selected levels (C2-C3, C3-C4, T8-T9, T9-T10, total acquisition time <8 min) and generated normative reference values of TCA and GM areas. We assessed test-retest, intra- and interoperator reliability of the acquisition strategy, and measurement steps. RESULTS The measurement procedure based on 2D PSIR imaging allowed TCA and GM area assessments along the entire spinal cord axis. The tests we performed revealed high test-retest/intraoperator reliability (mean coefficient of variation [COV] at C2-C3: TCA = 0.41%, GM area = 2.75%) and interoperator reliability of the measurements (mean COV on the 4 levels: TCA = 0.44%, GM area = 4.20%; mean intraclass correlation coefficient: TCA = 0.998, GM area = 0.906). CONCLUSION 2D PSIR allows reliable in vivo assessment of spinal cord TCA, GM, and WM areas in clinically feasible acquisition times. The area measurements presented here are in agreement with previous MRI and postmortem studies.
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Affiliation(s)
- Nico Papinutto
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Regina Schlaeger
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.,Department of Neurology, University of Basel, Basel, Switzerland
| | - Valentina Panara
- ITAB - Institute of Advanced Biomedical Technologies, University "G. D'Annunzio,", Chieti, Italy
| | - Eduardo Caverzasi
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Sinyeob Ahn
- Siemens Healthcare USA, San Francisco, California, USA
| | | | - Alyssa H Zhu
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - William A Stern
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Gerhard Laub
- Siemens Healthcare USA, San Francisco, California, USA
| | - Stephen L Hauser
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Roland G Henry
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.,Bioengineering Graduate Group, University of California San Francisco, San Francisco and University of California Berkeley, Berkeley, California, USA.,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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Framework for integrated MRI average of the spinal cord white and gray matter: the MNI-Poly-AMU template. Neuroimage 2014; 102 Pt 2:817-27. [PMID: 25204864 DOI: 10.1016/j.neuroimage.2014.08.057] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/04/2014] [Accepted: 08/30/2014] [Indexed: 12/14/2022] Open
Abstract
The field of spinal cord MRI is lacking a common template, as existing for the brain, which would allow extraction of multi-parametric data (diffusion-weighted, magnetization transfer, etc.) without user bias, thereby facilitating group analysis and multi-center studies. This paper describes a framework to produce an unbiased average anatomical template of the human spinal cord. The template was created by co-registering T2-weighted images (N = 16 healthy volunteers) using a series of pre-processing steps followed by non-linear registration. A white and gray matter probabilistic template was then merged to the average anatomical template, yielding the MNI-Poly-AMU template, which currently covers vertebral levels C1 to T6. New subjects can be registered to the template using a dedicated image processing pipeline. Validation was conducted on 16 additional subjects by comparing an automatic template-based segmentation and manual segmentation, yielding a median Dice coefficient of 0.89. The registration pipeline is rapid (~15 min), automatic after one C2/C3 landmark manual identification, and robust, thereby reducing subjective variability and bias associated with manual segmentation. The template can notably be used for measurements of spinal cord cross-sectional area, voxel-based morphometry, identification of anatomical features (e.g., vertebral levels, white and gray matter location) and unbiased extraction of multi-parametric data.
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Schlaeger R, Papinutto N, Panara V, Bevan C, Lobach IV, Bucci M, Caverzasi E, Gelfand JM, Green AJ, Jordan KM, Stern WA, von Büdingen HC, Waubant E, Zhu AH, Goodin DS, Cree BAC, Hauser SL, Henry RG. Spinal cord gray matter atrophy correlates with multiple sclerosis disability. Ann Neurol 2014; 76:568-80. [PMID: 25087920 DOI: 10.1002/ana.24241] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE In multiple sclerosis (MS), cerebral gray matter (GM) atrophy correlates more strongly than white matter (WM) atrophy with disability. The corresponding relationships in the spinal cord (SC) are unknown due to technical limitations in assessing SC GM atrophy. Using phase-sensitive inversion recovery (PSIR) magnetic resonance imaging, we determined the association of the SC GM and SC WM areas with MS disability and disease type. METHODS A total of 113 MS patients and 20 healthy controls were examined at 3T with a PSIR sequence acquired at the C2/C3 disk level. Two independent, clinically masked readers measured the cord WM and GM areas. Correlations between cord areas and Expanded Disability Status Score (EDSS) were determined. Differences in areas between groups were assessed with age and sex as covariates. RESULTS Relapsing MS (RMS) patients showed smaller SC GM areas than age- and sex-matched controls (p = 0.008) without significant differences in SC WM areas. Progressive MS patients showed smaller SC GM and SC WM areas compared to RMS patients (all p ≤ 0.004). SC GM, SC WM, and whole cord areas inversely correlated with EDSS (rho: -0.60, -0.32, -0.42, respectively; all p ≤ 0.001). The SC GM area was the strongest correlate of disability in multivariate models including brain GM and WM volumes, fluid-attenuated inversion recovery lesion load, T1 lesion load, SC WM area, number of SC T2 lesions, age, sex, and disease duration. Brain and spinal GM independently contributed to EDSS. INTERPRETATION SC GM atrophy is detectable in vivo in the absence of WM atrophy in RMS. It is more pronounced in progressive MS than RMS and contributes more to patient disability than SC WM or brain GM atrophy.
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Affiliation(s)
- Regina Schlaeger
- Department of Neurology, University of California, San Francisco, San Francisco, CA; Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
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Neuroimaging to investigate multisystem involvement and provide biomarkers in amyotrophic lateral sclerosis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:467560. [PMID: 24949452 PMCID: PMC4052676 DOI: 10.1155/2014/467560] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/25/2014] [Indexed: 12/11/2022]
Abstract
Neuroimaging allows investigating the extent of neurological systems degeneration in amyotrophic lateral sclerosis (ALS). Advanced MRI methods can detect changes related to the degeneration of upper motor neurons but have also demonstrated the participation of other systems such as the sensory system or basal ganglia, demonstrating in vivo that ALS is a multisystem disorder. Structural and functional imaging also allows studying dysfunction of brain areas associated with cognitive signs. From a biomarker perspective, numerous studies using diffusion tensor imaging showed a decrease of fractional anisotropy in the intracranial portion of the corticospinal tract but its diagnostic value at the individual level remains limited. A multiparametric approach will be required to use MRI in the diagnostic workup of ALS. A promising avenue is the new methodological developments of spinal cord imaging that has the advantage to investigate the two motor system components that are involved in ALS, that is, the lower and upper motor neuron. For all neuroimaging modalities, due to the intrinsic heterogeneity of ALS, larger pooled banks of images with standardized image acquisition and analysis procedures are needed. In this paper, we will review the main findings obtained with MRI, PET, SPECT, and nuclear magnetic resonance spectroscopy in ALS.
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