1
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Ge Y, Zhao R, Guo X, Liang M, Xue Y. Systematic investigation of cerebellar functional alterations and their association with surgical outcomes in patients with degenerative cervical myelopathy: a resting-state fMRI study. LA RADIOLOGIA MEDICA 2024; 129:280-290. [PMID: 38302829 DOI: 10.1007/s11547-024-01776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The aim of this study was to systematically investigate the changes in cerebellar neural activity and cerebellar-cortical functional connectivity (FC) in patients with degenerative cervical myelopathy (DCM) using resting-state functional magnetic resonance imaging (fMRI). METHODS In this study, we collected clinical data and resting-state fMRI data from 54 DCM patients and 50 healthy controls (HCs). We analyzed voxel-wise regional fMRI metrics, including amplitude of low frequency fluctuation (ALFF), fractional ALFF, regional homogeneity, functional connectivity density, and voxel-mirrored homotopic connectivity. In analysis 1, we examined the differences in regional fMRI metrics within the cerebellum between the DCM patient group and the healthy control group, as well as their correlation with preoperative neurological status and prognosis. In analysis 2, we investigated cerebellar-cortical functional connectivity differences between the two groups and their correlation with preoperative neurological status and prognosis. Lastly, in analysis 3, we explored the internetwork connectivity between the 'cerebellar-SMN' (sensorimotor network) system, examined the between-group differences, and investigated its correlation with preoperative neurological status and prognosis. RESULTS (1) Relative to HCs, DCM patients exhibited functional alterations in wide-spread cerebellar regions; (2) DCM patients exhibited altered cerebellar-cortical FC which was associated with the preoperative neurological status and prognosis; (3) DCM patients exhibited altered internetwork connectivity between 'cerebellar-SMN' system which was associated with duration of symptom. CONCLUSION Wide-spread cerebellar functional alterations occur in DCM pathogenesis and the deficits in cerebellar-SMN functional connectivity may be beneficial in future studies for predicting surgical outcomes in patients with DCM.
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Affiliation(s)
- Yuqi Ge
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xing Guo
- Department of Orthopedics, Cangzhou Central Hospital, Tianjin Medical University, Cangzhou, 061001, China
| | - Meng Liang
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, 300203, China
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for China, Tianjin, 300060, China
| | - Yuan Xue
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- School of Medical Imaging, Tianjin Medical University, Tianjin, 300070, China.
- Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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2
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Gudmundson AT, Koo A, Virovka A, Amirault AL, Soo M, Cho JH, Oeltzschner G, Edden RAE, Stark CEL. Meta-analysis and open-source database for in vivo brain Magnetic Resonance spectroscopy in health and disease. Anal Biochem 2023; 676:115227. [PMID: 37423487 PMCID: PMC10561665 DOI: 10.1016/j.ab.2023.115227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
Proton (1H) Magnetic Resonance Spectroscopy (MRS) is a non-invasive tool capable of quantifying brain metabolite concentrations in vivo. Prioritization of standardization and accessibility in the field has led to the development of universal pulse sequences, methodological consensus recommendations, and the development of open-source analysis software packages. One on-going challenge is methodological validation with ground-truth data. As ground-truths are rarely available for in vivo measurements, data simulations have become an important tool. The diverse literature of metabolite measurements has made it challenging to define ranges to be used within simulations. Especially for the development of deep learning and machine learning algorithms, simulations must be able to produce accurate spectra capturing all the nuances of in vivo data. Therefore, we sought to determine the physiological ranges and relaxation rates of brain metabolites which can be used both in data simulations and as reference estimates. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we've identified relevant MRS research articles and created an open-source database containing methods, results, and other article information as a resource. Using this database, expectation values and ranges for metabolite concentrations and T2 relaxation times are established based upon a meta-analyses of healthy and diseased brains.
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Affiliation(s)
- Aaron T Gudmundson
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Annie Koo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Anna Virovka
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Alyssa L Amirault
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Madelene Soo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Jocelyn H Cho
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Georg Oeltzschner
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Craig E L Stark
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA.
