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Yoo HJ, Koo B, Yong CW, Lee KS. Prediction of gait recovery using machine learning algorithms in patients with spinal cord injury. Medicine (Baltimore) 2024; 103:e38286. [PMID: 38847729 PMCID: PMC11155515 DOI: 10.1097/md.0000000000038286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/26/2024] [Indexed: 06/10/2024] Open
Abstract
With advances in artificial intelligence, machine learning (ML) has been widely applied to predict functional outcomes in clinical medicine. However, there has been no attempt to predict walking ability after spinal cord injury (SCI) based on ML. In this situation, the main purpose of this study was to predict gait recovery after SCI at discharge from an acute rehabilitation facility using various ML algorithms. In addition, we explored important variables that were related to the prognosis. Finally, we attempted to suggest an ML-based decision support system (DSS) for predicting gait recovery after SCI. Data were collected retrospectively from patients with SCI admitted to an acute rehabilitation facility between June 2008 to December 2021. Linear regression analysis and ML algorithms (random forest [RF], decision tree [DT], and support vector machine) were used to predict the functional ambulation category at the time of discharge (FAC_DC) in patients with traumatic or non-traumatic SCI (n = 353). The independent variables were age, sex, duration of acute care and rehabilitation, comorbidities, neurological information entered into the International Standards for Neurological Classification of SCI worksheet, and somatosensory-evoked potentials at the time of admission to the acute rehabilitation facility. In addition, the importance of variables and DT-based DSS for FAC_DC was analyzed. As a result, RF and DT accurately predicted the FAC_DC measured by the root mean squared error. The root mean squared error of RF and the DT were 1.09 and 1.24 for all participants, 1.20 and 1.06 for those with trauma, and 1.12 and 1.03 for those with non-trauma, respectively. In the analysis of important variables, the initial FAC was found to be the most influential factor in all groups. In addition, we could provide a simple DSS based on strong predictors such as the initial FAC, American Spinal Injury Association Impairment Scale grades, and neurological level of injury. In conclusion, we provide that ML can accurately predict gait recovery after SCI for the first time. By focusing on important variables and DSS, we can guide early prognosis and establish personalized rehabilitation strategies in acute rehabilitation hospitals.
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Affiliation(s)
- Hyun-Joon Yoo
- Korea University Research Institute for Medical Bigdata Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bummo Koo
- School of Health and Environmental Science, Korea University College of Health Science, Seoul, Republic of Korea
| | - Chan-woo Yong
- School of Health and Environmental Science, Korea University College of Health Science, Seoul, Republic of Korea
| | - Kwang-Sig Lee
- AI Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Mihailovic JM, Sanganahalli BG, Hyder F, Chitturi J, Elkabes S, Heary RF, Kannurpatti SS. Cross-hemicord spinal fiber reorganization associates with cortical sensory and motor network expansion in the rat model of hemicontusion cervical spinal cord injury. Neurosci Lett 2024; 820:137607. [PMID: 38141752 PMCID: PMC10797561 DOI: 10.1016/j.neulet.2023.137607] [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: 09/13/2023] [Revised: 12/01/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
Magnetic resonance imaging plays an important role in characterizing microstructural changes and reorganization after traumatic injuries to the nervous system. In this study, we tested the feasibility of ex-vivo spinal cord diffusion tensor imaging (DTI) in combination with in vivo brain functional MRI to characterize spinal reorganization and its supraspinal association after a hemicontusion cervical spinal cord injury (SCI). DTI parameters (fractional anisotropy [FA], mean diffusion [MD]) and fiber orientation changes related to reorganization in the contused cervical spinal cord were compared to sham specimens. Altered fiber density and fiber directions occurred across the ipsilateral and contralateral hemicords but with only ipsilateral FA and MD changes. The hemicontusion SCI resulted in ipsilateral fiber breaks, voids and vivid fiber reorientations along the injury epicenter. Fiber directional changes below the injury level were primarily inter-hemispheric, indicating prominent below-level cross-hemispheric reorganization. In vivo resting state functional connectivity of the brain from the respective rats before obtaining the spinal cord samples indicated spatial expansion and increased connectivity strength across both the sensory and motor networks after SCI. The consistency of the neuroplastic changes along the neuraxis (both brain and spinal cord) at the single-subject level, indicates that distinctive reorganizational relationships exist between the spinal cord and the brain post-SCI.
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Affiliation(s)
- Jelena M Mihailovic
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520, United States.
| | - Basavaraju G Sanganahalli
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520, United States.
| | - Fahmeed Hyder
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520, United States.
| | - Jyothsna Chitturi
- Department of Radiology, Rutgers Biomedical and Health Sciences-New Jersey Medical School, 30 Bergen Street, Newark, NJ 07103, United States
| | - Stella Elkabes
- Department of Neurosurgery, Rutgers Biomedical and Health Sciences-New Jersey Medical School. 205 South Orange Avenue, Newark, NJ 07103, United States.
| | - Robert F Heary
- Division of Neurosurgery, Hackensack Meridian School of Medicine, Mountainside Medical Center, Montclair, NJ, United States.
| | - Sridhar S Kannurpatti
- Department of Radiology, Rutgers Biomedical and Health Sciences-New Jersey Medical School, 30 Bergen Street, Newark, NJ 07103, United States.
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Kurihara K, Sasaki M, Nagahama H, Obara H, Fukushi R, Hirota R, Yoshimoto M, Teramoto A, Kocsis JD, Yamashita T, Honmou O. Repeated intravenous infusion of mesenchymal stem cells enhances recovery of motor function in a rat model with chronic spinal cord injury. Brain Res 2023; 1817:148484. [PMID: 37442249 DOI: 10.1016/j.brainres.2023.148484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
Spinal cord injury (SCI) can cause paralysis with a high disease burden with limited treatment options. A single intravenous infusion of mesenchymal stem cells (MSCs) improves motor function in rat SCI models, possibly through the induction of axonal sprouting and remyelination. Repeated infusions (thrice at weekly intervals) of MSCs were administered to rats with chronic SCI to determine if multiple-dosing regimens enhance motor improvement. Chronic SCI rats were randomized and infused with vehicle (vehicle), single MSC injection at week 6 (MSC-1) or repeatedly injections of MSCs at 6, 7, and 8 weeks (MSC-3) after SCI induction. In addition, a single high dose of MSCs (HD-MSC) equivalent to thrice the single dose was infused at week 6. Locomotor function, light and electron microscopy, immunohistochemistry and ex vivo diffusion tensor imaging were performed. Repeated infusion of MSCs (MSC-3) provided the greatest functional recovery compared to single and single high-dose infusions. The density of remyelinated axons in the injured spinal cord was the greatest in the MSC-3 group, followed by the MSC-1, HD-MSC and vehicle groups. Increased sprouting of the corticospinal tract and serotonergic axon density was the greatest in the MSC-3 group, followed by MSC-1, HD-MSC, and vehicle groups. Repeated infusion of MSCs over three weeks resulted in greater functional improvement than single administration of MSCs, even when the number of infused cells was tripled. MSC-treated rats showed axonal sprouting and remyelination in the chronic phase of SCI.
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Affiliation(s)
- Kota Kurihara
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Masanori Sasaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Hiroshi Nagahama
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Division of Radioisotope Research, Biomedical Research, Education and Instrumentation Center, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8556, Japan
| | - Hisashi Obara
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Ryunosuke Fukushi
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Ryosuke Hirota
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Jeffery D Kocsis
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA; Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA; Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Osamu Honmou
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
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Chen S, Zhang X, Chen X, Zhou Z, Cong W, Chong K, Xu Q, Wu J, Li Z, Lin W, Shan C. The assessment of interhemispheric imbalance using functional near-infrared spectroscopic and transcranial magnetic stimulation for predicting motor outcome after stroke. Front Neurosci 2023; 17:1231693. [PMID: 37655011 PMCID: PMC10466792 DOI: 10.3389/fnins.2023.1231693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
Objective To investigate changes in interhemispheric imbalance of cortical excitability during motor recovery after stroke and to clarify the relationship between motor function recovery and alterations in interhemispheric imbalance, with the aim to establish more effective neuromodulation strategies. Methods Thirty-one patients underwent assessments of resting motor threshold (RMT) using transcranial magnetic stimulation (TMS); the cortical activity of the primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA) using functional near-infrared spectroscopy (fNIRS); as well as motor function using upper extremity Fugl-Meyer (FMA-UE). The laterality index (LI) of RMT and fNIRS were also calculated. All indicators were measured at baseline(T1) and 1 month later(T2). Correlations between motor function outcome and TMS and fNIRS metrics at baseline were analyzed using bivariate correlation. Results All the motor function (FMA-UE1, FMA-UE2, FMA-d2) and LI-RMT (LI-RMT1 and LI-RMT2) had a moderate negative correlation. The higher the corticospinal excitability of the affected hemisphere, the better the motor outcome of the upper extremity, especially in the distal upper extremity (r = -0.366, p = 0.043; r = -0.393, p = 0.029). The greater the activation of the SMA of the unaffected hemisphere, the better the motor outcome, especially in the distal upper extremity (r = -0.356, p = 0.049; r = -0.367, p = 0.042). There was a significant moderate positive correlation observed between LI-RMT2 and LI-SMA1 (r = 0.422, p = 0.018). The improvement in motor function was most significant when both LI-RMT1 and LI-SMA1 were lower. Besides, in patients dominated by unaffected hemisphere corticospinal excitability during motor recovery, LI-(M1 + SMA + PMC)2 exhibited a significant moderate positive association with the proximal upper extremity function 1 month later (r = 0.642, p = 0.007). Conclusion The combination of both TMS and fNIRS can infer the prognosis of motor function to some extent. Which can infer the role of both hemispheres in recovery and may contribute to the development of effective individualized neuromodulation strategies.
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Affiliation(s)
- Songmei Chen
- Department of Rehabilitation Medicine, Shanghai No.3 Rehabilitation Hospital, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaolin Zhang
- Department of Rehabilitation Medicine, Shanghai No.3 Rehabilitation Hospital, Shanghai, China
| | - Xixi Chen
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhiqing Zhou
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weiqin Cong
- Department of Rehabilitation Medicine, Shanghai No.3 Rehabilitation Hospital, Shanghai, China
| | - KaYee Chong
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qing Xu
- Department of Rehabilitation Medicine, Shanghai No.3 Rehabilitation Hospital, Shanghai, China
| | - Jiali Wu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhaoyuan Li
- Department of Rehabilitation Medicine, Shanghai No.3 Rehabilitation Hospital, Shanghai, China
| | - Wanlong Lin
- Department of Rehabilitation Medicine, Shanghai No.3 Rehabilitation Hospital, Shanghai, China
| | - Chunlei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Institute of rehabilitation, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Porcine Model of the Growing Spinal Cord-Changes in Diffusion Tensor Imaging Parameters. Animals (Basel) 2023; 13:ani13040565. [PMID: 36830353 PMCID: PMC9951717 DOI: 10.3390/ani13040565] [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: 11/13/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Diffusion tensor imaging (DTI) is an advanced magnetic resonance imaging (MRI) technique that has promising applications for the objective assessment of the microstructure of the spinal cord. This study aimed to verify the parameters obtained using DTI change during the growth process. We also wanted to identify if the DTI values change on the course of the spinal cord. The model organism was a healthy growing porcine spinal cord (19 pigs, Polish White, weight 24-120 kg, mean 48 kg, median 48 kg, age 2.5-11 months, mean 5 months, median 5.5 months). DTI parameters were measured in three weight groups: up to 29 kg (five pigs), 30-59 kg (six pigs), and from 60 kg up (eight pigs). DTI was performed with a 1.5 Tesla magnetic resonance scanner (Philips, Ingenia). Image post-processing was done using the Fiber Track package (Philips Ingenia workstation) by manually drawing the regions of interest (nine ROIs). The measurements were recorded for three sections: the cervical, thoracolumbar and lumbar segments of the spinal cord at the C4/C5, Th13/L1, and L4/L5 vertebrae levels. In each case, one segment was measured cranially and one caudally from the above-mentioned places. The values of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were obtained for each ROIs and compared. It is shown that there is a correlation between age, weight gain, and change in FA and ADC parameters. Moreover, it is noted that, with increasing weight and age, the FA parameter increases and ADC decreases, whereas the FA and ADC measurement values did not significantly change between the three sections of the spinal cord. These findings could be useful in determining the reference values for the undamaged spinal cords of animals and growing humans.
