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Lo YL, Hwang R, Teng PPC, Tan YE. Corpus Callosum-Mediated Interhemispheric Interactions in Cervical Spondylotic Myelopathy. J Clin Neurophysiol 2024; 41:473-477. [PMID: 38922289 DOI: 10.1097/wnp.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
PURPOSE The corpus callosum is crucial for interhemispheric interactions in the motor control of limb functions. Human and animal studies suggested spinal cord pathologies may induce cortical reorganization in sensorimotor areas. We investigate participation of the corpus callosum in executions of a simple motor task in patients with cervical spondylotic myelopathy (CSM) using transcranial magnetic stimulation. METHODS Twenty patients with CSM with various MRI grades of severity of cord compression were compared with 19 normal controls. Ipsilateral silent period, contralateral silent period, central motor conduction time, and transcallosal conduction time (TCT) were determined. RESULTS In both upper and lower limbs, TCTs were significantly increased for patients with CSM than normal controls ( p < 0.001 for all), without side-to-side differences. Ipsilateral silent period and contralateral silent period durations were significantly increased bilaterally for upper limbs in comparison to controls ( p < 0.01 for all), without side-to-side differences. There were no significant correlations of TCT with central motor conduction time nor severity of CSM for both upper and lower limbs ( p > 0.05 for all) bilaterally. CONCLUSIONS Previous transcranial magnetic stimulation studies show increased motor cortex excitability in CSM; hence, increased TCTs observed bilaterally may be a compensatory mechanism for effective unidirectional and uniplanar execution of muscle activation in the distal limb muscles. Lack of correlation of TCTs with severity of CSM or central motor conduction time may be in keeping with a preexistent role of the corpus callosum as a predominantly inhibitory pathway for counteracting redundant movements resulting from increased motor cortex excitability occurring after spinal cord lesions.
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Affiliation(s)
- Yew Long Lo
- National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore; and
- Singapore General Hospital, Singapore, Singapore
| | - Ruby Hwang
- Singapore General Hospital, Singapore, Singapore
| | | | - Yam Eng Tan
- Singapore General Hospital, Singapore, Singapore
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Cheng L, Zhang J, Xi H, Li M, Hu S, Yuan W, Wang P, Chen L, Zhan L, Jia X. Abnormalities of brain structure and function in cervical spondylosis: a multi-modal voxel-based meta-analysis. Front Neurosci 2024; 18:1415411. [PMID: 38948928 PMCID: PMC11211609 DOI: 10.3389/fnins.2024.1415411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024] Open
Abstract
Background Previous neuroimaging studies have revealed structural and functional brain abnormalities in patients with cervical spondylosis (CS). However, the results are divergent and inconsistent. Therefore, the present study conducted a multi-modal meta-analysis to investigate the consistent structural and functional brain alterations in CS patients. Methods A comprehensive literature search was conducted in five databases to retrieve relevant resting-state functional magnetic resonance imaging (rs-fMRI), structural MRI and diffusion tensor imaging (DTI) studies that measured brain functional and structural differences between CS patients and healthy controls (HCs). Separate and multimodal meta-analyses were implemented, respectively, by employing Anisotropic Effect-size Signed Differential Mapping software. Results 13 rs-fMRI studies that used regional homogeneity, amplitude of low-frequency fluctuations (ALFF) and fractional ALFF, seven voxel-based morphometry (VBM) studies and one DTI study were finally included in the present research. However, no studies on surface-based morphometry (SBM) analysis were included in this research. Due to the insufficient number of SBM and DTI studies, only rs-fMRI and VBM meta-analyses were conducted. The results of rs-fMRI meta-analysis showed that compared to HCs, CS patients demonstrated decreased regional spontaneous brain activities in the right lingual gyrus, right middle temporal gyrus (MTG), left inferior parietal gyrus and right postcentral gyrus (PoCG), while increased activities in the right medial superior frontal gyrus, bilateral middle frontal gyrus and right precuneus. VBM meta-analysis detected increased GMV in the right superior temporal gyrus (STG) and right paracentral lobule (PCL), while decreased GMV in the left supplementary motor area and left MTG in CS patients. The multi-modal meta-analysis revealed increased GMV together with decreased regional spontaneous brain activity in the left PoCG, right STG and PCL among CS patients. Conclusion This meta-analysis revealed that compared to HCs, CS patients had significant alterations in GMV and regional spontaneous brain activity. The altered brain regions mainly included the primary visual cortex, the default mode network and the sensorimotor area, which may be associated with CS patients' symptoms of sensory deficits, blurred vision, cognitive impairment and motor dysfunction. The findings may contribute to understanding the underlying pathophysiology of brain dysfunction and provide references for early diagnosis and treatment of CS. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, CRD42022370967.
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Affiliation(s)
- Lulu Cheng
- School of Foreign Studies, China University of Petroleum (East China), Qingdao, China
- Shanghai Center for Research in English Language Education, Shanghai International Studies University, Shanghai, China
| | - Jianxin Zhang
- School of Foreign Studies, China University of Petroleum (East China), Qingdao, China
| | - Hongyu Xi
- School of Western Studies, Heilongjiang University, Harbin, China
| | - Mengting Li
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Su Hu
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Wenting Yuan
- School of Western Studies, Heilongjiang University, Harbin, China
- English Department, Heilongjiang International University, Harbin, China
| | - Peng Wang
- Department of Language, Literature and Communication, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Psychology, Education, and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Lanfen Chen
- School of Medical Imaging, Shandong Second Medical University, Weifang, Shandong, China
| | - Linlin Zhan
- School of Western Studies, Heilongjiang University, Harbin, China
| | - Xize Jia
- School of Psychology, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
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Kuang C, Zha Y. Neurodegeneration within the rostral spinal cord is associated with brain gray matter volume atrophy in the early stage of cervical spondylotic myelopathy. Spinal Cord 2024; 62:214-220. [PMID: 38454066 DOI: 10.1038/s41393-024-00971-0] [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: 09/29/2022] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
STUDY DESIGN Case-control study. OBJECTIVES Investigating the association between neurodegeneration within rostral spinal cord and brain gray matter volume (GMV) and assessing the relationship between remote neurodegenerative changes and clinical outcomes at the early phase of Cervical Spondylotic Myelopathy (CSM). SETTING University/hospital. METHODS Using Spinal Cord Toolbox, spinal cord morphometrics (cross-sectional area [CSA], gray matter area [GMA], white matter area [WMA]) of 40 patients with CSM and 28 healthy controls (HCs) were computed and compared using two-sample t test. Brain GMV of the two groups was analyzed using voxel-based morphometry approach. Pearson's correlation between spinal cord morphometrics and altered brain GMV and Spearman's relationship between remote neurodegenerations and clinical outcomes were conducted in CSM group. RESULTS Compared to HCs, CSA and WMA at C2/3 and GMV in right postcentral gyrus (PoCG.R) and left supplementary motor area (SMA.L) were significantly decreased in patients with CSM. CSA and WMA at C2/3 were associated with GMV in SMA.L and MCG.R in patients with CSM. CSA at C2/3 and GMV in PoCG.R were related to modified Japanese Orthopedic Association score in patients with CSM. CONCLUSIONS The associations between CSA and WMA at C2/3 and GMV in SMA.L and MCG.R suggest a concordant change pattern and adaptive mechanisms for neuronal plasticity underlying remote neurodegeneration in early CSM. The atrophy of CSA at C2/3 and GMV loss in PoCG.R can serve as potential neuroimaging biomarkers of early structural changes within spinal cord and brain preceding marked clinical disabilities in patients with CSM.
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Affiliation(s)
- Cuili Kuang
- Department of Radiological, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yunfei Zha
- Department of Radiological, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
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Jiang Z, Davies B, Zipser C, Margetis K, Martin A, Matsoukas S, Zipser-Mohammadzada F, Kheram N, Boraschi A, Zakin E, Obadaseraye OR, Fehlings MG, Wilson J, Yurac R, Cook CE, Milligan J, Tabrah J, Widdop S, Wood L, Roberts EA, Rujeedawa T, Tetreault L. The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review. Global Spine J 2024; 14:1395-1421. [PMID: 37917661 PMCID: PMC11289544 DOI: 10.1177/21925682231210468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
STUDY DESIGN Delayed diagnosis of degenerative cervical myelopathy (DCM) is associated with reduced quality of life and greater disability. Developing diagnostic criteria for DCM has been identified as a top research priority. OBJECTIVES This scoping review aims to address the following questions: What is the diagnostic accuracy and frequency of clinical symptoms in patients with DCM? METHODS A scoping review was conducted using a database of all primary DCM studies published between 2005 and 2020. Studies were included if they (i) assessed the diagnostic accuracy of a symptom using an appropriate control group or (ii) reported the frequency of a symptom in a cohort of DCM patients. RESULTS This review identified three studies that discussed the diagnostic accuracy of various symptoms and included a control group. An additional 58 reported on the frequency of symptoms in a cohort of patients with DCM. The most frequent and sensitive symptoms in DCM include unspecified paresthesias (86%), hand numbness (82%) and hand paresthesias (79%). Neck and/or shoulder pain was present in 51% of patients with DCM, whereas a minority had back (19%) or lower extremity pain (10%). Bladder dysfunction was uncommon (38%) although more frequent than bowel (23%) and sexual impairment (4%). Gait impairment is also commonly seen in patients with DCM (72%). CONCLUSION Patients with DCM present with many different symptoms, most commonly sensorimotor impairment of the upper extremities, pain, bladder dysfunction and gait disturbance. If patients present with a combination of these symptoms, further neuroimaging is indicated to confirm the diagnosis of DCM.