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3
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Bonosi L, Musso S, Cusimano LM, Porzio M, Giovannini EA, Benigno UE, Giammalva GR, Gerardi RM, Brunasso L, Costanzo R, Paolini F, Sciortino A, Campisi BM, Giardina K, Scalia G, Iacopino DG, Maugeri R. The role of neuronal plasticity in cervical spondylotic myelopathy surgery: functional assessment and prognostic implication. Neurosurg Rev 2023; 46:149. [PMID: 37358655 PMCID: PMC10293440 DOI: 10.1007/s10143-023-02062-9] [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: 02/12/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
Cervical spondylotic myelopathy (CSM) is a degenerative disease representing the most common spinal cord disorder in the adult population. It is characterized by chronic compression leading to neurological dysfunction due to static and dynamic injury of the spinal cord in cervical spine. These insidious damage mechanisms can result in the reorganization of cortical and subcortical areas. The cerebral cortex can reorganize due to spinal cord injury and may play a role in preserving neurological function. To date, the gold standard treatment of cervical myelopathy is surgery, comprising anterior, posterior, and combined approaches. However, the complex physiologic recovery processes involving cortical and subcortical neural reorganization following surgery are still inadequately understood. It has been demonstrated that diffusion MRI and functional imaging and techniques, such as transcranial magnetic stimulation (TMS) or functional magnetic resonance imaging (fMRI), can provide new insights into the diagnosis and prognosis of CSM. This review aims to shed light on the state-of-the-art regarding the pattern of cortical and subcortical areas reorganization and recovery before and after surgery in CSM patients, underlighting the critical role of neuroplasticity.
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Affiliation(s)
- Lapo Bonosi
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy.
| | - Sofia Musso
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Luigi Maria Cusimano
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Massimiliano Porzio
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Evier Andrea Giovannini
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Umberto Emanuele Benigno
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Giuseppe Roberto Giammalva
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Rosa Maria Gerardi
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Roberta Costanzo
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Federica Paolini
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Andrea Sciortino
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Benedetta Maria Campisi
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Kevin Giardina
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Gianluca Scalia
- Department of Neurosurgery, ARNAS Garibaldi, P.O. Garibaldi Nesima, 95122, Catania, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127, Palermo, Italy
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4
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Gudmundson AT, Koo A, Virovka A, Amirault AL, Soo M, Cho JH, Oeltzschner G, Edden RA, Stark C. Meta-analysis and Open-source Database for In Vivo Brain Magnetic Resonance Spectroscopy in Health and Disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.10.528046. [PMID: 37205343 PMCID: PMC10187197 DOI: 10.1101/2023.02.10.528046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Proton ( 1 H) Magnetic Resonance Spectroscopy (MRS) is a non-invasive tool capable of quantifying brain metabolite concentrations in vivo . Prioritization of standardization and accessibility in the field has led to the development of universal pulse sequences, methodological consensus recommendations, and the development of open-source analysis software packages. One on-going challenge is methodological validation with ground-truth data. As ground-truths are rarely available for in vivo measurements, data simulations have become an important tool. The diverse literature of metabolite measurements has made it challenging to define ranges to be used within simulations. Especially for the development of deep learning and machine learning algorithms, simulations must be able to produce accurate spectra capturing all the nuances of in vivo data. Therefore, we sought to determine the physiological ranges and relaxation rates of brain metabolites which can be used both in data simulations and as reference estimates. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we've identified relevant MRS research articles and created an open-source database containing methods, results, and other article information as a resource. Using this database, expectation values and ranges for metabolite concentrations and T 2 relaxation times are established based upon a meta-analyses of healthy and diseased brains.
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Affiliation(s)
- Aaron T. Gudmundson
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Annie Koo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Anna Virovka
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Alyssa L. Amirault
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Madelene Soo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Jocelyn H. Cho
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Georg Oeltzschner
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Richard A.E. Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Craig Stark
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
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5
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Yang HE, Kim WT, Kim DH, Kim SW, Yoo WK. Utility of Diffusion and Magnetization Transfer MRI in Cervical Spondylotic Myelopathy: A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12092090. [PMID: 36140491 PMCID: PMC9497906 DOI: 10.3390/diagnostics12092090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
Diffusion tensor imaging (DTI) and magnetization transfer (MT) magnetic resonance imaging (MRI) can help detect spinal cord pathology, and tract-specific analysis of their parameters, such as fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD), radial diffusivity (RD) and MT ratio (MTR), can give microstructural information. We performed the tract-based acquisition of MR parameters of three major motor tracts: the lateral corticospinal (CS), rubrospinal (RuS) tract, and lateral reticulospinal (RS) tract as well as two major sensory tracts, i.e., the fasciculus cuneatus (FC) and spinal lemniscus, to detect pathologic change and find correlations with clinical items. MR parameters were extracted for each tract at three levels: the most compressed lesion level and above and below the lesion. We compared the MR parameters of eight cervical spondylotic myelopathy patients and 12 normal controls and analyzed the correlation between clinical evaluation items and MR parameters in patients. RuS and lateral RS showed worse DTI parameters at the lesion level in patients compared to the controls. Worse DTI parameters in those tracts were correlated with weaker power grasp at the lesion level. FC and lateral CS showed a correlation between higher RD and lower FA and MTR with a weaker lateral pinch below the lesion level.