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Kauthankar AA, Jaseemudheen M. Diffusion Tensor Imaging in Spinal Cord Injury: A Review. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1751068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractMagnetic resonance diffusion tensor imaging (DTI) is a recent technique that can measure the direction and magnitude of diffusion of water. It is widely being utilized to evaluate several brain and spinal cord pathologies. The objective of this review is to evaluate the importance of the DTI in patients with spinal cord injury (SCI). It aims to review various articles on DTI SCI and includes both animal and human studies. This will help to describe the current status of the clinical applications of DTI and show its potential as a helpful instrument in clinical practice. The PubMed database was searched for articles relating to the application of DTI in SCI. Relevant articles were also used for the review. A variety of DTI parameters have been studied in various articles. The standard parameters are fractional anisotropy (FA) values, apparent diffusion coefficient (ADC) values, radial diffusivity values, and axial diffusivity values, followed by tractography. FA and ADC values are the most commonly used parameters. The findings observed in most of the studies are increased FA and reduced ADC values following injury to the spinal cord. DTI data metrics possess the potential to become a potent clinical tool in patients with SCI. It is helpful for diagnosis, prognosis, treatment planning, as well as to evaluate the recovery. Nonetheless, to overcome the limitations and determine its reliability clinically, more research has to be performed.
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Affiliation(s)
- Akshada Atchut Kauthankar
- Department of Radio-diagnosis and Imaging, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - M.M Jaseemudheen
- Department of Radio-diagnosis and Imaging, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
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A musculoskeletal finite element model of rat knee joint for evaluating cartilage biomechanics during gait. PLoS Comput Biol 2022; 18:e1009398. [PMID: 35657996 PMCID: PMC9166403 DOI: 10.1371/journal.pcbi.1009398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/26/2022] [Indexed: 12/02/2022] Open
Abstract
Abnormal loading of the knee due to injuries or obesity is thought to contribute to the development of osteoarthritis (OA). Small animal models have been used for studying OA progression mechanisms. However, numerical models to study cartilage responses under dynamic loading in preclinical animal models have not been developed. Here we present a musculoskeletal finite element model of a rat knee joint to evaluate cartilage biomechanical responses during a gait cycle. The rat knee joint geometries were obtained from a 3-D MRI dataset and the boundary conditions regarding loading in the joint were extracted from a musculoskeletal model of the rat hindlimb. The fibril-reinforced poroelastic (FRPE) properties of the rat cartilage were derived from data of mechanical indentation tests. Our numerical results showed the relevance of simulating anatomical and locomotion characteristics in the rat knee joint for estimating tissue responses such as contact pressures, stresses, strains, and fluid pressures. We found that the contact pressure and maximum principal strain were virtually constant in the medial compartment whereas they showed the highest values at the beginning of the gait cycle in the lateral compartment. Furthermore, we found that the maximum principal stress increased during the stance phase of gait, with the greatest values at midstance. We anticipate that our approach serves as a first step towards investigating the effects of gait abnormalities on the adaptation and degeneration of rat knee joint tissues and could be used to evaluate biomechanically-driven mechanisms of the progression of OA as a consequence of joint injury or obesity. Osteoarthritis is a disease of the musculoskeletal system which is characterized by the degradation of articular cartilage. Changes in the knee loading after injuries or obesity contribute to the development of cartilage degeneration. Since injured cartilage cannot be reversed back to intact conditions, small animal models have been widely used for investigating osteoarthritis progression mechanisms. Moreover, experimental studies have been complemented with numerical models to overcome inherent limitations such as cost, difficulties to obtain accurate measures and replicate degenerative situations in the knee joint. However, computational models to study articular cartilage responses under dynamic loading in small animal models have not been developed. Thus, here we present a musculoskeletal finite element model (MSFE) of a rat knee joint to evaluate cartilage biomechanical responses during gait. Our computational model considers both the anatomical and locomotion characteristics of the rat knee joint for estimating mechanical responses in the articular cartilage. We suggest that our approach can be used to investigate tissue adaptations based on the mechanobiological responses of the cartilage to prevent the progression of osteoarthritis.
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Morales-Guadarrama A, Salgado-Ceballos H, Grijalva I, Morales-Corona J, Hernández-Godínez B, Ibáñez-Contreras A, Ríos C, Diaz-Ruiz A, Cruz GJ, Olayo MG, Sánchez-Torres S, Mondragón-Lozano R, Alvarez-Mejia L, Fabela-Sánchez O, Olayo R. Evolution of Spinal Cord Transection of Rhesus Monkey Implanted with Polymer Synthesized by Plasma Evaluated by Diffusion Tensor Imaging. Polymers (Basel) 2022; 14:polym14050962. [PMID: 35267785 PMCID: PMC8912689 DOI: 10.3390/polym14050962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
In spinal cord injury (SCI) there is damage to the nervous tissue, due to the initial damage and pathophysiological processes that are triggered subsequently. There is no effective therapeutic strategy for motor functional recovery derived from the injury. Several studies have demonstrated neurons growth in cell cultures on polymers synthesized by plasma derived from pyrrole, and the increased recovery of motor function in rats by implanting the polymer in acute states of the SCI in contusion and transection models. In the process of transferring these advances towards humans it is recommended to test in mayor species, such as nonhuman primates, prioritizing the use of non-invasive techniques to evaluate the injury progression with the applied treatments. This work shows the ability of diffusion tensor imaging (DTI) to evaluate the evolution of the SCI in nonhuman primates through the fraction of anisotropy (FA) analysis and the diffusion tensor tractography (DTT) calculus. The injury progression was analysed up to 3 months after the injury day by FA and DTT. The FA recovery and the DTT re-stabilization were observed in the experimental implanted subject with the polymer, in contrast with the non-implanted subject. The parameters derived from DTI are concordant with the histology and the motor functional behaviour.
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Affiliation(s)
- Axayacatl Morales-Guadarrama
- Centro Nacional de Investigación en Imagenología e Instrumentación Médica, Universidad Autónoma Metropolitana Iztapalapa, CDMX, Mexico City 09340, Mexico;
- Departamento de Ingeniería Eléctrica, Universidad Autónoma Metropolitana Iztapalapa, CDMX, Mexico City 09340, Mexico;
- Departamento de Física, Instituto Nacional de Investigaciones Nucleares, Axapusco 52750, Mexico; (G.J.C.); (M.G.O.)
| | - Hermelinda Salgado-Ceballos
- Instituto Mexicano del Seguro Social, Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, CDMX, Mexico City 06720, Mexico; (H.S.-C.); (I.G.); (S.S.-T.); (L.A.-M.)
- Centro de Investigación del Proyecto CAMINA A.C., CDMX, Mexico City 14050, Mexico;
| | - Israel Grijalva
- Instituto Mexicano del Seguro Social, Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, CDMX, Mexico City 06720, Mexico; (H.S.-C.); (I.G.); (S.S.-T.); (L.A.-M.)
- Centro de Investigación del Proyecto CAMINA A.C., CDMX, Mexico City 14050, Mexico;
| | - Juan Morales-Corona
- Departamento de Física, Universidad Autónoma Metropolitana Iztapalapa, CDMX, Mexico City 09340, Mexico;
| | - Braulio Hernández-Godínez
- Investigación Biomédica Aplicada S.A.S. de C.V., CDMX, Mexico City 14240, Mexico; (B.H.-G.); (A.I.-C.)
| | | | - Camilo Ríos
- Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez S.S.A., CDMX, Mexico City 14269, Mexico; (C.R.); (A.D.-R.)
| | - Araceli Diaz-Ruiz
- Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez S.S.A., CDMX, Mexico City 14269, Mexico; (C.R.); (A.D.-R.)
| | - Guillermo Jesus Cruz
- Departamento de Física, Instituto Nacional de Investigaciones Nucleares, Axapusco 52750, Mexico; (G.J.C.); (M.G.O.)
| | - María Guadalupe Olayo
- Departamento de Física, Instituto Nacional de Investigaciones Nucleares, Axapusco 52750, Mexico; (G.J.C.); (M.G.O.)
| | - Stephanie Sánchez-Torres
- Instituto Mexicano del Seguro Social, Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, CDMX, Mexico City 06720, Mexico; (H.S.-C.); (I.G.); (S.S.-T.); (L.A.-M.)
- Centro de Investigación del Proyecto CAMINA A.C., CDMX, Mexico City 14050, Mexico;
| | - Rodrigo Mondragón-Lozano
- Centro de Investigación del Proyecto CAMINA A.C., CDMX, Mexico City 14050, Mexico;
- Catedrático CONACyT-Instituto Mexicano del Seguro Social, Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, CDMX, Mexico City 06720, Mexico
| | - Laura Alvarez-Mejia
- Instituto Mexicano del Seguro Social, Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades Centro Médico Nacional Siglo XXI, CDMX, Mexico City 06720, Mexico; (H.S.-C.); (I.G.); (S.S.-T.); (L.A.-M.)
- Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez S.S.A., CDMX, Mexico City 14269, Mexico; (C.R.); (A.D.-R.)
| | - Omar Fabela-Sánchez
- Departamento de Ingeniería Eléctrica, Universidad Autónoma Metropolitana Iztapalapa, CDMX, Mexico City 09340, Mexico;
- Departamento de Química Macromoléculas y Nanomateriales, Centro de Investigación en Química Aplicada, Saltillo 25294, Mexico
| | - Roberto Olayo
- Departamento de Física, Universidad Autónoma Metropolitana Iztapalapa, CDMX, Mexico City 09340, Mexico;
- Correspondence:
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Spinelli M, Boucard C, Ornaghi S, Schoeberlein A, Irene K, Coman D, Hyder F, Zhang L, Haesler V, Bordey A, Barnea E, Paidas M, Surbek D, Mueller M. Preimplantation factor modulates oligodendrocytes by H19-induced demethylation of NCOR2. JCI Insight 2021; 6:132335. [PMID: 34676826 PMCID: PMC8564895 DOI: 10.1172/jci.insight.132335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
Failed or altered gliogenesis is a major characteristic of diffuse white matter injury in survivors of premature birth. The developmentally regulated long noncoding RNA (lncRNA) H19 inhibits S-adenosylhomocysteine hydrolase (SAHH) and contributes to methylation of diverse cellular components, such as DNA, RNA, proteins, lipids, and neurotransmitters. We showed that the pregnancy-derived synthetic PreImplantation Factor (sPIF) induces expression of the nuclear receptor corepressor 2 (NCOR2) via H19/SAHH-mediated DNA demethylation. In turn, NCOR2 affects oligodendrocyte differentiation markers. Accordingly, after hypoxic-ischemic brain injury in rodents, myelin protection and oligodendrocytes' fate are in part modulated by sPIF and H19. Our results revealed an unexpected mechanism of the H19/SAHH axis underlying myelin preservation during brain recovery and its use in treating neurodegenerative diseases can be envisioned.
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Affiliation(s)
- Marialuigia Spinelli
- Department of Obstetrics and Gynecology and Department of Biomedical Research, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Celiné Boucard
- Department of Obstetrics and Gynecology and Department of Biomedical Research, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Sara Ornaghi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andreina Schoeberlein
- Department of Obstetrics and Gynecology and Department of Biomedical Research, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Keller Irene
- Department for Biomedical Research and Swiss Institute of Bioinformatics, University of Bern, Bern, Switzerland
| | | | - Fahmeed Hyder
- Department of Radiology and Biomedical Imaging.,Department of Biomedical Engineering
| | - Longbo Zhang
- Department of Neurosurgery, and Department of Cellular & Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Valérie Haesler
- Department of Obstetrics and Gynecology and Department of Biomedical Research, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Angelique Bordey
- Department of Neurosurgery, and Department of Cellular & Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eytan Barnea
- Department of Research, BioIncept LLC, New York, New York, USA
| | - Michael Paidas
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel Surbek
- Department of Obstetrics and Gynecology and Department of Biomedical Research, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Martin Mueller
- Department of Obstetrics and Gynecology and Department of Biomedical Research, University Hospital Bern, University of Bern, Bern, Switzerland.,Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
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10
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Neckel ND, Dai H, Hanckel J, Lee Y, Albanese C, Rodriguez O. Skilled reach training enhances robotic gait training to restore overground locomotion following spinal cord injury in rats. Behav Brain Res 2021; 414:113490. [PMID: 34358574 DOI: 10.1016/j.bbr.2021.113490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
Rehabilitative training has been shown to improve motor function following spinal cord injury (SCI). Unfortunately, these gains are primarily task specific; where reach training only improves reaching, step training only improves stepping and stand training only improves standing. More troublesome is the tendency that the improvement in a trained task often comes at the expense of an untrained task. However, the task specificity of training does not preclude the benefits of combined rehabilitative training. Here we show that robot assisted gait training alone can partially reduce the deficits in unassisted overground locomotion following a C4/5 overhemisection injury in rats. When robot-assisted gait training is done in conjunction with skilled forelimb training, we observe a much greater level of recovery of unassisted overground locomotion. In order to provide reach training that would not interfere with our robotic gait training schedule, we prompted rats to increase the use of their forelimbs by replacing the standard overhead feeder with a custom made, deep welled hopper that dispensed nutritionally equivalent small milled pellets. We speculate that the increase in recovery from combined training is due to a more robust interneuronal relay network around the injury site. in vivo manganese-enhanced magnetic resonance imaging of the spinal cord indicated that there was no increase in the cellular activity, however ex vivo diffusion tensor imaging (DTI) suggested an increase in collateralization around the injury site in rats that received both reach training and robot assisted gait training.