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Affiliation(s)
- Zhilin Jiang
- King’s College Hospital, NHS Foundation Trust, London, UK
| | | | - Carl Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Konstantinos Margetis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allan Martin
- Department of Neurosurgery, University of California Davis, Davis, CA, USA
| | - Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Najmeh Kheram
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Andrea Boraschi
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Elina Zakin
- Department of Neurology, New York UniversityLangone, New York, NY, USA
| | | | - Michael G. Fehlings
- Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, ON, Canada
| | - Jamie Wilson
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Ratko Yurac
- Professor of Orthopedics and Traumatology, University del Desarrollo, Clinica Alemana de Santiago, Santiago, Chile
| | | | - Jamie Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, USA
| | - Julia Tabrah
- Hounslow and Richmond Community Healthcare, London, UK
| | | | - Lianne Wood
- Nottingham University Hospital, Nottingham, UK
| | | | | | - Lindsay Tetreault
- Department of Neurology, New York UniversityLangone, New York, NY, USA
| | - AO Spine RECODE-DCM Diagnostic Criteria Incubator
- King’s College Hospital, NHS Foundation Trust, London, UK
- University of Cambridge, Cambridge, UK
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurosurgery, University of California Davis, Davis, CA, USA
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of Neurology, New York UniversityLangone, New York, NY, USA
- Department of Surgery, Asaba Specialist Hospital, Asaba, Nigeria
- Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, ON, Canada
- University of Nebraska Medical Center, Omaha, NE, USA
- Professor of Orthopedics and Traumatology, University del Desarrollo, Clinica Alemana de Santiago, Santiago, Chile
- Duke University Medical Center, Durham, NC, USA
- Department of Family Medicine, McMaster University, Hamilton, ON, USA
- Hounslow and Richmond Community Healthcare, London, UK
- Myelopathy.org, Cambridge, UK
- Nottingham University Hospital, Nottingham, UK
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Khan AF, Muhammad F, Mohammadi E, O'Neal C, Haynes G, Hameed S, Walker B, Rohan ML, Yabluchanskiy A, Smith ZA. Beyond the aging spine - a systematic review of functional changes in the human brain in cervical spondylotic myelopathy. GeroScience 2024; 46:1421-1450. [PMID: 37801201 PMCID: PMC10828266 DOI: 10.1007/s11357-023-00954-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023] Open
Abstract
Cervical Spondylotic Myelopathy (CSM) is a degenerative condition that leads to loss of cervical spinal cord integrity, typically affecting the aged population. Emerging fMRI-based evidence suggests that the brain is also affected by CSM. This systematic review aimed to understand the usefulness of brain fMRI in CSM. A comprehensive literature search was conducted until March 2023 according to PRISMA guidelines. The inclusion criteria included original research articles in English, primarily studying the human brain's functional changes in CSM using fMRI with at least 5 participants. The extracted data from each study included demographics, disease severity, MRI machine characteristics, affected brain areas, functional changes, and clinical utilities. A total of 30 studies met the inclusion criteria. Among the fMRI methods, resting-state fMRI was the most widely used experimental paradigm, followed by motor tasks. The brain areas associated with motor control were most affected in CSM, followed by the superior frontal gyrus and occipital cortex. Functional changes in the brain were correlated to clinical metrics showing clinical utility. However, the evidence that a specific fMRI metric correlating with a clinical metric was "very low" to "insufficient" due to a low number of studies and negative results. In conclusion, fMRI can potentially facilitate the diagnosis of CSM by quantitatively interrogating the functional changes of the brain, particularly areas of the brain associated with motor control. However, this field is in its early stages, and more studies are needed to establish the usefulness of brain fMRI in CSM.
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Affiliation(s)
- Ali Fahim Khan
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA.
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Christen O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Grace Haynes
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | - Sanaa Hameed
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Brynden Walker
- College of Arts and Sciences, University of Oklahoma, Norman, OK, USA
| | | | - Andriy Yabluchanskiy
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zachary Adam Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
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Wang Y, Zhao R, Zhu D, Fu X, Sun F, Cai Y, Ma J, Guo X, Zhang J, Xue Y. Voxel- and tensor-based morphometry with machine learning techniques identifying characteristic brain impairment in patients with cervical spondylotic myelopathy. Front Neurol 2024; 15:1267349. [PMID: 38419699 PMCID: PMC10899699 DOI: 10.3389/fneur.2024.1267349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Aim The diagnosis of cervical spondylotic myelopathy (CSM) relies on several methods, including x-rays, computed tomography, and magnetic resonance imaging (MRI). Although MRI is the most useful diagnostic tool, strategies to improve the precise and independent diagnosis of CSM using novel MRI imaging techniques are urgently needed. This study aimed to explore potential brain biomarkers to improve the precise diagnosis of CSM through the combination of voxel-based morphometry (VBM) and tensor-based morphometry (TBM) with machine learning techniques. Methods In this retrospective study, 57 patients with CSM and 57 healthy controls (HCs) were enrolled. The structural changes in the gray matter volume and white matter volume were determined by VBM. Gray and white matter deformations were measured by TBM. The support vector machine (SVM) was used for the classification of CSM patients from HCs based on the structural features of VBM and TBM. Results CSM patients exhibited characteristic structural abnormalities in the sensorimotor, visual, cognitive, and subcortical regions, as well as in the anterior corona radiata and the corpus callosum [P < 0.05, false discovery rate (FDR) corrected]. A multivariate pattern classification analysis revealed that VBM and TBM could successfully identify CSM patients and HCs [classification accuracy: 81.58%, area under the curve (AUC): 0.85; P < 0.005, Bonferroni corrected] through characteristic gray matter and white matter impairments. Conclusion CSM may cause widespread and remote impairments in brain structures. This study provided a valuable reference for developing novel diagnostic strategies to identify CSM.
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Affiliation(s)
- Yang Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Dan Zhu
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- Department of Radiology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Xiuwei Fu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Fengyu Sun
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuezeng Cai
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Juanwei Ma
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Xing Guo
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jing Zhang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Xue
- Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
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Akimoto H, Suzuki H, Kan S, Funaba M, Nishida N, Fujimoto K, Ikeda H, Yonezawa T, Ikushima K, Shimizu Y, Matsubara T, Harada K, Nakagawa S, Sakai T. Resting-state functional magnetic resonance imaging indices are related to electrophysiological dysfunction in degenerative cervical myelopathy. Sci Rep 2024; 14:2344. [PMID: 38282042 PMCID: PMC10822854 DOI: 10.1038/s41598-024-53051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/27/2024] [Indexed: 01/30/2024] Open
Abstract
The age-related degenerative pathologies of the cervical spinal column that comprise degenerative cervical myelopathy (DCM) cause myelopathy due spinal cord compression. Functional neurological assessment of DCM can potentially reveal the severity and pathological mechanism of DCM. However, functional assessment by conventional MRI remains difficult. This study used resting-state functional MRI (rs-fMRI) to investigate the relationship between functional connectivity (FC) strength and neurophysiological indices and examined the feasibility of functional assessment by FC for DCM. Preoperatively, 34 patients with DCM underwent rs-fMRI scans. Preoperative central motor conduction time (CMCT) reflecting motor functional disability and intraoperative somatosensory evoked potentials (SEP) reflecting sensory functional disability were recorded as electrophysiological indices of severity of the cervical spinal cord impairment. We performed seed-to-voxel FC analysis and correlation analyses between FC strength and the two electrophysiological indices. We found that FC strength between the primary motor cortex and the precuneus correlated significantly positively with CMCT, and that between the lateral part of the sensorimotor cortex and the lateral occipital cortex also showed a significantly positive correlation with SEP amplitudes. These results suggest that we can evaluate neurological and electrophysiological severity in patients with DCM by analyzing FC strengths between certain brain regions.
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Affiliation(s)
- Hironobu Akimoto
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Shigeyuki Kan
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Hiroshima, 734-8553, Japan
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Kazuhiro Fujimoto
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroaki Ikeda
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Teppei Yonezawa
- Department of Radiological Technology, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Kojiro Ikushima
- Department of Radiological Technology, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yoichiro Shimizu
- Department of Radiological Technology, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Toshio Matsubara
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, 755-8505, Japan
| | - Kenichiro Harada
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, 755-8505, Japan
| | - Shin Nakagawa
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
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8
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Rafati Fard A, Mowforth OD, Yuan M, Myrtle S, Lee KS, Banerjee A, Khan M, Kotter MR, Newcombe VFJ, Stamatakis EA, Davies BM. Brain MRI changes in degenerative cervical myelopathy: a systematic review. EBioMedicine 2024; 99:104915. [PMID: 38113760 PMCID: PMC10772405 DOI: 10.1016/j.ebiom.2023.104915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction globally. Associated neurological symptoms and signs have historically been explained by pathobiology within the cervical spine. However, recent advances in imaging have shed light on numerous brain changes in patients with DCM, and it is hypothesised that these changes contribute to DCM pathogenesis. The aetiology, significance, and distribution of these supraspinal changes is currently unknown. The objective was therefore to synthesise all current evidence on brain changes in DCM. METHODS A systematic review was performed. Cross-sectional and longitudinal studies with magnetic resonance imaging on a cohort of patients with DCM were eligible. PRISMA guidelines were followed. MEDLINE and Embase were searched to 28th August 2023. Duplicate title/abstract screening, data extraction and risk of bias assessments were conducted. A qualitative synthesis of the literature is presented as per the Synthesis Without Meta-Analysis (SWiM) reporting guideline. The review was registered with PROSPERO (ID: CRD42022298538). FINDINGS Of the 2014 studies that were screened, 47 studies were identified that used MRI to investigate brain changes in DCM. In total, 1500 patients with DCM were included in the synthesis, with a mean age of 53 years. Brain alterations on MRI were associated with DCM both before and after surgery, particularly within the sensorimotor network, visual network, default mode network, thalamus and cerebellum. Associations were commonly reported between brain MRI alterations and clinical measures, particularly the Japanese orthopaedic association (JOA) score. Risk of bias of included studies was low to moderate. INTERPRETATION The rapidly expanding literature provides mounting evidence for brain changes in DCM. We have identified key structures and pathways that are altered, although there remains uncertainty regarding the directionality and clinical significance of these changes. Future studies with greater sample sizes, more detailed phenotyping and longer follow-up are now needed. FUNDING ODM is supported by an Academic Clinical Fellowship at the University of Cambridge. BMD is supported by an NIHR Clinical Doctoral Fellowship at the University of Cambridge (NIHR300696). VFJN is supported by an NIHR Rosetrees Trust Advanced Fellowship (NIHR302544). This project was supported by an award from the Rosetrees Foundation with the Storygate Trust (A2844).