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Affiliation(s)
- Hea-Eun Yang
- Department of Rehabilitation Medicine, VHS Medical Center, Seoul 05368, Korea
| | - Wan-Tae Kim
- Department of Radiology, VHS Medical Center, Seoul 05368, Korea
| | - Dae-Hyun Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Seok-Woo Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
- Correspondence:
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6
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Zhang MZ, Ou-Yang HQ, Liu JF, Jin D, Wang CJ, Ni M, Liu XG, Lang N, Jiang L, Yuan HS. Predicting postoperative recovery in cervical spondylotic myelopathy: construction and interpretation of T 2*-weighted radiomic-based extra trees models. Eur Radiol 2022; 32:3565-3575. [PMID: 35024949 DOI: 10.1007/s00330-021-08383-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Conventional MRI may not be ideal for predicting cervical spondylotic myelopathy (CSM) prognosis. In this study, we used radiomics in predicting postoperative recovery in CSM. We aimed to develop and validate radiomic feature-based extra trees models. METHODS There were 151 patients with CSM who underwent preoperative T2-/ T2*-weighted imaging (WI) and surgery. They were divided into good/poor outcome groups based on the recovery rate. Datasets from multiple scanners were randomised into training and internal validation sets, while the dataset from an independent scanner was used for external validation. Radiomic features were extracted from the transverse spinal cord at the maximum compressed level. Threshold selection algorithm, collinearity removal, and tree-based feature selection were applied sequentially in the training set to obtain the optimal radiomic features. The classification of intramedullary increased signal on T2/T2*WI and compression ratio of the spinal cord on T2*WI were selected as the conventional MRI features. Clinical features were age, preoperative mJOA, and symptom duration. Four models were constructed: radiological, radiomic, clinical-radiological, and clinical-radiomic. An AUC significantly > 0.5 was considered meaningful predictive performance based on the DeLong test. The mean decrease in impurity was used to measure feature importance. p < 0.05 was considered statistically significant. RESULTS On internal and external validations, AUCs of the radiomic and clinical-radiomic models, and radiological and clinical-radiological models ranged from 0.71 to 0.81 (significantly > 0.5) and 0.40 to 0.55, respectively. Wavelet-LL first-order variance was the most important feature in the radiomic model. CONCLUSION Radiomic features, especially wavelet-LL first-order variance, contribute to meaningful predictive models for CSM prognosis. KEY POINTS • Conventional MRI features may not be ideal in predicting prognosis. • Radiomics provides greater predictive efficiency in the recovery from cervical spondylotic myelopathy.
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Affiliation(s)
- Meng-Ze Zhang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Han-Qiang Ou-Yang
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Jian-Fang Liu
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Dan Jin
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Chun-Jie Wang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Ming Ni
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Xiao-Guang Liu
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
| | - Hui-Shu Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China.