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Affiliation(s)
- Nathan D Neckel
- Department of Neuroscience, Georgetown University, United States; Department of Rehabilitation Medicine, Georgetown University, United States.
| | - Haining Dai
- Department of Neuroscience, Georgetown University, United States
| | - John Hanckel
- Department of Neuroscience, Georgetown University, United States
| | - Yichien Lee
- Department of Oncology, Georgetown University, United States; Center for Translational Imaging, Georgetown University, United States
| | - Christopher Albanese
- Department of Oncology, Georgetown University, United States; Center for Translational Imaging, Georgetown University, United States
| | - Olga Rodriguez
- Department of Oncology, Georgetown University, United States; Center for Translational Imaging, Georgetown University, United States
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11
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Diffusion weighted imaging as a biomarker of retinoic acid induced myelomeningocele. PLoS One 2021; 16:e0253583. [PMID: 34191842 PMCID: PMC8244849 DOI: 10.1371/journal.pone.0253583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/08/2021] [Indexed: 12/16/2022] Open
Abstract
Neural tube defects are a common congenital anomaly involving incomplete closure of the spinal cord. Myelomeningocele (MMC) is a severe form in which there is complete exposure of neural tissue with a lack of skin, soft tissue, or bony covering to protect the spinal cord. The all-trans retinoic acid (ATRA) induced rat model of (MMC) is a reproducible, cost-effective means of studying this disease; however, there are limited modalities to objectively quantify disease severity, or potential benefits from experimental therapies. We sought to determine the feasibility of detecting differences between MMC and wild type (WT) rat fetuses using diffusion magnetic resonance imaging techniques (MRI). Rat dams were gavage-fed ATRA to produce MMC defects in fetuses, which were surgically delivered prior to term. Average diffusion coefficient (ADC) and fractional anisotropy (FA) maps were obtained for each fetus. Brain volumes and two anatomically defined brain length measurements (D1 and D2) were significantly decreased in MMC compared to WT. Mean ADC signal was significantly increased in MMC compared to WT, but no difference was found for FA signal. In summary, ADC and brain measurements were significantly different between WT and MMC rat fetuses. ADC could be a useful complementary imaging biomarker to current histopathologic analysis of MMC models, and potentially expedite therapeutic research for this disease.
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12
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McLachlin S, Leung J, Sivan V, Quirion PO, Wilkie P, Cohen-Adad J, Whyne CM, Hardisty MR. Spatial correspondence of spinal cord white matter tracts using diffusion tensor imaging, fibre tractography, and atlas-based segmentation. Neuroradiology 2021; 63:373-380. [PMID: 33447915 DOI: 10.1007/s00234-021-02635-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Neuroimaging provides great utility in complex spinal surgeries, particularly when anatomical geometry is distorted by pathology (tumour, degeneration, etc.). Spinal cord MRI diffusion tractography can be used to generate streamlines; however, it is unclear how well they correspond with white matter tract locations along the cord microstructure. The goal of this work was to evaluate the spatial correspondence of DTI tractography with anatomical MRI in healthy anatomy (where anatomical locations can be well defined in T1-weighted images). METHODS Ten healthy volunteers were scanned on a 3T system. T1-weighted (1 × 1 × 1 mm) and diffusion-weighted images (EPI readout, 2 × 2 × 2 mm, 30 gradient directions) were acquired and subsequently registered (Spinal Cord Toolbox (SCT)). Atlas-based (SCT) anatomic label maps of the left and right lateral corticospinal tracts were identified for each vertebral region (C2-C6) from T1 images. Tractography streamlines were generated with a customized approach, enabling seeding of specific spinal tract regions corresponding to individual vertebral levels. Spatial correspondence of generated fibre streamlines with anatomic tract segmentations was compared in unseeded regions of interest (ROIs). RESULTS Spatial correspondence of the lateral corticospinal tract streamlines was good over a single vertebral ROI (Dice's similarity coefficient (DSC) = 0.75 ± 0.08, Hausdorff distance = 1.08 ± 0.17 mm). Over larger ROI, fair agreement between tractography and anatomical labels was achieved (two levels: DSC = 0.67 ± 0.13, three levels: DSC = 0.52 ± 0.19). CONCLUSION DTI tractography produced good spatial correspondence with anatomic white matter tracts, superior to the agreement between multiple manual tract segmentations (DSC ~ 0.5). This supports further development of spinal cord tractography for computer-assisted neurosurgery.
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Affiliation(s)
- Stewart McLachlin
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, E7 3424, Waterloo, Ontario, N2L 3G1, Canada
| | - Jason Leung
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, 2075 Bayview Ave, S621, Toronto, Ontario, M4N 3M5, Canada
| | - Vignesh Sivan
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, 2075 Bayview Ave, S621, Toronto, Ontario, M4N 3M5, Canada
| | - Pierre-Olivier Quirion
- Department of Electrical Engineering, Polytechnique Montreal, Ecole Polytechnique, Pavillon Lassonde, 2700 Ch de la Tour, L-5610, Montréal, Quebec, H3T 1N8, Canada
| | - Phoenix Wilkie
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, 2075 Bayview Ave, S621, Toronto, Ontario, M4N 3M5, Canada
| | - Julien Cohen-Adad
- Department of Electrical Engineering, Polytechnique Montreal, Ecole Polytechnique, Pavillon Lassonde, 2700 Ch de la Tour, L-5610, Montréal, Quebec, H3T 1N8, Canada
| | - Cari Marisa Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, 2075 Bayview Ave, S621, Toronto, Ontario, M4N 3M5, Canada
- Department of Surgery, University of Toronto, 2075 Bayview Ave, S621, Toronto, Ontario, M4N 3M5, Canada
| | - Michael Raymond Hardisty
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, 2075 Bayview Ave, S621, Toronto, Ontario, M4N 3M5, Canada.
- Department of Surgery, University of Toronto, 2075 Bayview Ave, S621, Toronto, Ontario, M4N 3M5, Canada.
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13
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Intravenous delivery of mesenchymal stem cells protects both white and gray matter in spinal cord ischemia. Brain Res 2020; 1747:147040. [DOI: 10.1016/j.brainres.2020.147040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022]
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14
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da Costa RC, De Decker S, Lewis MJ, Volk H. Diagnostic Imaging in Intervertebral Disc Disease. Front Vet Sci 2020; 7:588338. [PMID: 33195623 PMCID: PMC7642913 DOI: 10.3389/fvets.2020.588338] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/09/2020] [Indexed: 12/27/2022] Open
Abstract
Imaging is integral in the diagnosis of canine intervertebral disc disease (IVDD) and in differentiating subtypes of intervertebral disc herniation (IVDH). These include intervertebral disc extrusion (IVDE), intervertebral disc protrusion (IVDP) and more recently recognized forms such as acute non-compressive nucleus pulposus extrusion (ANNPE), hydrated nucleus pulposus extrusion (HNPE), and intradural/intramedullary intervertebral disc extrusion (IIVDE). Many imaging techniques have been described in dogs with roles for survey radiographs, myelography, computed tomography (CT), and magnetic resonance imaging (MRI). Given how common IVDH is in dogs, a thorough understanding of the indications and limitations for each imaging modality to aid in diagnosis, treatment planning and prognosis is essential to successful case management. While radiographs can provide useful information, especially for identifying intervertebral disc degeneration or calcification, there are notable limitations. Myelography addresses some of the constraints of survey radiographs but has largely been supplanted by cross-sectional imaging. Computed tomography with or without myelography and MRI is currently utilized most widely and have become the focus of most contemporary studies on this subject. Novel advanced imaging applications are being explored in dogs but are not yet routinely performed in clinical patients. The following review will provide a comprehensive overview on common imaging modalities reported to aid in the diagnosis of IVDH including IVDE, IVDP, ANNPE, HNPE, and IIVDE. The review focuses primarily on canine IVDH due to its frequency and vast literature as opposed to feline IVDH.
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Affiliation(s)
- Ronaldo C da Costa
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
| | - Steven De Decker
- Department of Clinical Sciences and Services, Royal Veterinary College, London, United Kingdom
| | - Melissa J Lewis
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, United States
| | - Holger Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover, Hanover, Germany
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15
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Longitudinal changes in DTI parameters of specific spinal white matter tracts correlate with behavior following spinal cord injury in monkeys. Sci Rep 2020; 10:17316. [PMID: 33057016 PMCID: PMC7560889 DOI: 10.1038/s41598-020-74234-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 09/23/2020] [Indexed: 12/27/2022] Open
Abstract
This study aims to evaluate how parameters derived from diffusion tensor imaging reflect axonal disruption and demyelination in specific white matter tracts within the spinal cord of squirrel monkeys following traumatic injuries, and their relationships to function and behavior. After a unilateral section of the dorsal white matter tract of the cervical spinal cord, we found that both lesioned dorsal and intact lateral tracts on the lesion side exhibited prominent disruptions in fiber orientation, integrity and myelination. The degrees of pathological changes were significantly more severe in segments below the lesion than above. The lateral tract on the opposite (non-injured) side was minimally affected by the injury. Over time, RD, FA, and AD values of the dorsal and lateral tracts on the injured side closely tracked measurements of the behavioral recovery. This unilateral section of the dorsal spinal tract provides a realistic model in which axonal disruption and demyelination occur together in the cord. Our data show that specific tract and segmental FA and RD values are sensitive to the effects of injury and reflect specific behavioral changes, indicating their potential as relevant indicators of recovery or for assessing treatment outcomes. These observations have translational value for guiding future studies of human subjects with spinal cord injuries.
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16
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Fiani B, Noblett C, Nanney J, Doan T, Pennington E, Jarrah R, Sarno E, Nikolaidis D. Diffusion tensor imaging of the spinal cord status post trauma. Surg Neurol Int 2020; 11:276. [PMID: 33033638 PMCID: PMC7538980 DOI: 10.25259/sni_495_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background Since its development in 1994, diffusion tensor imaging (DTI) has been successfully used to assess structural and functional changes to neurological tissue within the central nervous system. Namely, DTI is a noninvasive magnetic resonance imaging (MRI)-based technique that uses anisotropic diffusion to visualize and estimate the organization of white matter in neuronal tissue. It has been used to study various spinal pathologies including neoplastic diseases, degenerative myelopathy, demyelinating diseases, and infections involving the spinal cord. However, due to technical uncertainties and experimental limitations, DTI has rarely been clinically applied to assess trauma-related spinal pathologies. Methods An extensive review of the published literature on DTI was performed utilizing PubMed, OVID Medline, and EMBASE journals. Terms used for the search included DTI and spine trauma. Results The search yielded full text English language-related articles regarding DTIs application, limitations, and functional outcomes secondary to spinal trauma. Conclusion DTI relies on anisotropy in CNS tissues to determine the spatial orientation of surrounding axon tracts and define anatomical boundaries. Diffusion along three principle axes is used to calculate the following four DTI indices; fractional anisotropy, apparent diffusion coefficient (ADC), longitudinal ADC, and transverse ADC. Using DTI as a diagnostic tool status, post spine trauma has proven useful in examining the morphological and physiological extent of spinal lesions beyond conventional MRI. Experimental studies are now utilizing DTI to analyze the severity of spinal cord trauma during the hyperacute phase and may potentially be used to providing additional diagnostic information for improved treatment efficiency (e.g., as shown during the stem cell therapy trials).
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA
| | - Christian Noblett
- College of Osteopathic Medicine, University of New England, Biddeford, ME
| | - Jacob Nanney
- College of Medicine, University of Kentucky, Lexington, KY
| | - Thao Doan
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | | | - Ryan Jarrah
- College of Literature, Arts, and Sciences, University of Michigan-Flint, Flint, MI, United States
| | - Erika Sarno
- College of Osteopathic Medicine, Michigan State University, East Lansing
| | - Daniel Nikolaidis
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
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ÖZTÜRK G, SİLAV G, İNCİR S, ARSLANHAN A, AKÇETİN MA, TOKTAŞ OZ, KONYA D. Ratlarda Deneysel Spinal Kord Hasar Modelinde Genisteinin Nöroprotektif Etkisinin Araştırılması, Diffüz Tensor Görüntüleme ile Değerlendirilmesi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.38079/igusabder.742525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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18
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Yang Y, Cao TT, Tian ZM, Gao H, Wen HQ, Pang M, He WJ, Wang NX, Chen YY, Wang Y, Li H, Lin JW, Kang Z, Li MM, Liu B, Rong LM. Subarachnoid transplantation of human umbilical cord mesenchymal stem cell in rodent model with subacute incomplete spinal cord injury: Preclinical safety and efficacy study. Exp Cell Res 2020; 395:112184. [PMID: 32707134 DOI: 10.1016/j.yexcr.2020.112184] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/22/2022]
Abstract
Functional multipotency renders human umbilical cord mesenchymal stem cell (hUC-MSC) a promising candidate for the treatment of spinal cord injury (SCI). However, its safety and efficacy have not been fully understood for clinical translation. In this study, we performed cellular, kinematic, physiological, and anatomical analyses, either in vitro or in vivo, to comprehensively evaluate the safety and efficacy associated with subarachnoid transplantation of hUC-MSCs in rats with subacute incomplete SCI. Concerning safety, hUC-MSCs were shown to have normal morphology, excellent viability, steady proliferation, typical biomarkers, stable karyotype in vitro, and no tumorigenicity both in vitro and in vivo. Following subarachnoid transplantation of hUC-MSCs in the subject rodents, the biodistribution of hUC-MSCs was restricted to the spinal cord, and no toxicity to immune system or organ function was observed. Body weight, organ weight, and the ratio of the latter upon the former between stem cell-transplanted rats and placebo-injected rats revealed no statistical differences. Regarding efficacy, hUC-MSCs could differentiate into osteoblasts, chondrocytes, adipocytes and neural progenitor cells in vitro. While in vivo studies revealed that subarachnoid transplantation of stem cells resulted in significant improvement in locomotion, earlier automatic micturition recovery and reduced lesion size, which correlated with increased regeneration of tracking fiber and reduced parenchymal inflammation. In vivo luminescence imaging showed that a few of the transplanted luciferase-labeled hUC-MSCs tended to migrate towards the lesion epicenter. Shortened latency and enhanced amplitude were also observed in both motor and sensory evoked potentials, indicating improved signal conduction in the damaged site. Immunofluorescent staining confirmed that a few of the administrated hUC-MSCs integrated into the spinal cord parenchyma and differentiated into astrocytes and oligodendrocytes, but not neurons. Moreover, decreased astrogliosis, increased remyelination, and neuron regeneration could be observed. To the best of our knowledge, this preclinical study provides detailed safety and efficacy evidence regarding intrathecal transplantation of hUC-MSCs in treating SCI for the first time and thus, supports its initiation in the following clinical trial.