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Affiliation(s)
- Amir Rafati Fard
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Oliver D Mowforth
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
| | - Melissa Yuan
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Samuel Myrtle
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Keng Siang Lee
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Arka Banerjee
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Maaz Khan
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Mark R Kotter
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Virginia F J Newcombe
- PACE Section, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Emmanuel A Stamatakis
- PACE Section, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Guo X, Li J, Su Q, Song J, Cheng C, Chu X, Zhao R. Transcriptional correlates of frequency-dependent brain functional activity associated with symptom severity in degenerative cervical myelopathy. Neuroimage 2023; 284:120451. [PMID: 37949259 DOI: 10.1016/j.neuroimage.2023.120451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Neuroimaging techniques provide insights into the brain abnormalities secondary to degenerative cervical myelopathy (DCM) and their association with neurological deficits. However, the neural correlates underlying the discrepancy between symptom severity and the degree of spinal cord compression, as well as the transcriptional correlates of these cortical abnormalities, remain unknown in DCM patients. METHODS In this cross-sectional study, which collected resting-state functional MRI (rs-fMRI) images and the Japanese Orthopedic Association (JOA) score, enrolled 104 participants (54 patients and 50 healthy controls). The frequency-dependent amplitude of low-frequency fluctuation (ALFF) was obtained for all participants. We investigated the ALFF differences between mild-symptom DCM patients and severe-symptom DCM patients while carefully matching the degree of compression between these two groups via both univariate comparison and searchlight classification for three frequency bands (e.g., Slow-4, Slow-5, and Full-band). Additionally, we identified genes associated with symptom severity in DCM patients by linking the spatial patterns of gene expression of Allen Human Brain Atlas and brain functional differences between mild symptom and severe symptom groups. RESULTS (1) We found that the frequency-specific brain activities within the sensorimotor network (SMN), visual network (VN), and default mode network (DMN) were associated with the varying degrees of functional impairment in DCM patients; (2) the frequency-specific brain activity within the SMN correlated with the functional recovery in patients with DCM; (3) a spatial correlation between the brain-wide expression of genes involved in neuronal migration and the brain functional activities associated with symptom severity was identified in DCM patients. CONCLUSION In conclusion, our study bridges gaps between genes, cell classes, biological processes, and brain functional correlates of DCM. While our findings are correlational in nature, they suggest that the neural activities of sensorimotor cortices in DCM are associated with the severity of symptoms and might be associated with neuronal migration within the brain.
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Affiliation(s)
- Xing Guo
- Department of Orthopedic, Cangzhou Central Hospital, Cangzhou, Hebei 061017, China
| | - Jie Li
- Department of Orthopedic, Cangzhou Central Hospital, Cangzhou, Hebei 061017, China; Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Qian Su
- Department of Orthopedic, Cangzhou Central Hospital, Cangzhou, Hebei 061017, China; Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for China, Tianjin 300060, China
| | - Jiajun Song
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Cai Cheng
- Department of Orthopedic, Cangzhou Central Hospital, Cangzhou, Hebei 061017, China.
| | - Xu Chu
- Department of Shoulder and Elbow of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, China.
| | - Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
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10
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Zhao G, Zhan Y, Zha J, Cao Y, Zhou F, He L. Abnormal intrinsic brain functional network dynamics in patients with cervical spondylotic myelopathy. Cogn Neurodyn 2023; 17:1201-1211. [PMID: 37786665 PMCID: PMC10542087 DOI: 10.1007/s11571-022-09807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 11/03/2022] Open
Abstract
The specific topological changes in dynamic functional networks and their role in cervical spondylotic myelopathy (CSM) brain function reorganization remain unclear. This study aimed to investigate the dynamic functional connection (dFC) of patients with CSM, focusing on the temporal characteristics of the functional connection state patterns and the variability of network topological organization. Eighty-eight patients with CSM and 77 healthy controls (HCs) were recruited for resting-state functional magnetic resonance imaging. We applied the sliding time window analysis method and K-means clustering analysis to capture the dFC variability patterns of the two groups. The graph-theoretical approach was used to investigate the variance in the topological organization of whole-brain functional networks. All participants showed four types of dynamic functional connection states. The mean dwell time in state 2 was significantly different between the two groups. Particularly, the mean dwell time in state 2 was significantly longer in the CSM group than in the healthy control group. Among the four states, switching of relative brain networks mainly included the executive control network (ECN), salience network (SN), default mode network (DMN), language network (LN), visual network (VN), auditory network (AN), precuneus network (PN), and sensorimotor network (SMN). Additionally, the topological properties of the dynamic network were variable in patients with CSM. Dynamic functional connection states may offer new insights into intrinsic functional activities in CSM brain networks. The variance of topological organization may suggest instability of the brain networks in patients with CSM.
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Affiliation(s)
- Guoshu Zhao
- Department of Radiology, the First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi 330006 People’s Republic of China
- Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006 People’s Republic of China
| | - Yaru Zhan
- Department of Radiology, the First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi 330006 People’s Republic of China
- Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006 People’s Republic of China
| | - Jing Zha
- The 908th Hospital of Chinese People’s Liberation Army Joint Logistic Support Force, Fuzhou, 330006 People’s Republic of China
| | - Yuan Cao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, 610041 People’s Republic of China
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041 People’s Republic of China
- Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006 People’s Republic of China
| | - Fuqing Zhou
- Department of Radiology, the First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi 330006 People’s Republic of China
- Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006 People’s Republic of China
| | - Laichang He
- Department of Radiology, the First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, Jiangxi 330006 People’s Republic of China
- Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006 People’s Republic of China
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11
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Eto F, Inomata K, Sakashita K, Gamada H, Asada T, Sato K, Miura K, Noguchi H, Takahashi H, Funayama T, Koda M, Yamazaki M. Postoperative Changes in Resting State Functional Connectivity and Clinical Scores in Patients With Cervical Myelopathy. World Neurosurg 2022; 167:e1354-e1359. [PMID: 36100062 DOI: 10.1016/j.wneu.2022.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Resting state functional magnetic resonance imaging (rs-fMRI) is a technique for the analyzing functional connectivity (FC) between anatomically distant brain regions at rest. The purpose of this study was to analyze postoperative FC changes in patients with compression cervical myelopathy, to evaluate their relationship with clinical scores, and to examine the changes in spinal cord function associated with brain networks. METHODS This prospective study comprised 15 patients with cervical myelopathy who underwent planned surgery. Rs-fMRI was performed preoperatively and 6 months postoperatively with the similar protocol. Clinical function was assessed by the Japanese Orthopedic Association (JOA) score, the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and the numerical rating scale (NRS). We performed a seed-based analysis, and identified the networks that changed significantly following surgery. Furthermore, we performed a correlation analysis to compare the postoperative changes in FC with clinical scores. RESULTS Five FCs were significantly increased postoperatively; 4 were between the sensorimotor network (SMN) and other regions. We observed a significant correlation between the FC of the right SMN and the left precentral gyrus with the JOA score, the left SMN with the JOACMEQ for upper extremity function, and the left postcentral gyrus with the NRS. CONCLUSIONS The reorganization of the sensorimotor cortex occurred postoperatively in patients with compression cervical myelopathy. In addition, each change in FC was significantly correlated with the clinical scores, thus indicating an association between the recovery of spinal cord function and plastic changes in the sensorimotor cortex.
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Affiliation(s)
- Fumihiko Eto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Kento Inomata
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kotaro Sakashita
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hisanori Gamada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoyuki Asada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kosuke Sato
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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12
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Fan N, Zhao B, Liu L, Yang W, Chen X, Lu Z. Dynamic and Static Amplitude of Low-Frequency Fluctuation Is a Potential Biomarker for Predicting Prognosis of Degenerative Cervical Myelopathy Patients: A Preliminary Resting-State fMRI Study. Front Neurol 2022; 13:829714. [PMID: 35444605 PMCID: PMC9013796 DOI: 10.3389/fneur.2022.829714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to explore the clinical value of the static amplitude of low-frequency fluctuation (sALFF) and dynamic amplitude of low-frequency fluctuation (dALFF) in the identification of brain functional alterations in degenerative cervical myelopathy (DCM) patients. Methods Voxel-wise sALFF and dALFF of 47 DCM patients and 44 healthy controls were calculated using resting-state fMRI data, and an intergroup comparison was performed. The mean of sALFF or dALFF data were extracted within the resultant clusters and the correlation analysis of these data with the clinical measures was performed. Furthermore, whole-brain-wise and region-wise multivariate pattern analyses (MVPAs) were performed to classify DCM patients and healthy controls. sALFF and dALFF were used to predict the prognosis of DCM patients. Results The findings showed that (1) DCM patients exhibited higher sALFF within the left thalamus and putamen compared with that of the healthy controls. DCM patients also exhibited lower dALFF within bilateral postcentral gyrus compared with the healthy controls; (2) No significant correlations were observed between brain alterations and clinical measures through univariate correlation analysis; (3) sALFF (91%) and dALFF (95%) exhibited high accuracy in classifying the DCM patients and healthy controls; (4) Region-wise MVPA further revealed brain regions in which functional patterns were associated with prognosis in DCM patients. These regions were mainly located at the frontal lobe and temporal lobe. Conclusion In summary, sALFF and dALFF can be used to accurately reveal brain functional alterations in DCM patients. Furthermore, the multivariate approach is a more sensitive method in exploring neuropathology and establishing a prognostic biomarker for DCM compared with the conventional univariate method.
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13
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The Correlation between Functional Connectivity of the Primary Somatosensory Cortex and Cervical Spinal Cord Microstructural Injury in Patients with Cervical Spondylotic Myelopathy. DISEASE MARKERS 2022; 2022:2623179. [PMID: 35096201 PMCID: PMC8791726 DOI: 10.1155/2022/2623179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
Abstract
Objectives To explore functional connectivity reorganization of the primary somatosensory cortex, the chronic microstructure damage of the cervical spinal cord, and their relationship in cervical spondylotic myelopathy (CSM) patients. Methods Thirty-three patients with CSM and 23 healthy controls (HCs) were recruited for rs-fMRI and cervical spinal cord diffusion tensor imaging (DTI) scans. Six subregions (including leg, back, chest, hand, finger and face) of bilateral primary somatosensory cortex (S1) were selected for seed-based whole-brain functional connectivity (FC). Then, we calculated the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values of the cervical spinal cord. Correlation analysis was conducted between FC values of brain regions and DTI parameters of cervical spinal cord (ADC, FA), and their relationship with each other and clinical parameters. Results Compared with the HC group, the CSM group showed decreased FC between areas of the left S1hand, the left S1leg, the right S1chest, and the right S1leg with brain regions. The mean FA values of the cervical spinal cord in CSM patients were positively correlated with JOA scores. Especially, the FApos values of bilateral posterior funiculus were positively correlated with JOA scores. The ADC and FA values of bilateral posterior funiculus in the cervical spinal cord were also positively correlated with the FC values. Conclusions There was synchronization between chronic cervical spinal cord microstructural injury and cerebral cortex sensory function compensatory recombination. DTI parameters of the posterior cervical spinal cord could objectively reflect the degree of cerebral cortex sensory function impairment to a certain extent.