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7
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Horak T, Horakova M, Svatkova A, Kadanka Z, Kudlicka P, Valosek J, Rohan T, Kerkovsky M, Vlckova E, Kadanka Z, Deelchand DK, Henry PG, Bednarik J, Bednarik P. In vivo Molecular Signatures of Cervical Spinal Cord Pathology in Degenerative Compression. J Neurotrauma 2021; 38:2999-3010. [PMID: 34428934 PMCID: PMC8917902 DOI: 10.1089/neu.2021.0151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a severe consequence of degenerative cervical spinal cord (CSC) compression. The non-myelopathic stage of compression (NMDC) is highly prevalent and often progresses to disabling DCM. This study aims to disclose markers of progressive neurochemical alterations in NMDC and DCM by utilizing an approach based on state-of-the-art proton magnetic resonance spectroscopy (1H-MRS). Proton-MRS data were prospectively acquired from 73 participants with CSC compression and 47 healthy controls (HCs). The MRS voxel was centered at the C2 level. Compression-affected participants were clinically categorized as NMDC and DCM, radiologically as mild (MC) or severe (SC) compression. CSC volumes and neurochemical concentrations were compared between cohorts (HC vs. NMDC vs. DCM and HC vs. MC vs. SC) with general linear models adjusted for age and height (pFWE < 0.05) and correlated to stenosis severity, electrophysiology, and myelopathy symptoms (p < 0.05). Whereas the ratio of total creatine (tCr) to total N-acetylaspartate (tNAA) increased in NMDC (+11%) and in DCM (+26%) and SC (+21%), myo-inositol/tNAA, glutamate + glutamine/tNAA, and volumes changed only in DCM (+20%, +73%, and −14%) and SC (+12%, +46%, and −8%, respectively) relative to HCs. Both tCr/tNAA and myo-inositol/tNAA correlated with compression severity and volume (−0.376 < r < −0.259). Myo-inositol/tNAA correlated with myelopathy symptoms (r = −0.670), whereas CSC volume did not. Short-echo 1H-MRS provided neurochemical signatures of CSC impairment that reflected compression severity and clinical significance. Whereas volumetry only reflected clinically manifest myelopathy (DCM), MRS detected neurochemical changes already before the onset of myelopathy symptoms.
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Affiliation(s)
- Tomas Horak
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Magda Horakova
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Alena Svatkova
- Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria.,Department of Imaging Methods, Faculty of Medicine, University of Ostrava, Czechia
| | - Zdenek Kadanka
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia
| | - Petr Kudlicka
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Jan Valosek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czechia.,Department of Biomedical Engineering, University Hospital, Olomouc, Czechia
| | - Tomas Rohan
- Department of Radiology, University Hospital Brno, Brno, Czechia
| | - Milos Kerkovsky
- Department of Radiology, University Hospital Brno, Brno, Czechia
| | - Eva Vlckova
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Zdenek Kadanka
- Department of Neurology, University Hospital Brno, Brno, Czechia
| | - Dinesh K Deelchand
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Pierre-Gilles Henry
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Josef Bednarik
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Petr Bednarik
- Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia.,Department of Biomedical Imaging and Image-guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
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8
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Su Q, Zhao R, Wang S, Tu H, Guo X, Yang F. Identification and Therapeutic Outcome Prediction of Cervical Spondylotic Myelopathy Based on the Functional Connectivity From Resting-State Functional MRI Data: A Preliminary Machine Learning Study. Front Neurol 2021; 12:711880. [PMID: 34690912 PMCID: PMC8531403 DOI: 10.3389/fneur.2021.711880] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022] Open
Abstract
Currently, strategies to diagnose patients and predict neurological recovery in cervical spondylotic myelopathy (CSM) using MR images of the cervical spine are urgently required. In light of this, this study aimed at exploring potential preoperative brain biomarkers that can be used to diagnose and predict neurological recovery in CSM patients using functional connectivity (FC) analysis of a resting-state functional MRI (rs-fMRI) data. Two independent datasets, including total of 53 patients with CSM and 47 age- and sex-matched healthy controls (HCs), underwent the preoperative rs-fMRI procedure. The FC was calculated from the automated anatomical labeling (AAL) template and used as features for machine learning analysis. After that, three analyses were used, namely, the classification of CSM patients from healthy adults using the support vector machine (SVM) within and across datasets, the prediction of preoperative neurological function in CSM patients via support vector regression (SVR) within and across datasets, and the prediction of neurological recovery in CSM patients via SVR within and across datasets. The results showed that CSM patients could be successfully identified from HCs with high classification accuracies (84.2% for dataset 1, 95.2% for dataset 2, and 73.0% for cross-site validation). Furthermore, the rs-FC combined with SVR could successfully predict the neurological recovery in CSM patients. Additionally, our results from cross-site validation analyses exhibited good reproducibility and generalization across the two datasets. Therefore, our findings provide preliminary evidence toward the development of novel strategies to predict neurological recovery in CSM patients using rs-fMRI and machine learning technique.