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Affiliation(s)
- Yang Yang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China
| | - Ting-Ting Cao
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhen-Ming Tian
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China
| | - Han Gao
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China
| | - Hui-Quan Wen
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China
| | - Mao Pang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China
| | - Wei-Jie He
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China
| | - Nan-Xiang Wang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China
| | - Yu-Yong Chen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China
| | - Yang Wang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China
| | - He Li
- Department of Physiology, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, Guangdong Province, People's Republic of China
| | - Jun-Wei Lin
- Department of Obstetrics, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhuang Kang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China
| | - Mang-Mang Li
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, 1023 Shatai South Road, Baiyun District, Guangzhou, Guangdong Province, People's Republic of China.
| | - Bin Liu
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China.
| | - Li-Min Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, People's Republic of China.
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Zaninovich OA, Avila MJ, Kay M, Becker JL, Hurlbert RJ, Martirosyan NL. The role of diffusion tensor imaging in the diagnosis, prognosis, and assessment of recovery and treatment of spinal cord injury: a systematic review. Neurosurg Focus 2020; 46:E7. [PMID: 30835681 DOI: 10.3171/2019.1.focus18591] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/07/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVEDiffusion tensor imaging (DTI) is an MRI tool that provides an objective, noninvasive, in vivo assessment of spinal cord injury (SCI). DTI is significantly better at visualizing microstructures than standard MRI sequences. In this imaging modality, the direction and amplitude of the diffusion of water molecules inside tissues is measured, and this diffusion can be measured using a variety of parameters. As a result, the potential clinical application of DTI has been studied in several spinal cord pathologies, including SCI. The aim of this study was to describe the current state of the potential clinical utility of DTI in patients with SCI and the challenges to its use as a tool in clinical practice.METHODSA search in the PubMed database was conducted for articles relating to the use of DTI in SCI. The citations of relevant articles were also searched for additional articles.RESULTSAmong the most common DTI metrics are fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. Changes in these metrics reflect changes in tissue integrity. Several DTI metrics and combinations thereof have demonstrated significant correlations with clinical function both in model species and in humans. Its applications encompass the full spectrum of the clinical assessment of SCI including diagnosis, prognosis, recovery, and efficacy of treatments in both the spinal cord and potentially the brain.CONCLUSIONSDTI and its metrics have great potential to become a powerful clinical tool in SCI. However, the current limitations of DTI preclude its use beyond research and into clinical practice. Further studies are needed to significantly improve and resolve these limitations as well as to determine reliable time-specific changes in multiple DTI metrics for this tool to be used accurately and reliably in the clinical setting.
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Affiliation(s)
| | | | - Matthew Kay
- 3Department of Medical Imaging, University of Arizona, Tucson, Arizona
| | - Jennifer L Becker
- 3Department of Medical Imaging, University of Arizona, Tucson, Arizona
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Shanmuganathan K, Zhuo J, Bodanapally UK, Kuladeep S, Aarabi B, Adams J, Miller C, Gullapallie RP, Menakar J. Comparison of Acute Diffusion Tensor Imaging and Conventional Magnetic Resonance Parameters in Predicting Long-Term Outcome after Blunt Cervical Spinal Cord Injury. J Neurotrauma 2020; 37:458-465. [DOI: 10.1089/neu.2019.6394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
| | - Jiachen Zhuo
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Uttam K. Bodanapally
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sudini Kuladeep
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jason Adams
- Department of Rehabilitation Services, University of Maryland School of Medicine, Baltimore, Maryland
| | - Catriona Miller
- Aeromedical Research Department, U.S. Air Force School of Aerospace Medicine, Center for the Sustainment of Trauma and Readiness Skills, Baltimore, Maryland
| | - Rao P. Gullapallie
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jay Menakar
- R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
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21
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Liu XY, Liang J, Wang Y, Zhong L, Zhao CY, Wei MG, Wang JJ, Sun XZ, Wang KQ, Duan JH, Chen C, Tu Y, Zhang S, Ming D, Li XH. Diffusion tensor imaging predicting neurological repair of spinal cord injury with transplanting collagen/chitosan scaffold binding bFGF. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:123. [PMID: 31686219 DOI: 10.1007/s10856-019-6322-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
Prognosis and treatment evaluation of spinal cord injury (SCI) are still in the long-term research stage. Prognostic factors for SCI treatment need effective biomarker to assess therapeutic effect. Quantitative diffusion tensor imaging (DTI) may become a potential indicators for assessing SCI repair. However, its correlation with the results of locomotor function recovery and tissue repair has not been carefully studied. The aim of this study was to use quantitative DTI to predict neurological repair of SCI with transplanting collagen/chitosan scaffold binding basic fibroblast growth factor (bFGF). To achieve our research goals, T10 complete transection SCI model was established. Then collagen/chitosan mixture adsorbed with bFGF (CCS/bFGF) were implanted into rats with SCI. At 8 weeks after modeling, implanting CCS/bFGF demonstrated more significant improvements in locomotor function according to Basso-Beattie-Bresnahan (BBB) score, inclined-grid climbing test, and electrophysiological examinations. DTI was carried out to evaluate the repair of axons by diffusion tensor tractgraphy (DTT), fractional anisotropy (FA) and apparent diffusion coefficient (ADC), a numerical measure of relative white matter from the rostral to the caudal. Parallel to locomotor function recovery, the CCS/bFGF group could significantly promote the regeneration of nerve fibers tracts according to DTT, magnetic resonance imaging (MRI), Bielschowsky's silver staining and immunofluorescence staining. Positive correlations between imaging and locomotor function or histology were found at all locations from the rostral to the caudal (P < 0.0001). These results demonstrated that DTI might be used as an effective predictor for evaluating neurological repair after SCI in experimental trails and clinical cases.
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Affiliation(s)
- Xiao-Yin Liu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Characteristic Medical Center of PAPF, Tianjin, 300162, China
- Tianjin Medical University, Qixiangtai Road No. 22, Tianjin, 300070, China
| | - Jun Liang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Yi Wang
- Department of Neurology, Tianjin Hospital of Tianjin, Tianjin, 300211, China
| | - Lin Zhong
- Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Chang-Yu Zhao
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Characteristic Medical Center of PAPF, Tianjin, 300162, China
| | - Meng-Guang Wei
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Characteristic Medical Center of PAPF, Tianjin, 300162, China
| | - Jing-Jing Wang
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Characteristic Medical Center of PAPF, Tianjin, 300162, China
| | - Xiao-Zhe Sun
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Characteristic Medical Center of PAPF, Tianjin, 300162, China
| | - Ke-Qiang Wang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Jing-Hao Duan
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Chong Chen
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Characteristic Medical Center of PAPF, Tianjin, 300162, China
| | - Yue Tu
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Characteristic Medical Center of PAPF, Tianjin, 300162, China
| | - Sai Zhang
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Characteristic Medical Center of PAPF, Tianjin, 300162, China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China.
| | - Xiao-Hong Li
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China.
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Poplawski MM, Alizadeh M, Oleson CV, Fisher J, Marino RJ, Gorniak RJ, Leiby BE, Flanders AE. Application of Diffusion Tensor Imaging in Forecasting Neurological Injury and Recovery after Human Cervical Spinal Cord Injury. J Neurotrauma 2019; 36:3051-3061. [DOI: 10.1089/neu.2018.6092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Michael M. Poplawski
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mahdi Alizadeh
- Department of Neurosurgery, Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christina V. Oleson
- Department of Physical Medicine and Rehabilitation, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Joshua Fisher
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph J. Marino
- Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Richard J. Gorniak
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin E. Leiby
- Department of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam E. Flanders
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
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23
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Pukos N, Goodus MT, Sahinkaya FR, McTigue DM. Myelin status and oligodendrocyte lineage cells over time after spinal cord injury: What do we know and what still needs to be unwrapped? Glia 2019; 67:2178-2202. [PMID: 31444938 DOI: 10.1002/glia.23702] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/04/2023]
Abstract
Spinal cord injury (SCI) affects over 17,000 individuals in the United States per year, resulting in sudden motor, sensory and autonomic impairments below the level of injury. These deficits may be due at least in part to the loss of oligodendrocytes and demyelination of spared axons as it leads to slowed or blocked conduction through the lesion site. It has long been accepted that progenitor cells form new oligodendrocytes after SCI, resulting in the acute formation of new myelin on demyelinated axons. However, the chronicity of demyelination and the functional significance of remyelination remain contentious. Here we review work examining demyelination and remyelination after SCI as well as the current understanding of oligodendrocyte lineage cell responses to spinal trauma, including the surprisingly long-lasting response of NG2+ oligodendrocyte progenitor cells (OPCs) to proliferate and differentiate into new myelinating oligodendrocytes for months after SCI. OPCs are highly sensitive to microenvironmental changes, and therefore respond to the ever-changing post-SCI milieu, including influx of blood, monocytes and neutrophils; activation of microglia and macrophages; changes in cytokines, chemokines and growth factors such as ciliary neurotrophic factor and fibroblast growth factor-2; glutamate excitotoxicity; and axon degeneration and sprouting. We discuss how these changes relate to spontaneous oligodendrogenesis and remyelination, the evidence for and against demyelination being an important clinical problem and if remyelination contributes to motor recovery.
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Affiliation(s)
- Nicole Pukos
- Neuroscience Graduate Program, Ohio State University, Columbus, Ohio.,Belford Center for Spinal Cord Injury, Ohio State University, Columbus, Ohio
| | - Matthew T Goodus
- Belford Center for Spinal Cord Injury, Ohio State University, Columbus, Ohio.,Department of Neuroscience, Wexner Medical Center, Ohio State University, Columbus, Ohio
| | - Fatma R Sahinkaya
- Neuroscience Graduate Program, Ohio State University, Columbus, Ohio
| | - Dana M McTigue
- Belford Center for Spinal Cord Injury, Ohio State University, Columbus, Ohio.,Department of Neuroscience, Wexner Medical Center, Ohio State University, Columbus, Ohio
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24
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David G, Seif M, Huber E, Hupp M, Rosner J, Dietz V, Weiskopf N, Mohammadi S, Freund P. In vivo evidence of remote neural degeneration in the lumbar enlargement after cervical injury. Neurology 2019; 92:e1367-e1377. [PMID: 30770423 PMCID: PMC6511094 DOI: 10.1212/wnl.0000000000007137] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/07/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To characterize remote secondary neurodegeneration of spinal tracts and neurons below a cervical spinal cord injury (SCI) and its relation to the severity of injury, the integrity of efferent and afferent pathways, and clinical impairment. METHODS A comprehensive high-resolution MRI protocol was acquired in 17 traumatic cervical SCI patients and 14 controls at 3T. At the cervical lesion, a sagittal T2-weighted scan provided information on the width of preserved midsagittal tissue bridges. In the lumbar enlargement, high-resolution T2*-weighted and diffusion-weighted scans were used to calculate tissue-specific cross-sectional areas and diffusion indices, respectively. Regression analyses determined associations between MRI readouts and the electrophysiologic and clinical measures. RESULTS At the cervical injury level, preserved midsagittal tissue bridges were present in the majority of patients. In the lumbar enlargement, neurodegeneration-in terms of macrostructural and microstructural MRI changes-was evident in the white matter and ventral and dorsal horns. Patients with thinner midsagittal tissue bridges had smaller ventral horn area, higher radial diffusivity in the gray matter, smaller motor evoked potential amplitude from the lower extremities, and lower motor score. In addition, smaller width of midsagittal tissue bridges was also associated with smaller tibialis sensory evoked potential amplitude and lower light-touch score. CONCLUSIONS This study shows extensive tissue-specific cord pathology in infralesional spinal networks following cervical SCI, its magnitude relating to lesion severity, electrophysiologic integrity, and clinical impairment of the lower extremity. The clinical eloquence of remote neurodegenerative changes speaks to the application of neuroimaging biomarkers in diagnostic workup and planning of clinical trials.