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14
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Zhao R, Guo X, Wang Y, Song Y, Su Q, Sun H, Liang M, Xue Y. Functional MRI evidence for primary motor cortex plasticity contributes to the disease's severity and prognosis of cervical spondylotic myelopathy patients. Eur Radiol 2022; 32:3693-3704. [PMID: 35029735 DOI: 10.1007/s00330-021-08488-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/30/2021] [Accepted: 11/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the brain mechanism of non-correspondence between diseases severity and compression degree of the spinal cord in cervical spondylotic myelopathy (CSM) patients and to test the utility of brain imaging biomarkers for predicting prognosis of CSM. METHODS We calculated voxel-wise zALFF from 54 CSM patients and 50 healthy controls using resting-state fMRI data. In analysis 1, we identified the brain regions exhibited significant differences of zALFF between CSM patients and healthy controls. In analyses 2 through 3, we investigated the zALFF differences between light-symptom CSM patients and severe-symptom CSM patients while carefully matching the degree of compression between these two groups. In analysis 4, we tested the utility of zALFF within the primary motor cortex (M1) for predicting the prognosis of CSM. RESULTS We found that (1) compared with the healthy controls, CSM patients exhibited higher ALFF within left M1, bilateral superior frontal gyrus, and lower zALFF within right precuneus and calcarine, suggesting altered brain neural activity in CSM patients; (2) after matching the compression degree, the CSM patients with more severe clinical symptoms exhibited higher zALFF within M1, indicating cortical function contributes to disease's severity of CSM; (3) taking the M1 zALFF as features in the prognosis prediction model improves the prediction accuracy, indicating that the M1 zALFF provide additional value for predicting the prognosis of CSM patients following decompression surgery. CONCLUSION The functional state of M1 contributes to the disease's severity of CSM and can provide complementary information for predicting the prognosis of CSM following decompression surgery. KEY POINTS • Cervical spondylotic myelopathy (CSM) patients exhibited increased zALFF within the primary motor cortex (M1), bilateral superior frontal gyrus, and decreased zALFF within the right precuneus and calcarine. • After matching the compression degree, the CSM patients with more severe clinical symptoms exhibited higher zALFF within M1, indicating cortical function contributes to disease severity of CSM. • zALFF within M1 provided additional value for predicting the prognosis of CSM patients.
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Affiliation(s)
- Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xing Guo
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yang Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - YingChao Song
- School of Medical Imaging, Tianjin Medical University and Tianjin Key Laboratory of Functional Imaging, Tianjin, 300203, China
| | - Qian Su
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for China, Tianjin, 300060, China
| | - HaoRan Sun
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Meng Liang
- School of Medical Imaging, Tianjin Medical University and Tianjin Key Laboratory of Functional Imaging, Tianjin, 300203, China.
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for China, Tianjin, 300060, China.
| | - Yuan Xue
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- School of Medical Imaging, Tianjin Medical University, Tianjin, 300070, China.
- Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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15
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Li C, Huang S, Zhou W, Xie Z, Xie S, Li M. Spinal Cord Injury Inhibits the Differentiation and Maturation of NG2 Cells in the Cerebellum in Mice. World Neurosurg 2021; 160:e159-e168. [PMID: 34979285 DOI: 10.1016/j.wneu.2021.12.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Neuroimaging studies have shown that spinal cord injury (SCI) may lead to significant brain changes that are the key factors affecting functional recovery. However, little is known about the molecular and cellular biological mechanisms of these brain changes. The aim of this study was to investigate the molecular and cellular biological changes in the cerebellum after SCI. METHODS A total of 72 mice were randomly divided into 2 groups: sham group and SCI group. A mouse model of SCI was established by an aneurysm clip. Pathological examinations of the injured site were performed by hematoxylin and eosin staining and immunohistochemical. Western blot and immunohistochemical were used to determine the effect of SCI on the differentiation and maturation of NG2 cells. RESULTS Compared with the sham group, the spinal cord tissue structure was disrupted and the motor function decreased significantly in the SCI group; the number of NG2 cells in the ansiform lobule crus Ⅰ increased on the 7th and 14th days, whereas the expression of oligodendrocyte transcription factor 2, myelin basic protein, and proteolipid protein decreased on the 7th and 14th days after SCI. These results showed that the differentiation and maturation of NG2 cells in the ansiform lobule crus Ⅰ were inhibited after SCI, resulting in the decrease of the formation of mature oligodendrocytes. CONCLUSIONS These results indicate that SCI can lead to secondary changes in the cerebellum, which may affect the functional recovery. These findings may be used as biomarkers to evaluate the secondary changes in the brain after SCI.
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Affiliation(s)
- Chengcai Li
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Shaoxin Huang
- School of Basic Medicine, Jiujiang University, Jiujiang, Jiangxi, People's Republic of China
| | - Wu Zhou
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zhiping Xie
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Shenke Xie
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Meihua Li
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
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16
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Su Q, Zhao R, Wang S, Tu H, Guo X, Yang F. Identification and Therapeutic Outcome Prediction of Cervical Spondylotic Myelopathy Based on the Functional Connectivity From Resting-State Functional MRI Data: A Preliminary Machine Learning Study. Front Neurol 2021; 12:711880. [PMID: 34690912 PMCID: PMC8531403 DOI: 10.3389/fneur.2021.711880] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022] Open
Abstract
Currently, strategies to diagnose patients and predict neurological recovery in cervical spondylotic myelopathy (CSM) using MR images of the cervical spine are urgently required. In light of this, this study aimed at exploring potential preoperative brain biomarkers that can be used to diagnose and predict neurological recovery in CSM patients using functional connectivity (FC) analysis of a resting-state functional MRI (rs-fMRI) data. Two independent datasets, including total of 53 patients with CSM and 47 age- and sex-matched healthy controls (HCs), underwent the preoperative rs-fMRI procedure. The FC was calculated from the automated anatomical labeling (AAL) template and used as features for machine learning analysis. After that, three analyses were used, namely, the classification of CSM patients from healthy adults using the support vector machine (SVM) within and across datasets, the prediction of preoperative neurological function in CSM patients via support vector regression (SVR) within and across datasets, and the prediction of neurological recovery in CSM patients via SVR within and across datasets. The results showed that CSM patients could be successfully identified from HCs with high classification accuracies (84.2% for dataset 1, 95.2% for dataset 2, and 73.0% for cross-site validation). Furthermore, the rs-FC combined with SVR could successfully predict the neurological recovery in CSM patients. Additionally, our results from cross-site validation analyses exhibited good reproducibility and generalization across the two datasets. Therefore, our findings provide preliminary evidence toward the development of novel strategies to predict neurological recovery in CSM patients using rs-fMRI and machine learning technique.
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Affiliation(s)
- Qian Su
- Tianjin Key Laboratory of Cancer Prevention and Therapy, Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for China, Tianjin, China
| | - Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - ShuoWen Wang
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - HaoYang Tu
- School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China
| | - Xing Guo
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Fan Yang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
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17
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Wei W, Wang T, Abulizi T, Li B, Liu J. Altered Coupling Between Resting-State Cerebral Blood Flow and Functional Connectivity Strength in Cervical Spondylotic Myelopathy Patients. Front Neurol 2021; 12:713520. [PMID: 34566857 PMCID: PMC8455933 DOI: 10.3389/fneur.2021.713520] [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: 05/23/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Changes in regional neural activity and functional connectivity in cervical spondylotic myelopathy (CSM) patients have been reported. However, resting-state cerebral blood flow (CBF) changes and coupling between CBF and functional connectivity in CSM patients are largely unknown. Methods: Twenty-seven CSM patients and 24 sex/age-matched healthy participants underwent resting-state functional MRI and arterial spin labeling imaging to compare functional connectivity strength (FCS) and CBF between the two groups. The CBF–FCS coupling of the whole gray matter and specific regions of interest was also compared between the groups. Results: Compared with healthy individuals, CBF–FCS coupling was significantly lower in CSM patients. The decrease in CBF–FCS coupling in CSM patients was observed in the superior frontal gyrus, bilateral thalamus, and right calcarine cortex, whereas the increase in CBF–FCS coupling was observed in the middle frontal gyrus. Moreover, low CBF and high FCS were observed in sensorimotor cortices and visual cortices, respectively. Conclusion: In general, neurovascular decoupling at cortical level may be a potential neuropathological mechanism of CSM.
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Affiliation(s)
- Wuzeng Wei
- Department of Joints, Tianjin Hospital, Tianjin University, Tianjin, China.,Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Tao Wang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Tuersong Abulizi
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Bing Li
- Department of Joints, Tianjin Hospital, Tianjin University, Tianjin, China.,Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Jun Liu
- Department of Joints, Tianjin Hospital, Tianjin University, Tianjin, China.,Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
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18
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Cao Y, Zhan Y, Du M, Zhao G, Liu Z, Zhou F, He L. Disruption of human brain connectivity networks in patients with cervical spondylotic myelopathy. Quant Imaging Med Surg 2021; 11:3418-3430. [PMID: 34341720 DOI: 10.21037/qims-20-874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/08/2021] [Indexed: 02/05/2023]
Abstract
Background Brain functional plasticity and reorganization in patients with cervical spondylotic myelopathy (CSM) is increasingly being explored and validated. However, specific topological alterations in functional networks and their role in CSM brain functional reorganization remain unclear. This study investigates the topological architecture of intrinsic brain functional networks in CSM patients using graph theory. Methods Functional MRI was conducted on 67 CSM patients and 60 healthy controls (HCs). The topological organization of the whole-brain functional network was then calculated using theoretical graph analysis. The difference in categorical variables between groups was compared using a chi-squared test, while that between continuous variables was evaluated using a two-sample t-test. Nonparametric permutation tests were used to compare network measures between the two groups. Results Small-world architecture in functional brain networks were identified in both CSM patients and HCs. Compared with HCs, CSM patients showed a decreased area under the curve (AUC) of the characteristic path length (FDR q=0.040), clustering coefficient (FDR q=0.037), and normalized characteristic path length (FDR q=0.038) of the network. In contrast, there was an increased AUC of normalized clustering coefficient (FDR q=0.014), small-worldness (FDR q=0.009), and global network efficiency (FDR q=0.027) of the network. In local brain regions, nodal topological properties revealed group differences which were predominantly in the default-mode network (DMN), left postcentral gyrus, bilateral putamen, lingual gyrus, and posterior cingulate gyrus. Conclusions This study reported altered functional topological organization in CSM patients. Decreased nodal centralities in the visual cortex and sensory-motor regions may indicate sensory-motor dysfunction and blurred vision. Furthermore, increased nodal centralities in the cerebellum may be compensatory for sensory-motor dysfunction in CSM, while the increased DMN may indicate increased psychological processing in CSM patients.