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Affiliation(s)
- Qian Su
- Tianjin Key Laboratory of Cancer Prevention and Therapy, Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for China, Tianjin, China
| | - Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - ShuoWen Wang
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - HaoYang Tu
- School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China
| | - Xing Guo
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Fan Yang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
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Tu J, Vargas Castillo J, Das A, Diwan AD. Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms. J Clin Med 2021; 10:jcm10061214. [PMID: 33804008 PMCID: PMC8001572 DOI: 10.3390/jcm10061214] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy (CSM), is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck. The clinical features of DCM include localised neck pain and functional impairment of motor function in the arms, fingers and hands. If left untreated, this can lead to significant and permanent nerve damage including paralysis and death. Despite recent advancements in understanding the DCM pathology, prognosis remains poor and little is known about the molecular mechanisms underlying its pathogenesis. Moreover, there is scant evidence for the best treatment suitable for DCM patients. Decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of when to perform such a procedure remains challenging. Given the fact that the aged population in the world is continuously increasing, DCM is posing a formidable challenge that needs urgent attention. Here, in this comprehensive review, we discuss the current knowledge of DCM pathology, including epidemiology, diagnosis, natural history, pathophysiology, risk factors, molecular features and treatment options. In addition to describing different scoring and classification systems used by clinicians in diagnosing DCM, we also highlight how advanced imaging techniques are being used to study the disease process. Last but not the least, we discuss several molecular underpinnings of DCM aetiology, including the cells involved and the pathways and molecules that are hallmarks of this disease.
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Affiliation(s)
- Ji Tu
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
| | | | - Abhirup Das
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia;
- Correspondence:
| | - Ashish D. Diwan
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia;
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Jütten K, Mainz V, Schubert GA, Fabian Gohmann R, Schmidt T, Ridwan H, Clusmann H, Mueller CA, Blume C. Cortical volume reductions as a sign of secondary cerebral and cerebellar impairment in patients with degenerative cervical myelopathy. NEUROIMAGE-CLINICAL 2021; 30:102624. [PMID: 33773163 PMCID: PMC8025145 DOI: 10.1016/j.nicl.2021.102624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Degenerative cervical myelopathy is the most common cause of chronic impairment of the spinal cord. MRI-based anatomical assessment of cerebral and cerebellar areas revealed significant tissue volume reduction in DCM patients compared to healthy controls. Disease severity correlated with cerebral and cerebellar atrophy in the primary motor cortex, primary somatosensory cortex and cerebellar areas. Chronic injury to the spinal cord seems to have impact on remote anatomical structures in the brain.
This study investigated supra- and infratentorial structural gray and white matter (GM, WM) alterations in patients with degenerative cervical myelopathy (DCM) as an indicator of secondary harm due to chronic cervical cord compression and micro trauma. With MRI-based anatomical assessment and subsequent voxel-based morphometry analyses, pre- and postoperative volume alterations in the primary motor cortex (MI), the primary somatosensory cortex (SI), the supplementary motor area (SMA), and the cerebellum were analyzed in 43 DCM patients and 20 controls. We assessed disease-related symptom severity by the modified Japanese Orthopaedic Association scale (mJOA). The study also explored symptom severity-based brain volume alterations as well as their association with clinical status. Patients had lower mJOA scores (p = .000) and lower GM volume than controls in SI (p = .016) and cerebellar regions (p = .001). Symptom severity-based subgroup analyses revealed volume reductions in almost all investigated GM ROIs (MI: p = .001; CB: p = .040; SMA: p = .007) in patients with severe clinical symptoms as well as atrophy already present in patients with moderate symptom severity. Clinical symptoms in DCM were associated with cortical and cerebellar volume reduction. GM volume alterations may serve as an indicator of both disease severity and ongoing disease progression in DCM, and should be considered in further patient care and treatment monitoring.