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Affiliation(s)
- Gergely David
- From the Spinal Cord Injury Center Balgrist (G.D., M.S., E.H., M.H., J.R., V.D., P.F.), University Hospital Zurich, University of Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, London, UK; Department of Neurophysics (M.S., N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maryam Seif
- From the Spinal Cord Injury Center Balgrist (G.D., M.S., E.H., M.H., J.R., V.D., P.F.), University Hospital Zurich, University of Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, London, UK; Department of Neurophysics (M.S., N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eveline Huber
- From the Spinal Cord Injury Center Balgrist (G.D., M.S., E.H., M.H., J.R., V.D., P.F.), University Hospital Zurich, University of Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, London, UK; Department of Neurophysics (M.S., N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Hupp
- From the Spinal Cord Injury Center Balgrist (G.D., M.S., E.H., M.H., J.R., V.D., P.F.), University Hospital Zurich, University of Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, London, UK; Department of Neurophysics (M.S., N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Rosner
- From the Spinal Cord Injury Center Balgrist (G.D., M.S., E.H., M.H., J.R., V.D., P.F.), University Hospital Zurich, University of Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, London, UK; Department of Neurophysics (M.S., N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volker Dietz
- From the Spinal Cord Injury Center Balgrist (G.D., M.S., E.H., M.H., J.R., V.D., P.F.), University Hospital Zurich, University of Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, London, UK; Department of Neurophysics (M.S., N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaus Weiskopf
- From the Spinal Cord Injury Center Balgrist (G.D., M.S., E.H., M.H., J.R., V.D., P.F.), University Hospital Zurich, University of Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, London, UK; Department of Neurophysics (M.S., N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Siawoosh Mohammadi
- From the Spinal Cord Injury Center Balgrist (G.D., M.S., E.H., M.H., J.R., V.D., P.F.), University Hospital Zurich, University of Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, London, UK; Department of Neurophysics (M.S., N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Freund
- From the Spinal Cord Injury Center Balgrist (G.D., M.S., E.H., M.H., J.R., V.D., P.F.), University Hospital Zurich, University of Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging (N.W., S.M., P.F.), UCL Institute of Neurology, London, UK; Department of Neurophysics (M.S., N.W., P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig; and Department of Systems Neuroscience (S.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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25
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Changes in diffusion tensor imaging indices of the lumbosacral enlargement correlate with cervical spinal cord changes and clinical assessment in patients with cervical spondylotic myelopathy. Clin Neurol Neurosurg 2019; 186:105282. [PMID: 31569059 DOI: 10.1016/j.clineuro.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/03/2019] [Accepted: 02/09/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We examined whether changes in diffusion tensor imaging (DTI) indices of the lumbosacral enlargement are similar to those at the cervical level, and correlate with clinical assessments in patients with cervical spondylotic myelopathy (CSM). PATIENTS AND METHODS Patients with CSM and healthy volunteers (40-42/group) received DTI scans at both lumbosacral enlargement and cervical spinal cord. Modified Japanese Orthopedic Association (mJOA) score was also recorded for those with CSM. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values of DTI in the two groups were compared. We also examined the correlation between DTI indices (ADC and FA) of the lumbosacral enlargement and those of the cervical spinal cord, and between DTI indices and mJOA in the CSM group. RESULTS Compared with the values of healthy subjects, the ADC values of patients with CSM were significantly increased, and FA values were significantly decreased at both cervical spinal cord and lumbosacral enlargement. Changes in FA value of the cervical cord showed a positive correlation to those of the lumbosacral enlargement in the CSM group. Importantly, a linear correlation was detected between mJOA score and DTI indices (ADC and FA) of the cervical cord, as well as FA value of the lumbosacral enlargement in the CSM group. CONCLUSION DTI indices, especially FA, of the lumbosacral enlargement correlate with clinical assessments of patients with CSM, and hence may be useful for evaluating the severity of cervical cord injury.
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26
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Evaluation of hyperbaric oxygen therapy for spinal cord injury in rats with different treatment course using diffusion tensor imaging. Spinal Cord 2019; 57:404-411. [PMID: 30643168 DOI: 10.1038/s41393-018-0238-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/26/2018] [Accepted: 12/20/2018] [Indexed: 12/20/2022]
Abstract
STUDY DESIGN Animal study. OBJECTIVES To evaluate the efficacy of hyperbaric oxygen (HBO) therapy for spinal cord injury (SCI) in rats with different treatment course using diffusion tensor imaging (DTI). SETTING Hospital in Fuzhou, China. METHODS Fifty adult Sprague-Dawley rats were grouped as: (A) sham-operated group (n = 10); (B) SCI without HBO therapy group (n = 10); (C) SCI with HBO therapy for 2 weeks (SCI+HBO2W) group (n = 10); (D) SCI with HBO therapy for 4 weeks (SCI+HBO4W) group (n = 10); (E) SCI with HBO therapy for 6 weeks (SCI+HBO6W) group (n = 10). Basso Beattie Bresnahan (BBB) scores and diffusion tensor imaging parameters including fractional anisotropy (FA), mean diffusivity (MD), radial diffusion (RD), and axial diffusion (AD) values in the injury epicenter, as well as 2 mm rostral and caudal to the injury epicenter were collected and analyzed 6 weeks post-injury. RESULTS Higher BBB score and FA values were found in the SCI+HBO4W group than in the SCI and SCI+HBO2W groups (all P < 0.05), whereas no significant differences of these metrics were observed between the SCI+HBO4W and SCI+HBO6W groups. MD and RD values of the SCI+HBO4W group were significantly lower than those of the SCI group (all P < 0.01). FA values were positively correlated with BBB scores. MD and RD values were negatively correlated with BBB scores. CONCLUSION DTI parameters, especially FA, could non-invasively and quantifiably evaluate the efficacy of HBO treatment for rats with SCI and 4 weeks may be the more appropriate treatment course.
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27
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Diogo CC, da Costa LM, Pereira JE, Filipe V, Couto PA, Geuna S, Armada-da-Silva PA, Maurício AC, Varejão ASP. Kinematic and kinetic gait analysis to evaluate functional recovery in thoracic spinal cord injured rats. Neurosci Biobehav Rev 2019; 98:18-28. [PMID: 30611796 DOI: 10.1016/j.neubiorev.2018.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/16/2018] [Accepted: 12/24/2018] [Indexed: 12/29/2022]
Abstract
The recovery of walking function following spinal cord injury (SCI) is of major importance to patients and clinicians. In experimental SCI studies, a rat model is widely used to assess walking function, following thoracic spinal cord lesion. In an effort to provide a resource which investigators can refer to when seeking the most appropriate functional assay, the authors have compiled and categorized the behavioral assessments used to measure the deficits and recovery of the gait in thoracic SCI rats. These categories include kinematic and kinetic measurements. Within this categorization, we discuss the advantages and disadvantages of each type of measurement. The present review includes the type of outcome data that they produce, the technical difficulty and the time required to potentially train the animals to perform them, and the need for expensive or highly specialized equipment. The use of multiple kinematic and kinetic parameters is recommended to identify subtle deficits and processes involved in the compensatory mechanisms of walking function after experimental thoracic SCI in rats.
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Affiliation(s)
- Camila Cardoso Diogo
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Quinta de Prados, 5000-801 Vila Real, Portugal
| | - Luís Maltez da Costa
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Quinta de Prados, 5000-801 Vila Real, Portugal; CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Quinta de Prados, 5000-801 Vila Real, Portugal
| | - José Eduardo Pereira
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Quinta de Prados, 5000-801 Vila Real, Portugal; CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Quinta de Prados, 5000-801 Vila Real, Portugal
| | - Vítor Filipe
- Department of Engineering, School of Science and Technology, University of Trás-os-Montes e Alto Douro, UTAD, Quinta de Prados, 5000-801 Vila Real, Portugal; INESC TEC, Rua Dr. Roberto Frias, 4200 - 465 Porto, Portugal
| | - Pedro Alexandre Couto
- Department of Engineering, School of Science and Technology, University of Trás-os-Montes e Alto Douro, UTAD, Quinta de Prados, 5000-801 Vila Real, Portugal; CITAB, Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes e Alto Douro, Quinta de Prados, 5000-801 Vila Real, Portugal
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Paulo A Armada-da-Silva
- Faculdade de Motricidade Humana (FMH), Universidade de Lisboa (ULisboa), Estrada da Costa, 1499-002, Dafundo, Cruz Quebrada, Portugal; CIPER-FMH: Centro Interdisciplinar de Estudo de Performance Humana, Faculdade de Motricidade Humana (FMH), Universidade de Lisboa (ULisboa), Estrada da Costa, 1499-002, Cruz Quebrada - Dafundo, Portugal
| | - Ana Colette Maurício
- Department of Veterinary Clinics, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313 Porto, Portugal; Animal Science and Study Centre (CECA), Institute of Sciences, Technologies and Agroenvironment of the University of Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401, Porto, Portugal
| | - Artur S P Varejão
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Quinta de Prados, 5000-801 Vila Real, Portugal; CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Quinta de Prados, 5000-801 Vila Real, Portugal.
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28
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Motovylyak A, Skinner NP, Schmit BD, Wilkins N, Kurpad SN, Budde MD. Longitudinal In Vivo Diffusion Magnetic Resonance Imaging Remote from the Lesion Site in Rat Spinal Cord Injury. J Neurotrauma 2018; 36:1389-1398. [PMID: 30259800 DOI: 10.1089/neu.2018.5964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Diffusion tensor imaging (DTI) has demonstrated success as a biomarker of spinal cord injury (SCI) severity as shown from numerous pre-clinical studies. However, artifacts from stabilization hardware at the lesion have precluded its use for longitudinal assessments. Previous research has documented ex vivo diffusion changes in the spinal cord both caudal and cranial to the injury epicenter. The aim of this study was to use a rat contusion model of SCI to evaluate the utility of in vivo cervical DTI after a thoracic injury. Forty Sprague-Dawley rats underwent a thoracic contusion (T8) of mild, moderate, severe, or sham severity. Magnetic resonance imaging (MRI) of the cervical cord was performed at 2, 30, and 90 days post-injury, and locomotor performance was assessed weekly using the Basso, Bresnahan, and Beattie (BBB) scoring scale. The relationships between BBB scores and MRI were assessed using region of interest analysis and voxel-wise linear regression of DTI, and free water elimination (FWE) modeling to reduce partial volume effects. At 90 days, axial diffusivity (ADFWE), mean diffusivity (MDFWE), and free water fraction (FWFFWE) using the FWE model were found to be significantly correlated with BBB score. FWE was found to be more predictive of injury severity than conventional DTI, specifically at later time-points. This study validated the use of FWE technique in spinal cord and demonstrated its sensitivity to injury remotely.
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Affiliation(s)
- Alice Motovylyak
- 1 Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathan P Skinner
- 2 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,3 Medical Scientist Training Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian D Schmit
- 1 Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Natasha Wilkins
- 2 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shekar N Kurpad
- 2 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew D Budde
- 2 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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29
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Testing Pathological Variation of White Matter Tract in Adult Rats after Severe Spinal Cord Injury with MRI. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4068156. [PMID: 30534561 PMCID: PMC6252222 DOI: 10.1155/2018/4068156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/07/2018] [Accepted: 10/15/2018] [Indexed: 01/21/2023]
Abstract
The purpose of this study was to assess the pathological variation in white matter tracts in the adult severe thoracic contusion spinal cord injury (SCI) rat models combined with in vivo magnetic resonance imaging (MRI), as well as the effect of spared white matter (WM) quantity on hindlimb motor function recovery. 7.0T MRI was conducted for all experimental animals before SCI and 1, 3, 7, and 14 days after SCI. The variation in the white matter tract in different regions of the spinal cord after SCI was examined by luxol fast blue (LFB) staining, NF200 immunochemistry, and diffusion tensor imaging (DTI) parameters, including fraction anisotropy, mean diffusivity, axial diffusion, and radial diffusivity. Meanwhile, Basso-Beattie-Bresnahan (BBB) open-field scoring was performed to evaluate the behavior of the paraplegic hind limbs. The quantitative analysis showed that spared white matter measures assessed by LFB and MRI had a close correlation (R2 = 0.8508). The percentage of spared white matter area was closely correlated with BBB score (R2 = 0.8460). After SCI, spared white matter in the spinal cord, especially the ventral column WM, played a critical role in motor function restoration. The results suggest that the first three days provides a key time window for SCI protection and treatment; spared white matter, especially in the ventral column, plays a key role in motor function recovery in rats. Additionally, DTI may be an important noninvasive technique to diagnose acute SCI degree as well as a tool to evaluate functional prognosis. During the transition from nerve protection toward clinical treatment after SCI, in vivo DTI may serve as an emerging noninvasive technique to diagnose acute SCI degree and predict the degree of spontaneous functional recovery after SCI.