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Affiliation(s)
- Yuan Cao
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.,Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yaru Zhan
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Miao Du
- College of Electrical Engineering of Sichuan University, Chengdu, China
| | - Guoshu Zhao
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Zhili Liu
- Department of Orthopedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fuqing Zhou
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Laichang He
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
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19
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Valošek J, Labounek R, Horák T, Horáková M, Bednařík P, Keřkovský M, Kočica J, Rohan T, Lenglet C, Cohen-Adad J, Hluštík P, Vlčková E, Kadaňka Z, Bednařík J, Svatkova A. Diffusion magnetic resonance imaging reveals tract-specific microstructural correlates of electrophysiological impairments in non-myelopathic and myelopathic spinal cord compression. Eur J Neurol 2021; 28:3784-3797. [PMID: 34288268 PMCID: PMC8530898 DOI: 10.1111/ene.15027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Non-myelopathic degenerative cervical spinal cord compression (NMDC) frequently occurs throughout aging and may progress to potentially irreversible degenerative cervical myelopathy (DCM). Whereas standard clinical magnetic resonance imaging (MRI) and electrophysiological measures assess compression severity and neurological dysfunction, respectively, underlying microstructural deficits still have to be established in NMDC and DCM patients. The study aims to establish tract-specific diffusion MRI markers of electrophysiological deficits to predict the progression of asymptomatic NMDC to symptomatic DCM. METHODS High-resolution 3 T diffusion MRI was acquired for 103 NMDC and 21 DCM patients compared to 60 healthy controls to reveal diffusion alterations and relationships between tract-specific diffusion metrics and corresponding electrophysiological measures and compression severity. Relationship between the degree of DCM disability, assessed by the modified Japanese Orthopaedic Association scale, and tract-specific microstructural changes in DCM patients was also explored. RESULTS The study identified diffusion-derived abnormalities in the gray matter, dorsal and lateral tracts congruent with trans-synaptic degeneration and demyelination in chronic degenerative spinal cord compression with more profound alterations in DCM than NMDC. Diffusion metrics were affected in the C3-6 area as well as above the compression level at C3 with more profound rostral deficits in DCM than NMDC. Alterations in lateral motor and dorsal sensory tracts correlated with motor and sensory evoked potentials, respectively, whereas electromyography outcomes corresponded with gray matter microstructure. DCM disability corresponded with microstructure alteration in lateral columns. CONCLUSIONS Outcomes imply the necessity of high-resolution tract-specific diffusion MRI for monitoring degenerative spinal pathology in longitudinal studies.
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Affiliation(s)
- Jan Valošek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia.,Department of Biomedical Engineering, University Hospital, Olomouc, Czechia
| | - René Labounek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia.,Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tomáš Horák
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Magda Horáková
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petr Bednařík
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Miloš Keřkovský
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Jan Kočica
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tomáš Rohan
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Christophe Lenglet
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada.,Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, Quebec, Canada.,Mila - Quebec AI Institute, Montreal, Quebec, Canada
| | - Petr Hluštík
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia
| | - Eva Vlčková
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Zdeněk Kadaňka
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Josef Bednařík
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Alena Svatkova
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
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20
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Zhao R, Song Y, Guo X, Yang X, Sun H, Chen X, Liang M, Xue Y. Enhanced Information Flow From Cerebellum to Secondary Visual Cortices Leads to Better Surgery Outcome in Degenerative Cervical Myelopathy Patients: A Stochastic Dynamic Causal Modeling Study With Functional Magnetic Resonance Imaging. Front Hum Neurosci 2021; 15:632829. [PMID: 34248520 PMCID: PMC8261284 DOI: 10.3389/fnhum.2021.632829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) damages the spinal cord, resulting in long-term neurological impairment including motor and visual deficits. Given that visual feedback is crucial in guiding movements, the visual disorder may be a cause of motor deficits in patients with DCM. It has been shown that increased functional connectivity between secondary visual cortices and cerebellum, which are functionally related to the visually guided movements, was correlated with motor function in patients with DCM. One possible explanation is that the information integration between these regions was increased to compensate for impaired visual acuity in patients with DCM and resulted in better visual feedback during motor function. However, direct evidence supporting this hypothesis is lacking. To test this hypothesis and explore in more detail the information flow within the "visual-cerebellum" system, we measured the effective connectivity (EC) among the "visual-cerebellum" system via dynamic causal modeling and then tested the relationship between the EC and visual ability in patients with DCM. Furthermore, the multivariate pattern analysis was performed to detect the relationship between the pattern of EC and motor function in patients with DCM. We found (1) significant increases of the bidirectional connections between bilateral secondary visual cortices and cerebellum were observed in patients with DCM; (2) the increased self-connection of the cerebellum was positively correlated with the impaired visual acuity in patients; (3) the amplitude of effectivity from the cerebellum to secondary visual cortices was positively correlated with better visual recovery following spinal cord decompression surgery; and (4) the pattern of EC among the visual-cerebellum system could be used to predict the pre-operative motor function. In conclusion, this study provided direct evidence that the increased information integration within the "visual-cerebellum" system compensated for visual impairments, which might have importance for sustaining better motor function in patients with DCM.
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Affiliation(s)
- Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China.,School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Yingchao Song
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Xing Guo
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaotian Yang
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Haoran Sun
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xukang Chen
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Meng Liang
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Yuan Xue
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
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21
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Jütten K, Mainz V, Schubert GA, Fabian Gohmann R, Schmidt T, Ridwan H, Clusmann H, Mueller CA, Blume C. Cortical volume reductions as a sign of secondary cerebral and cerebellar impairment in patients with degenerative cervical myelopathy. NEUROIMAGE-CLINICAL 2021; 30:102624. [PMID: 33773163 PMCID: PMC8025145 DOI: 10.1016/j.nicl.2021.102624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Degenerative cervical myelopathy is the most common cause of chronic impairment of the spinal cord. MRI-based anatomical assessment of cerebral and cerebellar areas revealed significant tissue volume reduction in DCM patients compared to healthy controls. Disease severity correlated with cerebral and cerebellar atrophy in the primary motor cortex, primary somatosensory cortex and cerebellar areas. Chronic injury to the spinal cord seems to have impact on remote anatomical structures in the brain.
This study investigated supra- and infratentorial structural gray and white matter (GM, WM) alterations in patients with degenerative cervical myelopathy (DCM) as an indicator of secondary harm due to chronic cervical cord compression and micro trauma. With MRI-based anatomical assessment and subsequent voxel-based morphometry analyses, pre- and postoperative volume alterations in the primary motor cortex (MI), the primary somatosensory cortex (SI), the supplementary motor area (SMA), and the cerebellum were analyzed in 43 DCM patients and 20 controls. We assessed disease-related symptom severity by the modified Japanese Orthopaedic Association scale (mJOA). The study also explored symptom severity-based brain volume alterations as well as their association with clinical status. Patients had lower mJOA scores (p = .000) and lower GM volume than controls in SI (p = .016) and cerebellar regions (p = .001). Symptom severity-based subgroup analyses revealed volume reductions in almost all investigated GM ROIs (MI: p = .001; CB: p = .040; SMA: p = .007) in patients with severe clinical symptoms as well as atrophy already present in patients with moderate symptom severity. Clinical symptoms in DCM were associated with cortical and cerebellar volume reduction. GM volume alterations may serve as an indicator of both disease severity and ongoing disease progression in DCM, and should be considered in further patient care and treatment monitoring.
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Affiliation(s)
- Kerstin Jütten
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Verena Mainz
- Institute of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstraße 19, 52074 Aachen, Germany
| | | | - Robin Fabian Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpelstraße 39, 04289 Leipzig, Germany; Medical Faculty, University of Leipzig, Liebigstraße 27, 04103 Leipzig, Germany
| | - Tobias Schmidt
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Hani Ridwan
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | | | - Christian Blume
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
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22
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Zhou F, Zhu Y, Zhu Y, Huang M, Jiang J, He L, Huang S, Zeng X, Gong H. Altered long- and short-range functional connectivity density associated with poor sleep quality in patients with chronic insomnia disorder: A resting-state fMRI study. Brain Behav 2020; 10:e01844. [PMID: 32935924 PMCID: PMC7667361 DOI: 10.1002/brb3.1844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 08/30/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Previous neuroimaging studies have suggested that brain functional impairment and hyperarousal occur during the daytime among patients with chronic insomnia disorder (CID); however, alterations to the brain's intrinsic functional architecture and their association with sleep quality have not yet been documented. METHODS In this study, our aim was to investigate the insomnia-related alterations to the intrinsic connectome in patients with CID (n = 27) at resting state, with a data-driven approach based on graph theory assessment and functional connectivity density (FCD), which can be interpreted as short-range (intraregional) or long-range (interregional) mapping. RESULTS Compared with healthy controls with good sleep, CID patients showed significantly decreased long-range FCD in the dorsolateral prefrontal cortices and the putamen. These patients also showed decreased short-range FCD in their multimodal-processing regions, executive control network, and supplementary motor-related areas. Furthermore, several regions showed increased short-range FCD in patients with CID, implying hyper-homogeneity of local activity. CONCLUSIONS Together, these findings suggest that insufficient sleep during chronic insomnia widely affects cortical functional activities, including disrupted FCD and increased short-range FCD, which is associated with poor sleep quality.
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Affiliation(s)
- Fuqing Zhou
- Department of RadiologyThe First Affiliated HospitalNanchang UniversityNanchangChina
- Neuroimaging LaboratoryJiangxi Province Medical Imaging Research InstituteNanchangChina
| | - Yanyan Zhu
- Department of RadiologyThe First Affiliated HospitalNanchang UniversityNanchangChina
- Neuroimaging LaboratoryJiangxi Province Medical Imaging Research InstituteNanchangChina
| | - Yujun Zhu
- Department of RespiratoryThe People’s Hospital of Yichun CityYichunChina
| | - Muhua Huang
- Department of RadiologyThe First Affiliated HospitalNanchang UniversityNanchangChina
- Neuroimaging LaboratoryJiangxi Province Medical Imaging Research InstituteNanchangChina
| | - Jian Jiang
- Department of RadiologyThe First Affiliated HospitalNanchang UniversityNanchangChina
- Neuroimaging LaboratoryJiangxi Province Medical Imaging Research InstituteNanchangChina
| | - Laichang He
- Department of RadiologyThe First Affiliated HospitalNanchang UniversityNanchangChina
- Neuroimaging LaboratoryJiangxi Province Medical Imaging Research InstituteNanchangChina
| | - Suhua Huang
- Department of RadiologyJiangxi Province Children's HospitalNanchangChina
| | - Xianjun Zeng
- Department of RadiologyThe First Affiliated HospitalNanchang UniversityNanchangChina
- Neuroimaging LaboratoryJiangxi Province Medical Imaging Research InstituteNanchangChina
| | - Honghan Gong
- Department of RadiologyThe First Affiliated HospitalNanchang UniversityNanchangChina
- Neuroimaging LaboratoryJiangxi Province Medical Imaging Research InstituteNanchangChina
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23
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Surface-based analysis increases the specificity of cortical activation patterns and connectivity results. Sci Rep 2020; 10:5737. [PMID: 32235885 PMCID: PMC7109138 DOI: 10.1038/s41598-020-62832-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 03/11/2020] [Indexed: 12/13/2022] Open
Abstract
Spatial smoothing of functional magnetic resonance imaging (fMRI) data can be performed on volumetric images and on the extracted surface of the brain. Smoothing on the unfolded cortex should theoretically improve the ability to separate signals between brain areas that are near together in the folded cortex but are more distant in the unfolded cortex. However, surface-based method approaches (SBA) are currently not utilized as standard procedure in the preprocessing of neuroimaging data. Recent improvements in the quality of cortical surface modeling and improvements in its usability nevertheless advocate this method. In the current study, we evaluated the benefits of an up-to-date surface-based smoothing in comparison to volume-based smoothing. We focused on the effect of signal contamination between different functional systems using the primary motor and primary somatosensory cortex as an example. We were particularly interested in how this signal contamination influences the results of activity and connectivity analyses for these brain regions. We addressed this question by performing fMRI on 19 subjects during a tactile stimulation paradigm and by using simulated BOLD responses. We demonstrated that volume-based smoothing causes contamination of the primary motor cortex by somatosensory cortical responses, leading to false positive motor activation. These false positive motor activations were not found by using surface-based smoothing for reasonable kernel sizes. Accordingly, volume-based smoothing caused an exaggeration of connectivity estimates between these regions. In conclusion, this study showed that surface-based smoothing decreases signal contamination considerably between neighboring functional brain regions and improves the validity of activity and connectivity results.
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24
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Functional Connectivity Changes of the Visual Cortex in the Cervical Spondylotic Myelopathy Patients: A Resting-State fMRI Study. Spine (Phila Pa 1976) 2020; 45:E272-E279. [PMID: 31513096 DOI: 10.1097/brs.0000000000003245] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To analyze altered functional connectivity (FC) in the visual cortex of cervical spondylotic myelopathy (CSM) patients using resting-state functional magnetic resonance imaging (fMRI). SUMMARY OF BACKGROUND DATA We previously showed changes in visual cortex neural activity in CSM patients. METHODS Thirty CSM patients and 20 healthy controls were recruited. MR data were collected using a 3.0 T MR. FC of the regions of interest (ROI) (Brodmann areas [BA] 17/18/19/7) were calculated in a voxel-wise manner and compared between groups. Correlation analyses were performed between preoperative Japanese Orthopaedic Association (JOA) scores and altered FC, as well as between preoperative best corrected visual acuity (BCVA) and altered FC. Furthermore, the FC where was compared between the preoperative and the postoperative CSM patients in an ROI-wise manner. RESULTS Increased FC was found between BA19 and the cerebellum inferior lobe; between the left BA7 and bilateral calcarine, right lingual, right fusiform gyrus, and left precuneus (BA17); between the left BA7 and right fusiform gyrus and right inferior occipital gyrus (right BA19); and between the right BA7 and right superior lobe of cerebellum (right BA19) in CSM patients (P < 0.05). A negative correlation was found between JOA score and FC of the left and right BA19, and a positive correlation was found between the BCVA and FC of the left and right BA7 (P < 0.05). ROI analysis demonstrated statistically significant FC differences in between the preoperative and the postoperative CSM patients (P < 0.05). CONCLUSION FC changes were present in the visual cortex of CSM patients, which negatively correlated with preoperative JOA scores and positively correlated with preoperative BCVA. Significant recovery of FC in the visual cortex was detected in CSM patients postoperatively. LEVEL OF EVIDENCE 4.
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25
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MRI evidence of brain atrophy, white matter damage, and functional adaptive changes in patients with cervical spondylosis and prolonged spinal cord compression. Eur Radiol 2019; 30:357-369. [DOI: 10.1007/s00330-019-06352-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/13/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
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Towards prognostic functional brain biomarkers for cervical myelopathy: A resting-state fMRI study. Sci Rep 2019; 9:10456. [PMID: 31320690 PMCID: PMC6639260 DOI: 10.1038/s41598-019-46859-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/05/2019] [Indexed: 02/02/2023] Open
Abstract
Recently, there has been increasing interest in strategies to predict neurological recovery in cervical myelopathy (CM) based on clinical images of the cervical spine. In this study, we aimed to explore potential preoperative brain biomarkers that can predict postoperative neurological recovery in CM patients by using resting-state functional magnetic resonance imaging (rs-fMRI) and functional connectivity (FC) analysis. Twenty-eight patients with CM and 28 age- and sex-matched healthy controls (HCs) underwent rs-fMRI (twice for CM patients, before and six months after surgery). A seed-to-voxel analysis was performed, and the following three statistical analyses were conducted: (i) FC comparisons between preoperative CM and HC; (ii) correlation analysis between preoperative FCs and clinical scores; and (iii) postoperative FC changes in CM. Our analyses identified three FCs between the visual cortex and the right superior frontal gyrus based on the conjunction of the first two analyses [(i) and (ii)]. These FCs may act as potential biomarkers for postoperative gain in the 10-second test and might be sufficient to provide a prediction formula for potential recovery. Our findings provide preliminary evidence supporting the possibility of novel predictive measures for neurological recovery in CM using rs-fMRI.
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27
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Mowforth OD, Davies BM, Kotter MR. "I am not delusional!" Sensory dysaesthesia secondary to degenerative cervical myelopathy. BMJ Case Rep 2019; 12:12/4/e229033. [PMID: 30975783 PMCID: PMC6505976 DOI: 10.1136/bcr-2018-229033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction, most classically presenting with a broad-based gait and clumsy hands. Limb sensory loss and paraesthesia are considered common symptoms of DCM. However, we report an unusual case of a patient presenting with prominent and atypical sensory symptoms. The patient repeatedly presented to accident and emergency complaining of her body resembling a wet gel-like substance that she attributed to the use of olive oil moisturising cream. The patient was found to have myelopathic signs on examination and MRI consistent with severe cervical myelopathy. She subsequently underwent successful decompressive anterior cervical discectomy, as recommended by international guidelines. This case serves to remind health professionals of uncommon presentations of common disease and the importance of maintaining a wide initial differential diagnosis.
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Affiliation(s)
- Oliver Daniel Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Benjamin Marshall Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Mark Reinhard Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Anne McLaren Laboratory for Regenerative Medicine, Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
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28
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Abstract
Previous studies have shown compensatory adaptive changes in cerebral functions before surgery in patients with cervical spondylotic myelopathy (CSM), especially in the sensorimotor cortices. However, the structural changes in the sensorimotor cortices in patients with CSM remain poorly understood. The aim of this study was to assess the volumetric changes in the sensorimotor cortices using morphological MRI and to correlate these changes with clinical scales. We hypothesize that CSM causes atrophy in the sensorimotor cortices, which results in functional changes during CSM progression. The study participants included 30 CSM patients and 25 matched healthy controls. The patients underwent brain morphological MRI before surgery. Compared with the healthy controls, the patients with CSM showed significant atrophy in the primary somatosensory cortex (S1), the primary motor cortex (M1), the somatosensory association cortex, and the supplementary motor area. The gray matter volumes in the S1 and M1 were correlated positively with the motor scores of the Japanese Orthopedic Association in patients with CSM. The change in supplementary motor area correlated with the sphincter scores of the Japanese Orthopedic Association in CSM patients. Our findings provide new insights into the compensatory reaction in CSM patients.
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29
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Kuang C, Zha Y. Abnormal intrinsic functional activity in patients with cervical spondylotic myelopathy: a resting-state fMRI study. Neuropsychiatr Dis Treat 2019; 15:2371-2383. [PMID: 31686821 PMCID: PMC6708884 DOI: 10.2147/ndt.s209952] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/31/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE We employed resting-state fMRI analyses to reveal central functional reorganization in the brains of patients with cervical spondylotic myelopathy (CSM) and to provide complementary evidence of cortex reorganization in these patients. PATIENTS AND METHODS We obtained Fisher's z transformation amplitude of low-frequency fluctuations (zALFF) and Fisher's z transformation regional homogeneity (zReHo) measurements from 33 patients with CSM and 33 healthy controls (HC) and used the brain regions with significant alterations in the zALFF or zReHo values as seed regions. Then, we calculated Pearson's correlation coefficients between the resting-state time courses of each seed and the time series of the rest of the brain. Lastly, we computed correlations between the altered zALFF, zReHo, and functional connectivity with Japanese Orthopaedic Association scores, Neck Disability Index score, and the duration of symptoms in patients with CSM. RESULTS zALFF and zReHo values were increased in the left medial superior frontal gyrus (lSFGmed) and left supramarginal gyrus (lSMG) in patients with CSM compared with those in the HC group. Selecting lSFGmed as the seed, we observed increased functional connectivity between it and the left postcentral gyrus (lPoCG) and left rolandic operculum and decreased functional connectivity with the right medial superior frontal gyrus in patients with CSM. In addition, there was a significant increase in the functional connectivity between the lSMG (seed) and the left calcarine and lPoCG in patients with CSM. However, we did not find any significant correlation between the resting-state findings and the clinical performance of patients with CSM. CONCLUSION These observed intrinsic functional changes in the patients with CSM may be related to functional reorganization and reflect the innate cortical plasticity in patients with CSM. Notably, the increased connectivity between the lPoCG and the two seed ROIs indicates the adaptive changes in patients with CSM. These findings provide complementary evidence of cortex reorganization in CSM.
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Affiliation(s)
- Cuili Kuang
- Radiological Department, Renmin Hospital of Wuhan University, Hubei, People's Republic of China
| | - Yunfei Zha
- Radiological Department, Renmin Hospital of Wuhan University, Hubei, People's Republic of China
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30
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Chen J, Wang Z, Tu Y, Liu X, Jorgenson K, Ye G, Lin C, Liu J, Park J, Lang C, Liu B, Kong J. Regional Homogeneity and Multivariate Pattern Analysis of Cervical Spondylosis Neck Pain and the Modulation Effect of Treatment. Front Neurosci 2018; 12:900. [PMID: 30574062 PMCID: PMC6292425 DOI: 10.3389/fnins.2018.00900] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/19/2018] [Indexed: 11/13/2022] Open
Abstract
Objects: We investigated brain functional alteration in patients with chronic cervical spondylosis neck pain (CSNP) compared to healthy controls (HCs) and the effect of intervention. Methods: 104 CSNP patients and 96 matched HCs were recruited. Patients received 4 weeks of treatment. Resting-state fMRI and Northwick Park Neck Pain Questionnaire (NPQ) were collected before and after treatment. Resting state regional homogeneity (rs-ReHo) and multivariate pattern analysis (MVPA) were applied to (1) investigate rs-ReHo differences between CSNP patients and controls and the effect of longitudinal treatment and (2) classify CSNP patients from HCs and predict clinical outcomes before treatment using MVPA. Results: We found that (1) CSNP patients showed decreased rs-ReHo in the left sensorimotor cortex and right temporo-parietal junction (rTPJ), and rs-ReHo at the rTPJ significantly increased after treatment; (2) rs-ReHo at rTPJ was associated with NPQ at baseline, and pre- and post-treatment rs-ReHo changes at rTPJ were associated with NPQ changes in CSNP patients; and (3) MVPA could discriminate CSNP patients from HCs with 72% accuracy and predict clinical outcomes with a mean absolute error of 19.6%. Conclusion: CSNP patients are associated with dysfunction of the rTPJ and sensorimotor area. Significance: rTPJ plays on important role in the pathophysiology and development of CSNP.