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30
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Nagahama H, Nakazaki M, Sasaki M, Kataoka-Sasaki Y, Namioka T, Namioka A, Oka S, Onodera R, Suzuki J, Sasaki Y, Kocsis JD, Honmou O. Preservation of interhemispheric cortical connections through corpus callosum following intravenous infusion of mesenchymal stem cells in a rat model of cerebral infarction. Brain Res 2018; 1695:37-44. [PMID: 29802840 DOI: 10.1016/j.brainres.2018.05.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/09/2018] [Accepted: 05/22/2018] [Indexed: 01/01/2023]
Abstract
Systemic administration of mesenchymal stem cells (MSCs) following cerebral infarction exerts functional improvements. Previous research has suggested potential therapeutic mechanisms that promote neuroprotection and synaptogenesis. These include secretion of neurotrophic factors, remodeling of neural circuits, restoration of the blood brain barrier, reduction of inflammatory infiltration and demyelination, and elevation of trophic factors. In addition to these mechanisms, we hypothesized that restored interhemispheric bilateral motor cortex connectivity might be an additional mechanism of functional recovery. In the present study, we have shown, with both MRI diffusion tensor imaging (DTI) and neuroanatomical tracing techniques using an adeno-associated virus (AAV) expressing GFP, that there was anatomical restoration of cortical interhemispheric connections through the corpus callosum after intravenous infusion of MSCs in a rat middle cerebral artery occlusion (MCAO) stroke model. Moreover, the degree of connectivity was greater in the MSC-treated group than in the vehicle-infused group. In accordance, both the thickness of corpus callosum and synaptic puncta in the contralateral (non-infarcted) motor cortex connected to the corpus callosum were greater in the MSC-treated group than in the vehicle group. Together, these results suggest that distinct preservation of interhemispheric cortical connections through corpus callosum was promoted by intravenous infusion of MSCs. This anatomical preservation of the motor cortex in the contralateral hemisphere may contribute to functional improvements following MSC therapy for cerebral stroke.
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Affiliation(s)
- Hiroshi Nagahama
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Masahito Nakazaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Masanori Sasaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA; Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
| | - Yuko Kataoka-Sasaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Takahiro Namioka
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Ai Namioka
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Shinichi Oka
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Rie Onodera
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Junpei Suzuki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Yuichi Sasaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Jeffery D Kocsis
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA; Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Osamu Honmou
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA; Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, CT 06516, USA
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31
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Yao S, Yu S, Cao Z, Yang Y, Yu X, Mao HQ, Wang LN, Sun X, Zhao L, Wang X. Hierarchically aligned fibrin nanofiber hydrogel accelerated axonal regrowth and locomotor function recovery in rat spinal cord injury. Int J Nanomedicine 2018; 13:2883-2895. [PMID: 29844671 PMCID: PMC5961640 DOI: 10.2147/ijn.s159356] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Designing novel biomaterials that incorporate or mimic the functions of extracellular matrix to deliver precise regulatory signals for tissue regeneration is the focus of current intensive research efforts in tissue engineering and regenerative medicine. METHODS AND RESULTS To mimic the natural environment of the spinal cord tissue, a three-dimensional hierarchically aligned fibrin hydrogel (AFG) with oriented topography and soft stiffness has been fabricated by electrospinning and a concurrent molecular self-assembling process. In this study, the AFG was implanted into a rat dorsal hemisected spinal cord injury model to bridge the lesion site. Host cells invaded promptly along the aligned fibrin hydrogels to form aligned tissue cables in the first week, and then were followed by axonal regrowth. At 4 weeks after the surgery, neurofilament (NF)-positive staining fibers were detected near the rostral end as well as the middle site of defect, which aligned along the tissue cables. Abundant NF- and GAP-43-positive staining indicated new axon regrowth in the oriented tissue cables, which penetrated throughout the lesion site in 8 weeks. Additionally, the abundant blood vessels marked with RECA-1 had reconstructed within the lesion site at 4 weeks after surgery. Basso-Beattie-Bresnahan scoring showed that the locomotor performance of the AFG group recovered much faster than that of blank control group or the random fibrin hydrogel (RFG) group from 2 weeks after surgery. Furthermore, diffusion tensor imaging tractography of MRI confirmed the optimal axon fiber reconstruction compared with the RFG and control groups. CONCLUSION Taken together, our results suggested that the AFG scaffold provided an inductive matrix for accelerating directional host cell invasion, vascular system reconstruction, and axonal regrowth, which could promote and support extensive aligned axonal regrowth and locomotor function recovery.
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Affiliation(s)
- Shenglian Yao
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, China
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, China
| | - Shukui Yu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Cao
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, China
| | - Yongdong Yang
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, China
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xing Yu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hai-Quan Mao
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Lu-Ning Wang
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, China
| | - Xiaodan Sun
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, China
| | - Lingyun Zhao
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, China
| | - Xiumei Wang
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, China
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32
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Dong F, Wu Y, Song P, Qian Y, Wang Y, Xu L, Yin M, Zhang R, Tao H, Ge P, Liu C, Zhang H, Zhu J, Shen C, Yu Y. A preliminary study of 3.0-T magnetic resonance diffusion tensor imaging in cervical spondylotic myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1839-1845. [DOI: 10.1007/s00586-018-5579-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/05/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
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Tae WS, Ham BJ, Pyun SB, Kang SH, Kim BJ. Current Clinical Applications of Diffusion-Tensor Imaging in Neurological Disorders. J Clin Neurol 2018; 14:129-140. [PMID: 29504292 PMCID: PMC5897194 DOI: 10.3988/jcn.2018.14.2.129] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 12/11/2022] Open
Abstract
Diffusion-tensor imaging (DTI) is a noninvasive medical imaging tool used to investigate the structure of white matter. The signal contrast in DTI is generated by differences in the Brownian motion of the water molecules in brain tissue. Postprocessed DTI scalars can be used to evaluate changes in the brain tissue caused by disease, disease progression, and treatment responses, which has led to an enormous amount of interest in DTI in clinical research. This review article provides insights into DTI scalars and the biological background of DTI as a relatively new neuroimaging modality. Further, it summarizes the clinical role of DTI in various disease processes such as amyotrophic lateral sclerosis, multiple sclerosis, Parkinson's disease, Alzheimer's dementia, epilepsy, ischemic stroke, stroke with motor or language impairment, traumatic brain injury, spinal cord injury, and depression. Valuable DTI postprocessing tools for clinical research are also introduced.
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Affiliation(s)
- Woo Suk Tae
- Brain Convergence Research Center, Korea University, Seoul, Korea
| | - Byung Joo Ham
- Brain Convergence Research Center, Korea University, Seoul, Korea
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Sung Bom Pyun
- Brain Convergence Research Center, Korea University, Seoul, Korea
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Shin Hyuk Kang
- Brain Convergence Research Center, Korea University, Seoul, Korea
- Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea
| | - Byung Jo Kim
- Brain Convergence Research Center, Korea University, Seoul, Korea
- Department of Neurology, Korea University College of Medicine, Seoul, Korea.
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34
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Budde MD, Skinner NP, Muftuler LT, Schmit BD, Kurpad SN. Optimizing Filter-Probe Diffusion Weighting in the Rat Spinal Cord for Human Translation. Front Neurosci 2017; 11:706. [PMID: 29311786 PMCID: PMC5742102 DOI: 10.3389/fnins.2017.00706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/01/2017] [Indexed: 12/15/2022] Open
Abstract
Diffusion tensor imaging (DTI) is a promising biomarker of spinal cord injury (SCI). In the acute aftermath, DTI in SCI animal models consistently demonstrates high sensitivity and prognostic performance, yet translation of DTI to acute human SCI has been limited. In addition to technical challenges, interpretation of the resulting metrics is ambiguous, with contributions in the acute setting from both axonal injury and edema. Novel diffusion MRI acquisition strategies such as double diffusion encoding (DDE) have recently enabled detection of features not available with DTI or similar methods. In this work, we perform a systematic optimization of DDE using simulations and an in vivo rat model of SCI and subsequently implement the protocol to the healthy human spinal cord. First, two complementary DDE approaches were evaluated using an orientationally invariant or a filter-probe diffusion encoding approach. While the two methods were similar in their ability to detect acute SCI, the filter-probe DDE approach had greater predictive power for functional outcomes. Next, the filter-probe DDE was compared to an analogous single diffusion encoding (SDE) approach, with the results indicating that in the spinal cord, SDE provides similar contrast with improved signal to noise. In the SCI rat model, the filter-probe SDE scheme was coupled with a reduced field of view (rFOV) excitation, and the results demonstrate high quality maps of the spinal cord without contamination from edema and cerebrospinal fluid, thereby providing high sensitivity to injury severity. The optimized protocol was demonstrated in the healthy human spinal cord using the commercially-available diffusion MRI sequence with modifications only to the diffusion encoding directions. Maps of axial diffusivity devoid of CSF partial volume effects were obtained in a clinically feasible imaging time with a straightforward analysis and variability comparable to axial diffusivity derived from DTI. Overall, the results and optimizations describe a protocol that mitigates several difficulties with DTI of the spinal cord. Detection of acute axonal damage in the injured or diseased spinal cord will benefit the optimized filter-probe diffusion MRI protocol outlined here.
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Affiliation(s)
- Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Nathan P Skinner
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States.,Medical Scientist Training Program, Medical College of Wisconsin, Milwaukee, WI, United States
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
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35
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Lewis MJ, Yap PT, McCullough S, Olby NJ. The Relationship between Lesion Severity Characterized by Diffusion Tensor Imaging and Motor Function in Chronic Canine Spinal Cord Injury. J Neurotrauma 2017; 35:500-507. [PMID: 28974151 DOI: 10.1089/neu.2017.5255] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Lesion heterogeneity among chronically paralyzed dogs after acute, complete thoracolumbar spinal cord injury (TLSCI) is poorly described. We hypothesized that lesion severity quantified by diffusion tensor imaging (DTI) is associated with hindlimb motor function. Our objectives were to quantify lesion severity with fractional anisotropy (FA), mean diffusivity (MD), and tractography and investigate associations with motor function. Twenty-two dogs with complete TLSCI in the chronic stage were enrolled and compared with six control dogs. All underwent thoracolumbar magnetic resonance imaging (MRI) with DTI and gait analysis. FA and MD were calculated on regions of interest (ROI) at the lesion epicenter and cranial and caudal to the visible lesion on conventional MRI and in corresponding ROI in controls. Tractography was performed to detect translesional fibers. Gait was quantified using an ordinal scale (OFS). FA and MD values were compared between cases and controls, and relationships between FA, MD, presence of translesional fibers and OFS were investigated. The FA at the epicenter (median: 0.228, 0.107-0.320), cranial (median: 0.420, 0.391-0.561), and caudal to the lesion (median: 0.369, 0.265-0.513) was lower than combined ROI in controls (median: 0.602, 0.342-0.826, p < 0.0001). The MD at the epicenter (median: 2.06 × 10-3, 1.33-2.96 × 10-3) and cranially (median: 1.52 × 10-3, 1.03-1.87 × 10-3) was higher than combined ROI in controls (median: 1.28 × 10-3, 0.81-1.44 × 10-3, p ≤ 0.001). Four dogs had no translesional fibers. Median OFS was 2 (0-6). The FA at the lesion epicenter and presence of translesional fibers were associated with OFS (p ≤ 0.0299). DTI can detect degeneration and physical transection after severe TLSCI. Findings suggest DTI quantifies injury severity and suggests motor recovery in apparently complete dogs is because of supraspinal input.
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Affiliation(s)
- Melissa J Lewis
- 1 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University , Raleigh, North Carolina.,2 Comparative Medicine Institute, North Carolina State University , Raleigh, North Carolina
| | - Pew-Thian Yap
- 3 Department of Radiology, School of Medicine, University of North Carolina , Chapel Hill, North Carolina
| | - Susan McCullough
- 4 Animal Scan Advanced Veterinary Imaging , Raleigh, North Carolina
| | - Natasha J Olby
- 1 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University , Raleigh, North Carolina.,2 Comparative Medicine Institute, North Carolina State University , Raleigh, North Carolina
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36
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Shanmuganathan K, Zhuo J, Chen HH, Aarabi B, Adams J, Miller C, Menakar J, Gullapalli RP, Mirvis SE. Diffusion Tensor Imaging Parameter Obtained during Acute Blunt Cervical Spinal Cord Injury in Predicting Long-Term Outcome. J Neurotrauma 2017; 34:2964-2971. [DOI: 10.1089/neu.2016.4901] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Jaichen Zhuo
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hegang H. Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jason Adams
- Department of Rehabilitation Services, University of Maryland School of Medicine, Baltimore, Maryland
| | - Catriona Miller
- Department of Aeromedical Research, U.S. Air Force School of Aerospace Medicine, Research Initiatives, US Air Force c-STARS Baltimore, Baltimore, Maryland
| | - Jay Menakar
- R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rao P. Gullapalli
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stuart E. Mirvis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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37
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Ganz J, Shor E, Guo S, Sheinin A, Arie I, Michaelevski I, Pitaru S, Offen D, Levenberg S. Implantation of 3D Constructs Embedded with Oral Mucosa-Derived Cells Induces Functional Recovery in Rats with Complete Spinal Cord Transection. Front Neurosci 2017; 11:589. [PMID: 29163001 PMCID: PMC5671470 DOI: 10.3389/fnins.2017.00589] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/06/2017] [Indexed: 12/23/2022] Open
Abstract
Spinal cord injury (SCI), involving damaged axons and glial scar tissue, often culminates in irreversible impairments. Achieving substantial recovery following complete spinal cord transection remains an unmet challenge. Here, we report of implantation of an engineered 3D construct embedded with human oral mucosa stem cells (hOMSC) induced to secrete neuroprotective, immunomodulatory, and axonal elongation-associated factors, in a complete spinal cord transection rat model. Rats implanted with induced tissue engineering constructs regained fine motor control, coordination and walking pattern in sharp contrast to the untreated group that remained paralyzed (42 vs. 0%). Immunofluorescence, CLARITY, MRI, and electrophysiological assessments demonstrated a reconnection bridging the injured area, as well as presence of increased number of myelinated axons, neural precursors, and reduced glial scar tissue in recovered animals treated with the induced cell-embedded constructs. Finally, this construct is made of bio-compatible, clinically approved materials and utilizes a safe and easily extractable cell population. The results warrant further research with regards to the effectiveness of this treatment in addressing spinal cord injury.
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Affiliation(s)
- Javier Ganz
- Department of Human Molecular Genetics and Biochemistry, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erez Shor
- Department of Biomedical Engineering, Technion, Haifa, Israel
| | - Shaowei Guo
- Department of Biomedical Engineering, Technion, Haifa, Israel
| | - Anton Sheinin
- Department of Neurobiology, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ina Arie
- Department of Oral Biology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Izhak Michaelevski
- Department of Neurobiology, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel.,Department of Molecular Biology, Faculty of Natural Sciences, Ariel University, Ariel, Israel
| | - Sandu Pitaru
- Department of Oral Biology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Offen
- Department of Human Molecular Genetics and Biochemistry, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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38
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Liu Y, Kong C, Cui L, Yuan X, Zhao P, Zhang Y, Guan Y, Chen X. Correlation between diffusion tensor imaging parameters and clinical assessments in patients with cervical spondylotic myelopathy with and without high signal intensity. Spinal Cord 2017; 55:1079-1083. [PMID: 28872149 DOI: 10.1038/sc.2017.75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 05/03/2017] [Accepted: 05/22/2017] [Indexed: 12/16/2022]
Abstract
STUDY DESIGN A cross-sectional observational study. OBJECTIVES The aim of this study is to compare the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) between patients with cervical spondylotic myelopathy (CSM) with and without high T2-weighted signal intensity, and to correlate each parameter with clinical assessments. SETTING CSM is a common cause of spinal cord dysfunction. The significance of T2 high signal intensity in the prognosis of CSM remains controversial. METHODS Diffusion tensor imaging was performed at the cervical spinal cord in 40 patients with CSM and 42 healthy subjects. Patients with high signal intensity were separated from those without high signal intensity. ADC and FA values were compared among different groups, and the correlation between each parameter and the modified Japanese Orthopedic Association (mJOA) score was examined. RESULTS The ADC and FA values of C2/3 differed significantly from those of C5/6 and C6/7 in healthy subjects. Patients with CSM had a higher ADC but a lower FA value than did healthy subjects. In all patients with CSM, there was a negative linear correlation between ADC and mJOA score, but FA value correlated positively with mJOA score. Secondary analysis suggested that FA value in patients with high signal intensity was lower than that in patients without high signal intensity. FA value showed a positive linear correlation with mJOA score in the patients with high signal intensity but not in the patients without high signal intensity. CONCLUSIONS Patients with high signal intensity may have more severe spinal cord injury than patients without high signal intensity, and FA may be a useful indicator of functional status in patients with CSM with high signal intensity.
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Affiliation(s)
- Y Liu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - C Kong
- Department of Orthopedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - L Cui
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - X Yuan
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - P Zhao
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Y Zhang
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Y Guan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - X Chen
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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39
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Wang-Leandro A, Hobert MK, Alisauskaite N, Dziallas P, Rohn K, Stein VM, Tipold A. Spontaneous acute and chronic spinal cord injuries in paraplegic dogs: a comparative study of in vivo diffusion tensor imaging. Spinal Cord 2017; 55:1108-1116. [DOI: 10.1038/sc.2017.83] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/12/2017] [Accepted: 06/20/2017] [Indexed: 12/17/2022]
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40
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Gu M, Gao Z, Li X, Zhao F, Guo L, Liu J, He X. Feasibility of Diffusion Tensor Imaging for Assessing Functional Recovery in Rats with Olfactory Ensheathing Cell Transplantation After Contusive Spinal Cord Injury (SCI). Med Sci Monit 2017. [PMID: 28623671 PMCID: PMC5484594 DOI: 10.12659/msm.902126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Olfactory ensheathing cell transplantation is a promising treatment for spinal cord injury. Diffusion tensor imaging has been applied to assess various kinds of spinal cord injury. However, it has rarely been used to evaluate the beneficial effects of olfactory ensheathing cell transplantation. This study aimed to explore the feasibility of diffusion tensor imaging in the evaluation of functional recovery in rats with olfactory ensheathing cell transplantation after contusive spinal cord injury. Material/Methods Immunofluorescence staining was performed to determine the purity of olfactory ensheathing cells. Rats received cell transplantation at week 1 after injury. Basso, Beattie, and Bresnahan score was used to assess the functional recovery. Magnetic resonance imaging was applied weekly, including diffusion tensor imaging. Diffusion tensor tractography was reconstructed to visualize the repair process. Results The results showed that olfactory ensheathing cell transplantation increased the functional and histological recovery and restrained the secondary injury process after the initial spinal cord injury. The fractional anisotropy values in rats with cell transplantation were significantly higher than those in the control group, while the apparent diffusion coefficient values were significantly lower. Basso, Beattie, and Bresnahan score was positively and linearly correlated with fractional anisotropy value, and it was negatively and linearly correlated with apparent diffusion coefficient value. Conclusions These findings suggest that diffusion tensor imaging parameters are sensitive biomarker indices for olfactory ensheathing cell transplantation interventions, and diffusion tensor imaging scan can reflect the functional recovery promoted by the olfactory ensheathing cell transplantation after contusive spinal cord injury.
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Affiliation(s)
- Mengchao Gu
- Department of Othopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Zhengchao Gao
- Department of Othopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xiaohui Li
- Department of Radiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Feng Zhao
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Lei Guo
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Jiantao Liu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xijing He
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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41
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Cohen Y, Anaby D, Morozov D. Diffusion MRI of the spinal cord: from structural studies to pathology. NMR IN BIOMEDICINE 2017; 30:e3592. [PMID: 27598689 DOI: 10.1002/nbm.3592] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 06/01/2016] [Accepted: 07/05/2016] [Indexed: 05/27/2023]
Abstract
Diffusion MRI is extensively used to study brain microarchitecture and pathologies, and water diffusion appears highly anisotropic in the white matter (WM) of the spinal cord (SC). Despite these facts, the use of diffusion MRI to study the SC, which has increased in recent years, is much less common than that in the brain. In the present review, after a brief outline of early studies of diffusion MRI (DWI) and diffusion tensor MRI (DTI) of the SC, we provide a short survey on DTI and on diffusion MRI methods beyond the tensor that have been used to study SC microstructure and pathologies. After introducing the porous view of WM and describing the q-space approach and q-space diffusion MRI (QSI), we describe other methodologies that can be applied to study the SC. Selected applications of the use of DTI, QSI, and other more advanced diffusion MRI methods to study SC microstructure and pathologies are presented, with some emphasis on the use of less conventional diffusion methodologies. Because of length constraints, we concentrate on structural studies and on a few selected pathologies. Examples of the use of diffusion MRI to study dysmyelination, demyelination as in experimental autoimmune encephalomyelitis and multiple sclerosis, amyotrophic lateral sclerosis, and traumatic SC injury are presented. We conclude with a brief summary and a discussion of challenges and future directions for diffusion MRI of the SC. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yoram Cohen
- The Sackler School of Chemistry, The Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
- The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Debbie Anaby
- The Sackler School of Chemistry, The Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Darya Morozov
- The Sackler School of Chemistry, The Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
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42
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Haefeli J, Mabray MC, Whetstone WD, Dhall SS, Pan JZ, Upadhyayula P, Manley GT, Bresnahan JC, Beattie MS, Ferguson AR, Talbott JF. Multivariate Analysis of MRI Biomarkers for Predicting Neurologic Impairment in Cervical Spinal Cord Injury. AJNR Am J Neuroradiol 2017; 38:648-655. [PMID: 28007771 PMCID: PMC5671488 DOI: 10.3174/ajnr.a5021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/04/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Acute markers of spinal cord injury are essential for both diagnostic and prognostic purposes. The goal of this study was to assess the relationship between early MR imaging biomarkers after acute cervical spinal cord injury and to evaluate their predictive validity of neurologic impairment. MATERIALS AND METHODS We performed a retrospective cohort study of 95 patients with acute spinal cord injury and preoperative MR imaging within 24 hours of injury. The American Spinal Injury Association Impairment Scale was used as our primary outcome measure to define neurologic impairment. We assessed several MR imaging features of injury, including axial grade (Brain and Spinal Injury Center score), sagittal grade, length of injury, maximum canal compromise, and maximum spinal cord compression. Data-driven nonlinear principal component analysis was followed by correlation and optimal-scaled multiple variable regression to predict neurologic impairment. RESULTS Nonlinear principal component analysis identified 2 clusters of MR imaging variables related to 1) measures of intrinsic cord signal abnormality and 2) measures of extrinsic cord compression. Neurologic impairment was best accounted for by MR imaging measures of intrinsic cord signal abnormality, with axial grade representing the most accurate predictor of short-term impairment, even when correcting for surgical decompression and degree of cord compression. CONCLUSIONS This study demonstrates the utility of applying nonlinear principal component analysis for defining the relationship between MR imaging biomarkers in a complex clinical syndrome of cervical spinal cord injury. Of the assessed imaging biomarkers, the intrinsic measures of cord signal abnormality were most predictive of neurologic impairment in acute spinal cord injury, highlighting the value of axial T2 MR imaging.
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Affiliation(s)
- J Haefeli
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - M C Mabray
- Radiology and Biomedical Imaging (M.C.M., J.F.T.)
| | - W D Whetstone
- Emergency Medicine (W.D.W.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - S S Dhall
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - J Z Pan
- Anesthesia and Perioperative Care (J.Z.P.), University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California.,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - P Upadhyayula
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - G T Manley
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - J C Bresnahan
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - M S Beattie
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - A R Ferguson
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.) .,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).,San Francisco VA Medical Center (A.R.F.), San Francisco, California
| | - J F Talbott
- Radiology and Biomedical Imaging (M.C.M., J.F.T.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
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Effect of hierarchically aligned fibrin hydrogel in regeneration of spinal cord injury demonstrated by tractography: A pilot study. Sci Rep 2017; 7:40017. [PMID: 28067245 PMCID: PMC5220328 DOI: 10.1038/srep40017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 12/01/2016] [Indexed: 12/26/2022] Open
Abstract
Some studies have reported that scaffold or cell-based transplantation may improve functional recovery following SCI, but no imaging information regarding regeneration has been provided to date. This study used tractography to show the regenerating process induced by a new biomaterial-aligned fibrin hydrogel (AFG). A total of eight canines subjected to SCI procedures were assigned to the control or the AFG group. AFG was implanted into the SCI lesion immediately after injury in 5 canines. A follow-up was performed at 12 weeks to evaluate the therapeutic effect including the hindlimb functional recovery, anisotropy and continuity of fibers on tractography. Using tractography, we found new fibers running across the SCI in three canines of the AFG group. Further histological examination confirmed limited glial scarring and regenerated nerve fibers in the lesions. Moreover, Repeated Measures Analysis revealed a significantly different change in fractional anisotropy (FA) between the two groups during the follow-up interval. An increase in FA during the post injury time interval was detected in the AFG group, indicating a beneficial effect of AFG in the rehabilitation of injured axons. Using tractography, AFG was suggested to be helpful in the restoration of fibers in SCI lesions, thus leading to promoted functional recovery.