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Affiliation(s)
- Jun Chen
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Zengjian Wang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Xian Liu
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Kristen Jorgenson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Guoxi Ye
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Chenlin Lin
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jianhua Liu
- Key Laboratory for Studying Regularities and Mechanism of Acu-moxibustion, Department of Acu-moxibustion, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Joel Park
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Courtney Lang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Bo Liu
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
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Wright D, Martin S, Pereira EA, Kong Y, Tracey I, Cadoux-Hudson T. High field structural MRI in the management of degenerative cervical myelopathy. Br J Neurosurg 2018; 32:595-598. [PMID: 29688066 DOI: 10.1080/02688697.2018.1467371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction: This is a narrative overview of the pathophysiology, investigation and management of Degenerative Cervical Myelopathy (DCM). This review article also takes a look ahead to the impact high resolution MRI may have on treatment.Background: DCM is the most common cause of spinal dysfunction and yet it remains poorly understood. It is becoming increasingly common in our ageing population. Disc and facet joint abnormalities, osteophytes, spondylothisthesis and ligamentous hypertrophy all act together to produce spinal canal and neuronal foramina stenosis which in turn causes neural compromise. Its impact on the quality of life of this patient group and the wider economy is vast. Some patients with overt cord compression and MRI signal change in their cervical cord may only have subtle clinical signs whilst others with less striking imaging may be profoundly myelopathic. Who to operate on and when remains a neurosurgical dilemma in this group of patients.Methods: A number of articles with a broad variation in methodology were reviewed and referenced during the production of this paper.Results: This paper is a narrative review. The results presented in all the referenced articles were considered.Conclusion: The process of developing new imaging techniques will give a greater understanding of the causes of the symptoms of DCM and in a wider context facilitate further surgical and medical strategies that are more cost effective and beneficial to patients. The advent of 7T MRI or further optimisation of safer 3T MRI sequences may soon provide this opportunity and the diagnostic gap in spinal cord imaging can begin to close.
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Affiliation(s)
- Dan Wright
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sean Martin
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Erlick Ac Pereira
- Academic Neurosurgery Unit, St George's University of London, London, UK
| | - Yazhuo Kong
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Irene Tracey
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas Cadoux-Hudson
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Hawasli AH, Rutlin J, Roland JL, Murphy RKJ, Song SK, Leuthardt EC, Shimony JS, Ray WZ. Spinal Cord Injury Disrupts Resting-State Networks in the Human Brain. J Neurotrauma 2018; 35:864-873. [PMID: 29179629 DOI: 10.1089/neu.2017.5212] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Despite 253,000 spinal cord injury (SCI) patients in the United States, little is known about how SCI affects brain networks. Spinal MRI provides only structural information with no insight into functional connectivity. Resting-state functional MRI (RS-fMRI) quantifies network connectivity through the identification of resting-state networks (RSNs) and allows detection of functionally relevant changes during disease. Given the robust network of spinal cord afferents to the brain, we hypothesized that SCI produces meaningful changes in brain RSNs. RS-fMRIs and functional assessments were performed on 10 SCI subjects. Blood oxygen-dependent RS-fMRI sequences were acquired. Seed-based correlation mapping was performed using five RSNs: default-mode (DMN), dorsal-attention (DAN), salience (SAL), control (CON), and somatomotor (SMN). RSNs were compared with normal control subjects using false-discovery rate-corrected two way t tests. SCI reduced brain network connectivity within the SAL, SMN, and DMN and disrupted anti-correlated connectivity between CON and SMN. When divided into separate cohorts, complete but not incomplete SCI disrupted connectivity within SAL, DAN, SMN and DMN and between CON and SMN. Finally, connectivity changed over time after SCI: the primary motor cortex decreased connectivity with the primary somatosensory cortex, the visual cortex decreased connectivity with the primary motor cortex, and the visual cortex decreased connectivity with the sensory parietal cortex. These unique findings demonstrate the functional network plasticity that occurs in the brain as a result of injury to the spinal cord. Connectivity changes after SCI may serve as biomarkers to predict functional recovery following an SCI and guide future therapy.
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Affiliation(s)
- Ammar H Hawasli
- 1 Department of Neurological Surgery, Washington University School of Medicine , Saint Louis, Missouri.,2 Department of Biomedical Engineering, Washington University School of Medicine , Saint Louis, Missouri.,3 Department of Orthopedic Surgery, Washington University School of Medicine , Saint Louis, Missouri
| | - Jerrel Rutlin
- 4 Department of Mallinckrodt Institute of Radiology, Washington University School of Medicine , Saint Louis, Missouri
| | - Jarod L Roland
- 1 Department of Neurological Surgery, Washington University School of Medicine , Saint Louis, Missouri
| | - Rory K J Murphy
- 5 Department of Neurosurgery, University of California San Francisco , California
| | - Sheng-Kwei Song
- 4 Department of Mallinckrodt Institute of Radiology, Washington University School of Medicine , Saint Louis, Missouri
| | - Eric C Leuthardt
- 1 Department of Neurological Surgery, Washington University School of Medicine , Saint Louis, Missouri.,2 Department of Biomedical Engineering, Washington University School of Medicine , Saint Louis, Missouri
| | - Joshua S Shimony
- 4 Department of Mallinckrodt Institute of Radiology, Washington University School of Medicine , Saint Louis, Missouri
| | - Wilson Z Ray
- 1 Department of Neurological Surgery, Washington University School of Medicine , Saint Louis, Missouri.,2 Department of Biomedical Engineering, Washington University School of Medicine , Saint Louis, Missouri
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33
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Zhou F, Huang M, Wu L, Tan Y, Guo J, Zhang Y, He L, Gong H. Altered perfusion of the sensorimotor cortex in patients with cervical spondylotic myelopathy: an arterial spin labeling study. J Pain Res 2018; 11:181-190. [PMID: 29391824 PMCID: PMC5769569 DOI: 10.2147/jpr.s148076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective Advanced magnetic resonance imaging studies have shown functional plasticity or reorganization and metabolite alterations of N-acetyl aspartate in the sensorimotor cortex (SMC), a hallmark region and key brain network, in patients with cervical spondylotic myelopathy (CSM). However, the nature of perfusion in the SMC and the relationship between regional cerebral blood flow (CBF), motor function scores, and structural damage of the cervical cord in patients with CSM are not fully understood. Materials and methods All right-handed participants underwent pseudo-continuous arterial spin labeling pulse sequence scanning, and CBF was then calculated and compared between CSM and healthy groups. Clinical and structural associations were assessed in the SMC. Receiver operating characteristic (ROC) and leave-one-out cross-validation analyses were used to estimate the sensitivity and specificity of the significantly altered CBF in the SMC to distinguish myelopathy-related impairment. Results A total of 18 pairs of CSM patients and well-matched healthy subjects were included in the analyses. Compared with healthy subjects, CSM patients exhibited significantly decreased CBF in the left premotor ventral/precentral operculum (PMv/PrCO) and the bilateral dorsal anterior cingulate cortex (dACC); and increased CBF in the left paracentral lobule (PCL), the right PCL/supplementary motor area (PCL/SMA), and the right postcentral gyrus (PoCG; Gaussian random field correction at P<0.01). In the CSM group, the CBF values in the right PoCG were negatively correlated with Japanese Orthopaedic Association scores, and the CBF values in several regions were negatively correlated with Neck Disability Index scores. Finally, the ROC analysis revealed that significantly increased CBF in the left PCL, the right PCL/SMA, and the right PoCG discriminated patients with myelopathy-related impairment from healthy subjects. Conclusion Regional CBF was reduced in operculum-integrated (PMv/PrCO) and motor control (dACC) regions but increased in sensory (PoCG) and motor-sensory processing (PCL/SMA) regions in patients with CSM.
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Affiliation(s)
- Fuqing Zhou
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Muhua Huang
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Lin Wu
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Yongming Tan
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Jianqiang Guo
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Yong Zhang
- Department of Pain Clinic, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Laichang He
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Honghan Gong
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
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Li F, Zhou F, Huang M, Gong H, Xu R. Frequency-Specific Abnormalities of Intrinsic Functional Connectivity Strength among Patients with Amyotrophic Lateral Sclerosis: A Resting-State fMRI Study. Front Aging Neurosci 2017; 9:351. [PMID: 29163133 PMCID: PMC5681965 DOI: 10.3389/fnagi.2017.00351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/17/2017] [Indexed: 01/06/2023] Open
Abstract
The classical concept that amyotrophic lateral sclerosis (ALS) is a degenerative disorder characterized by the loss of upper and lower motor neurons is agreed. However, more and more studies have suggested the involvement of some extra-motor regions. The aim of this study is to investigate the frequency-related alteration pattern of intrinsic functional connectivity strength (FCS) at the voxel-wise level in the relatively early-stage of ALS on a whole brain scale. In this study, 21 patients with ALS and 21 well-matched healthy control subjects were enrolled to examine the intrinsic FCS in the different frequencies (slow-4: 0.027-0.073 Hz; slow-5: 0.01-0.027 Hz, and typical band: 0.01-0.1 Hz). Compared with the control subjects, the ALS patients showed a significantly decreased FCS in the left prefrontal cortex (PFC) and the bilateral superior frontal gyrus. In the slow-5 band, the patients with ALS showed decreased FCS in the left lingual gyrus, as well as increased FCS in the left postcentral gyrus/paracentral lobule (PoCG/PARC). In the slow-4 band, the ALS patients presented decreased FCS in the left and right ventrolateral PFC. Moreover, the increased FCS in the left PoCG/PARC in the slow-5 band was positively correlated with the ALSFRS-r score (P = 0.015). Our results demonstrated that the FCS changes in ALS were wide spread and frequency dependent. These findings may provide some evidences that ALS patients have the consistent impairment in some extra-motor regions at a relatively early-stage.