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Gu M, Gao Z, Li X, Guo L, Lu T, Li Y, He X. Conditioned medium of olfactory ensheathing cells promotes the functional recovery and axonal regeneration after contusive spinal cord injury. Brain Res 2017; 1654:43-54. [DOI: 10.1016/j.brainres.2016.10.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/05/2016] [Accepted: 10/22/2016] [Indexed: 01/15/2023]
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Zhao P, Kong C, Chen X, Guan H, Yu Z, Cui L, Wang Y, Yuan X. In vivo diffusion tensor imaging of chronic spinal cord compression : a rat model with special attention to the conus medullaris. Acta Radiol 2016; 57:1531-1539. [PMID: 26893214 DOI: 10.1177/0284185116631185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Few studies have focused on diffusion tensor imaging (DTI) parameters of the conus medullaris after chronic compression in the cervical spinal cord. Purpose To discuss the correlation of DTI parameters between the chronically compressed cervical spinal cord and the conus medullaris in a rat model at different time points. Material and Methods Fifty female Sprague-Dawley rats were randomized into five groups: control group (group A), sham group (group B), and test groups C, D, and E (1, 2, and 3 weeks after compression, respectively). Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values of the cervical spinal cord and conus medullaris were compared among different groups. Correlations of ADC and FA values of the cervical spinal cord with those of the conus medullaris were performed in all groups. Results The ADC values at the cervical spinal cord and conus medullaris in all test groups were higher than those of group A and B, while the FA values were lower. The ADC value of the cervical spinal cord was linearly correlated with that of the conus medullaris only in group D. There were no linear correlations of FA values between the cervical spinal cord and the conus medullaris in all test groups. Conclusion After compression of the cervical spinal cord, ADC values of the cervical spinal cord and conus medullaris in test group were significantly increased, while FA values were significantly decreased. The ADC value of the cervical spinal cord was linearly correlated with that of the conus medullaris at 2 weeks after compression.
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Affiliation(s)
- Peng Zhao
- Beijing Luhe Hospital, Capital Medical University, Beijing, PR China
| | - Chao Kong
- Beijing Luhe Hospital, Capital Medical University, Beijing, PR China
| | - Xueming Chen
- Beijing Luhe Hospital, Capital Medical University, Beijing, PR China
| | - Hua Guan
- Beijing Luhe Hospital, Capital Medical University, Beijing, PR China
| | - Zhenshan Yu
- Beijing Luhe Hospital, Capital Medical University, Beijing, PR China
| | - Libin Cui
- Beijing Luhe Hospital, Capital Medical University, Beijing, PR China
| | - Yanhui Wang
- Beijing Luhe Hospital, Capital Medical University, Beijing, PR China
| | - Xin Yuan
- Beijing Luhe Hospital, Capital Medical University, Beijing, PR China
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Brennan FH, Kurniawan ND, Vukovic J, Bartlett PF, Käsermann F, Arumugam TV, Basta M, Ruitenberg MJ. IVIg attenuates complement and improves spinal cord injury outcomes in mice. Ann Clin Transl Neurol 2016; 3:495-511. [PMID: 27386499 PMCID: PMC4931715 DOI: 10.1002/acn3.318] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 12/22/2022] Open
Abstract
Objective Traumatic spinal cord injury (SCI) elicits immediate neural cell death, axonal damage, and disruption of the blood–spinal cord barrier, allowing circulating immune cells and blood proteins into the spinal parenchyma. The inflammatory response to SCI involves robust complement system activation, which contributes to secondary injury and impairs neurological recovery. This study aimed to determine whether intravenous immunoglobulin (IVIg), an FDA‐approved treatment for inflammatory conditions, can scavenge complement activation products and improve recovery from contusive SCI. Methods We used functional testing, noninvasive imaging, and detailed postmortem analysis to assess whether IVIg therapy is effective in a mouse model of severe contusive SCI. Results IVIg therapy at doses of 0.5–2 g/kg improved the functional and histopathological outcomes from SCI, conferring protection against lesion enlargement, demyelination, central canal dilation, and axonal degeneration. The benefits of IVIg were detectable through noninvasive diffusion tensor imaging (DTI), with IVIg treatment counteracting the progressive SCI‐induced increase in radial diffusivity (RD) in white matter. Diffusion indices significantly correlated with the functional performance of individual mice and accurately predicted the degree of myelin preservation. Further experiments revealed that IVIg therapy reduced the presence of complement activation products and phagocytically active macrophages at the lesion site, providing insight as to its mechanisms of action. Interpretation Our findings highlight the potential of using IVIg as an immunomodulatory treatment for SCI, and the value of DTI to assess tissue damage and screen for the efficacy of candidate intervention strategies in preclinical models of SCI, both quantitatively and noninvasively.
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Affiliation(s)
- Faith H Brennan
- School of Biomedical Sciences The University of Queensland Brisbane 4072 Australia
| | - Nyoman D Kurniawan
- Centre for Advanced Imaging The University of Queensland Brisbane 4072 Australia
| | - Jana Vukovic
- School of Biomedical Sciences The University of Queensland Brisbane 4072 Australia; Queensland Brain Institute The University of Queensland Brisbane 4072 Australia
| | - Perry F Bartlett
- Queensland Brain Institute The University of Queensland Brisbane 4072 Australia
| | | | - Thiruma V Arumugam
- Department of Physiology Yong Loo Lin School of Medicine National University of Singapore 117597 Singapore
| | - Milan Basta
- BioVisions Inc. 9012 Wandering Trail Dr Potomac Maryland 20854 USA
| | - Marc J Ruitenberg
- School of Biomedical Sciences The University of Queensland Brisbane 4072 Australia; Queensland Brain Institute The University of Queensland Brisbane 4072 Australia; Trauma Critical Care and Recovery Brisbane Diamantina Health Partners The University of Queensland Brisbane 4072 Australia
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Mabray MC, Talbott JF, Whetstone WD, Dhall SS, Phillips DB, Pan JZ, Manley GT, Bresnahan JC, Beattie MS, Haefeli J, Ferguson AR. Multidimensional Analysis of Magnetic Resonance Imaging Predicts Early Impairment in Thoracic and Thoracolumbar Spinal Cord Injury. J Neurotrauma 2016; 33:954-62. [PMID: 26414451 PMCID: PMC4876497 DOI: 10.1089/neu.2015.4093] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Literature examining magnetic resonance imaging (MRI) in acute spinal cord injury (SCI) has focused on cervical SCI. Reproducible systems have been developed for MRI-based grading; however, it is unclear how they apply to thoracic SCI. Our hypothesis is that MRI measures will group as coherent multivariate principal component (PC) ensembles, and that distinct PCs and individual variables will show discriminant validity for predicting early impairment in thoracic SCI. We undertook a retrospective cohort study of 25 patients with acute thoracic SCI who underwent MRI on admission and had American Spinal Injury Association Impairment Scale (AIS) assessment at hospital discharge. Imaging variables of axial grade, sagittal grade, length of injury, thoracolumbar injury classification system (TLICS), maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were collected. We performed an analytical workflow to detect multivariate PC patterns followed by explicit hypothesis testing to predict AIS at discharge. All imaging variables loaded positively on PC1 (64.3% of variance), which was highly related to AIS at discharge. MCC, MSCC, and TLICS also loaded positively on PC2 (22.7% of variance), while variables concerning cord signal abnormality loaded negatively on PC2. PC2 was highly related to the patient undergoing surgical decompression. Variables of signal abnormality were all negatively correlated with AIS at discharge with the highest level of correlation for axial grade as assessed with the Brain and Spinal Injury Center (BASIC) score. A multiple variable model identified BASIC as the only statistically significant predictor of AIS at discharge, signifying that BASIC best captured the variance in AIS within our study population. Our study provides evidence of convergent validity, construct validity, and clinical predictive validity for the sampled MRI measures of SCI when applied in acute thoracic and thoracolumbar SCI.
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Affiliation(s)
- Marc C. Mabray
- Department of Radiology and Biomedical Imaging, University of California San Francisco and San Francisco General Hospital, San Francisco, California
| | - Jason F. Talbott
- Department of Radiology and Biomedical Imaging, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - William D. Whetstone
- Department of Emergency Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Sanjay S. Dhall
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - David B. Phillips
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Jonathan Z. Pan
- Department of Anesthesia and Perioperative Care, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Jacqueline C. Bresnahan
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Michael S. Beattie
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Jenny Haefeli
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Adam R. Ferguson
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
- San Francisco Veteran's Affairs Medical Center, San Francisco, California
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Talekar K, Poplawski M, Hegde R, Cox M, Flanders A. Imaging of Spinal Cord Injury: Acute Cervical Spinal Cord Injury, Cervical Spondylotic Myelopathy, and Cord Herniation. Semin Ultrasound CT MR 2016; 37:431-47. [PMID: 27616315 DOI: 10.1053/j.sult.2016.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We review the pathophysiology and imaging findings of acute traumatic spinal cord injury (SCI), cervical spondylotic myelopathy, and briefly review the much less common cord herniation as a unique cause of myelopathy. Acute traumatic SCI is devastating to the patient and the costs to society are staggering. There are currently no "cures" for SCI and the only accepted pharmacologic treatment regimen for traumatic SCI is currently being questioned. Evaluation and prognostication of SCI is a demanding area with significant deficiencies, including lack of biomarkers. Accurate classification of SCI is heavily dependent on a good clinical examination, the results of which can vary substantially based upon the patient׳s condition or comorbidities and the skills of the examiner. Moreover, the full extent of a patients׳ neurologic injury may not become apparent for days after injury; by then, therapeutic response may be limited. Although magnetic resonance imaging (MRI) is the best imaging modality for the evaluation of spinal cord parenchyma, conventional MR techniques do not appear to differentiate edema from axonal injury. Recently, it is proposed that in addition to characterizing the anatomic extent of injury, metrics derived from conventional MRI and diffusion tensor imaging, in conjunction with the neurological examination, can serve as a reliable objective biomarker for determination of the extent of neurologic injury and early identification of patients who would benefit from treatment. Cervical spondylosis is a common disorder affecting predominantly the elderly with a potential to narrow the spinal canal and thereby impinge or compress upon the neural elements leading to cervical spondylotic myelopathy and radiculopathy. It is the commonest nontraumatic cause of spinal cord disorder in adults. Imaging plays an important role in grading the severity of spondylosis and detecting cord abnormalities suggesting myelopathy.
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Affiliation(s)
- Kiran Talekar
- Section of Neuroradiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Michael Poplawski
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Rahul Hegde
- Section of Neuroradiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Mougnyan Cox
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Adam Flanders
- Section of Neuroradiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Sparrey CJ, Salegio EA, Camisa W, Tam H, Beattie MS, Bresnahan JC. Mechanical Design and Analysis of a Unilateral Cervical Spinal Cord Contusion Injury Model in Non-Human Primates. J Neurotrauma 2016; 33:1136-49. [PMID: 26670940 DOI: 10.1089/neu.2015.3974] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Non-human primate (NHP) models of spinal cord injury better reflect human injury and provide a better foundation to evaluate potential treatments and functional outcomes. We combined finite element (FE) and surrogate models with impact data derived from in vivo experiments to define the impact mechanics needed to generate a moderate severity unilateral cervical contusion injury in NHPs (Macaca mulatta). Three independent variables (impactor displacement, alignment, and pre-load) were examined to determine their effects on tissue level stresses and strains. Mechanical measures of peak force, peak displacement, peak energy, and tissue stiffness were analyzed as potential determinants of injury severity. Data generated from FE simulations predicted a lateral shift of the spinal cord at high levels of compression (>64%) during impact. Submillimeter changes in mediolateral impactor position over the midline increased peak impact forces (>50%). Surrogate cords established a 0.5 N pre-load protocol for positioning the impactor tip onto the dural surface to define a consistent dorsoventral baseline position before impact, which corresponded with cerebrospinal fluid displacement and entrapment of the spinal cord against the vertebral canal. Based on our simulations, impactor alignment and pre-load were strong contributors to the variable mechanical and functional outcomes observed in in vivo experiments. Peak displacement of 4 mm after a 0.5N pre-load aligned 0.5-1.0 mm over the midline should result in a moderate severity injury; however, the observed peak force and calculated peak energy and tissue stiffness are required to properly characterize the severity and variability of in vivo NHP contusion injuries.
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Affiliation(s)
- Carolyn J Sparrey
- 1 Mechatronic Systems Engineering, Simon Fraser University , Surrey, British Columbia, Canada .,2 International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia, Canada
| | - Ernesto A Salegio
- 3 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - William Camisa
- 4 Taylor Collaboration, St Mary's Medical Center , San Francisco, California
| | - Horace Tam
- 1 Mechatronic Systems Engineering, Simon Fraser University , Surrey, British Columbia, Canada
| | - Michael S Beattie
- 3 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Jacqueline C Bresnahan
- 3 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
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Reliability of TMS metrics in patients with chronic incomplete spinal cord injury. Spinal Cord 2016; 54:980-990. [DOI: 10.1038/sc.2016.47] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/18/2016] [Accepted: 02/28/2016] [Indexed: 12/26/2022]
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