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Affiliation(s)
- Fangjun Li
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Muhua Huang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Renshi Xu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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35
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Bhagavatula ID, Shukla D, Sadashiva N, Saligoudar P, Prasad C, Bhat DI. Functional cortical reorganization in cases of cervical spondylotic myelopathy and changes associated with surgery. Neurosurg Focus 2017; 40:E2. [PMID: 27246485 DOI: 10.3171/2016.3.focus1635] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The physiological mechanisms underlying the recovery of motor function after cervical spondylotic myelopathy (CSM) surgery are poorly understood. Neuronal plasticity allows neurons to compensate for injury and disease and to adjust their activities in response to new situations or changes in their environment. Cortical reorganization as well as improvement in corticospinal conduction happens during motor recovery after stroke and spinal cord injury. In this study the authors aimed to understand the cortical changes that occur due to CSM and following CSM surgery and to correlate these changes with functional recovery by using blood oxygen level-dependent (BOLD) functional MRI (fMRI). METHODS Twenty-two patients having symptoms related to cervical cord compression due to spondylotic changes along with 12 age- and sex-matched healthy controls were included in this study. Patients underwent cervical spine MRI and BOLD fMRI at 1 month before surgery (baseline) and 6 months after surgery. RESULTS Five patients were excluded from analysis because of technical problems; thus, 17 patients made up the study cohort. The mean overall modified Japanese Orthopaedic Association score improved in patients following surgery. Mean upper-extremity, lower-extremity, and sensory scores improved significantly. In the preoperative patient group the volume of activation (VOA) was significantly higher than that in controls. The VOA after surgery was reduced as compared with that before surgery, although it remained higher than that in the control group. In the preoperative patient group, activations were noted only in the left precentral gyrus (PrCG). In the postoperative group, activations were seen in the left postcentral gyrus (PoCG), as well as the PrCG and premotor and supplementary motor cortices. In postoperative group, the VOA was higher in both the PrCG and PoCG as compared with those in the control group. CONCLUSIONS There is over-recruitment of sensorimotor cortices during nondexterous relative to dexterous movements before surgery. After surgery, there was recruitment of other cortical areas such as the PoCG and premotor and supplementary motor cortices, which correlated with improvement in dexterity, but activation in these areas was greater than that found in controls. The results show that improvement in dexterity and finer movements of the upper limbs is associated with recruitment areas other than the premotor cortex to compensate for the damage in the cervical spinal cord.
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Affiliation(s)
| | | | | | | | - Chandrajit Prasad
- Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Liu X, Qian W, Jin R, Li X, Luk KDK, Wu EX, Hu Y. Amplitude of Low Frequency Fluctuation (ALFF) in the Cervical Spinal Cord with Stenosis: A Resting State fMRI Study. PLoS One 2016; 11:e0167279. [PMID: 27907060 PMCID: PMC5132295 DOI: 10.1371/journal.pone.0167279] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/09/2016] [Indexed: 12/14/2022] Open
Abstract
Cervical spondylotic myelopathy (CSM) is a common spinal cord dysfunction disease with complex symptoms in clinical presentation. Resting state fMRI (rsfMRI) has been introduced to study the mechanism of neural development of CSM. However, most of those studies focused on intrinsic functional connectivity rather than intrinsic regional neural activity level which is also frequently analyzed in rsfMRI studies. Thus, this study aims to explore whether the level of neural activity changes on the myelopathic cervical cord and evaluate the possible relationship between this change and clinical symptoms through amplitude of low frequency fluctuation (ALFF). Eighteen CSM patients and twenty five healthy subjects participated in rsfMRI scanning. ALFF was investigated on each patient and subject. The results suggested that ALFF values were higher in the CSM patients at all cervical segments, compared to the healthy controls. The severity of myelopathy was associated with the increase of ALFF. This finding would enrich our understanding on the neural development mechanism of CSM.
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Affiliation(s)
- Xiaojia Liu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Electrical and Electronic Engineering, Faculty of Engineering, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wenshu Qian
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Richu Jin
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Xiang Li
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Keith DK Luk
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ed. X. Wu
- Department of Electrical and Electronic Engineering, Faculty of Engineering, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yong Hu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Spinal division, Department of Orthopaedics, Affiliated Hospital of Guangdong Medical University, Guangdong, China
- * E-mail:
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Voxel-based analysis of grey and white matter degeneration in cervical spondylotic myelopathy. Sci Rep 2016; 6:24636. [PMID: 27095134 PMCID: PMC4837346 DOI: 10.1038/srep24636] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 04/04/2016] [Indexed: 12/21/2022] Open
Abstract
In this prospective study, we made an unbiased voxel-based analysis to investigate above-stenosis spinal degeneration and its relation to impairment in patients with cervical spondylotic myelopathy (CSM). Twenty patients and 18 controls were assessed with high-resolution MRI protocols above the level of stenosis. Cross-sectional areas of grey matter (GM), white matter (WM), and posterior columns (PC) were measured to determine atrophy. Diffusion indices assessed tract-specific integrity of PC and lateral corticospinal tracts (CST). Regression analysis was used to reveal relationships between MRI measures and clinical impairment. Patients showed mainly sensory impairment. Atrophy was prominent within the cervical WM (13.9%, p = 0.004), GM (7.2%, p = 0.043), and PC (16.1%, p = 0.005). Fractional anisotropy (FA) was reduced in the PC (−11.98%, p = 0.006) and lateral CST (−12.96%, p = 0.014). In addition, radial (+28.47%, p = 0.014), axial (+14.72%, p = 0.005), and mean (+16.50%, p = 0.001) diffusivities were increased in the PC. Light-touch score was associated with atrophy (R2 = 0.3559, p = 0.020) and FA (z score 3.74, p = 0.003) in the PC, as was functional independence and FA in the lateral CST (z score 3.68, p = 0.020). This study demonstrates voxel-based degeneration far above the stenosis at a level not directly affected by the compression and provides unbiased readouts of tract-specific changes that relate to impairment.
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Wu L, Zhang Y, Zhou F, Gao L, He L, Zeng X, Gong H. Altered intra- and interregional synchronization in relapsing-remitting multiple sclerosis: a resting-state fMRI study. Neuropsychiatr Dis Treat 2016; 12:853-62. [PMID: 27143886 PMCID: PMC4841392 DOI: 10.2147/ndt.s98962] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Neuroimaging studies of relapsing-remitting multiple sclerosis (RRMS) have found structural disconnection and large-scale neural network dysfunction. However, few studies have explored the local brain activity of RRMS patients in the resting state. PATIENTS AND METHODS In this study, regional homogeneity (ReHo) and resting-state functional connectivity (FC) were used to investigate intra- and interregional synchronized activity in 22 patients with RRMS and 22 matched healthy controls (HCs). RESULTS Compared with HCs, patients with RRMS showed significantly decreased ReHo in the left insula and right caudate. Through further seed-based FC analysis, we found decreased FC between the left insula and left precentral gyrus in patients with RRMS compared with HCs, as well as increased FC between the right caudate and right dorsolateral prefrontal cortex. Pearson's correlation analysis showed that a decreased ReHo value in the left insula was associated with an increased total white matter lesion loads (TWMLL) score (r=-0.594, P=0.004) or a worsened paced auditory serial addition test score (r=0.536, P=0.010). No other significant correlations were observed between the FC value (left insula - left precentral gyrus) and clinical scores (P=0.246-0.982). The ReHo value of the right caudate was negatively correlated with disease duration (r=-0.526, P=0.012) and with the TWMLL score (r=-0.596, P=0.003). Moreover, a positive correlation was observed between the FC value (right caudate - right dorsolateral prefrontal cortex) and the TWMLL score (r=0.523, P=0.012) or the modified fatigue impact scale-5 score (r=0.608, P=0.003). CONCLUSION Together, these findings suggest that the insula with regional dysfunction involves disconnection with sensorimotor regions, and demyelinating lesion-related intra- and interregional dysfunction in the caudate is associated with the impact of fatigue on cognitive control functions. Abnormal synchronization of intra- and interregional activity in the insula and caudate may play important roles in the pathology of RRMS.
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Affiliation(s)
- Lin Wu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China; Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Yue Zhang
- Department of Radiology, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China; Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Lei Gao
- Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Laichang He
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China; Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Xianjun Zeng
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China; Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China; Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
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Zhuang Y, Zhou F, Gong H. Intrinsic functional plasticity of the sensorimotor network in relapsing-remitting multiple sclerosis: evidence from a centrality analysis. PLoS One 2015; 10:e0130524. [PMID: 26110420 PMCID: PMC4482320 DOI: 10.1371/journal.pone.0130524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/21/2015] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Advanced MRI studies have revealed regional alterations in the sensorimotor cortex of patients with relapsing-remitting multiple sclerosis (RRMS). However, the organizational features underlying the relapsing phase and the subsequent remitting phase have not been directly shown at the functional network or the connectome level. Therefore, this study aimed to characterize MS-related centrality disturbances of the sensorimotor network (SMN) and to assess network integrity and connectedness. Methods Thirty-four patients with clinically definite RRMS and well-matched healthy controls participated in the study. Twenty-three patients in the remitting phase underwent one resting-state functional MRI, and 11 patients in the relapsing-remitting phase underwent two different MRIs. We measured voxel-wise centrality metrics to determine direct (degree centrality, DC) and global (eigenvector centrality, EC) functional relationships across the entire SMN. Results In the relapsing phase, DC was significantly decreased in the bilateral primary motor and somatosensory cortex (M1/S1), left dorsal premotor (PMd), and operculum-integrated regions. However, DC was increased in the peripheral SMN areas. The decrease in DC in the bilateral M1/S1 was associated with the expanded disability status scale (EDSS) and total white matter lesion loads (TWMLLs), suggesting that this adaptive response is related to the extent of brain damage in the rapid-onset attack stage. During the remission process, these alterations in centrality were restored in the bilateral M1/S1 and peripheral SMN areas. In the remitting phase, DC was reduced in the premotor, supplementary motor, and operculum-integrated regions, reflecting an adaptive response due to brain atrophy. However, DC was enhanced in the right M1 and left parietal-integrated regions, indicating chronic reorganization. In both the relapsing and remitting phases, the changes in EC and DC were similar. Conclusions The alterations in centrality within the SMN indicate rapid plasticity and chronic reorganization with a biased impairment of specific functional areas in RRMS patients.
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Affiliation(s)
- Ying Zhuang
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
- Department of Oncology, the Second Hospital of Nanchang, Nanchang, Jiangxi Province, China
| | - Fuqing Zhou
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, China
- * E-mail:
| | - Honghan. Gong
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
- Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, China
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