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Affiliation(s)
- Kerstin Jütten
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Verena Mainz
- Institute of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstraße 19, 52074 Aachen, Germany
| | | | - Robin Fabian Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpelstraße 39, 04289 Leipzig, Germany; Medical Faculty, University of Leipzig, Liebigstraße 27, 04103 Leipzig, Germany
| | - Tobias Schmidt
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Hani Ridwan
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | | | - Christian Blume
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
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Liu M, Tan Y, Zhang C, He L. Cortical anatomy plasticity in cases of cervical spondylotic myelopathy associated with decompression surgery: A strobe-compliant study of structural magnetic resonance imaging. Medicine (Baltimore) 2021; 100:e24190. [PMID: 33530210 PMCID: PMC7850749 DOI: 10.1097/md.0000000000024190] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 12/12/2020] [Indexed: 11/25/2022] Open
Abstract
Using voxel-based morphometry (VBM), we studied cortical gray matter volume changes in patients with cervical spondylotic myelopathy (CSM) before and after cervical cord surgical decompression. We then discussed the structural damage mechanisms and the neural plasticity mechanisms involved in postsurgical CSM.Forty-five presurgical CSM patients, 41 of the same group followed-up 6 months after decompression surgery and 45 normal controls (NC) matched for age, sex and level of education underwent high-resolution 3-dimensional T1-weighted scans by 3.0 T MR. Then, VBM measurements were compared and cortical gray matter volume alterations were assessed among pre- or postsurgical CSM patients and NC, as well as correlations with clinical indexes by Pearson correlation.Compared with NC, presurgical CSM patients showed reduced gray matter volume in the left caudate nucleus and the right thalamus. After 6 months, postsurgical CSM patients had lower gray matter volume in the bilateral cerebellar posterior lobes but had higher gray matter volume in the brain-stem than did presurgical CSM patients. Postsurgical CSM patients had significantly lower gray matter volume in the left caudate nucleus but greater regional gray matter volume in the right inferior temporal gyrus, the right middle orbitofrontal cortex (OFC) and the bilateral lingual gyrus / precuneus /posterior cingulate cortex than did NC. Abnormal areas gray volume in presurgical CSM and postsurgical CSM patients showed no significant correlation with clinical data (P > .05).Myelopathy in the cervical cord may cause chronic cerebral structural damage before and after the decompression stage, markedly in outlier brain regions involving motor execution/control, vision processing and the default mode network and in areas associated with brain compensatory plasticity to reverse downstream spinal cord compression and respond to spinal cord surgical decompression.
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Affiliation(s)
| | - Yongming Tan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Chenlei Zhang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Laichang He
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
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12
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Chen YC, Kuo CH, Cheng CM, Wu JC. Recent advances in the management of cervical spondylotic myelopathy: bibliometric analysis and surgical perspectives. J Neurosurg Spine 2019; 31:299-309. [PMID: 31473666 DOI: 10.3171/2019.5.spine18769] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cervical spondylotic myelopathy (CSM) has become a prevalent cause of spinal cord dysfunction among the aging population worldwide. Although great strides have been made in spine surgery in past decades, the optimal timing and surgical strategy to treat CSM have remained controversial. In this article the authors aimed to analyze the current trends in studies of CSM and to summarize the recent advances of surgical techniques in its treatment. METHODS The PubMed database was searched using the keywords pertaining to CSM in human studies that were published between 1975 and 2018. Analyses of both the bibliometrics and contents, including the types of papers, authors, affiliations and countries, number of patients, and the surgical approaches were conducted. A systematic review of the literature was also performed with emphasis on the diagnosis and treatment of mild CSM. RESULTS A total of 1008 papers published during the span of 44 years were analyzed. These CSM studies mainly focused on the natural history, diagnosis, and treatment, and only a few prospective randomized trials were reported. For the authors and affiliations, there was a shift of clustering of papers toward Asian countries in the past decades. Regarding the treatment for CSM, there was an exponential growth of surgical series published, and there was a trend toward slightly more anterior than posterior approaches through the past decade. Patients with CSM had increased risks of neurological deterioration or spinal cord injury with nonoperative management. Because surgery might reduce the risks, and early surgery was likely to be correlated with better outcomes, there was a trend toward attention to mildly symptomatic CSM. CONCLUSIONS There is emerging enthusiasm for research on CSM worldwide, with more publications originating in Asian countries over the past few decades. The surgical management of CSM is evolving continuously toward early and anterior approaches. More prospective investigations on the optimal timing and choices of surgery are therefore needed.
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Affiliation(s)
- Yu-Chun Chen
- 1School of Medicine, National Yang-Ming University, Taipei
- 2Department of Family Medicine, Taipei Veterans General Hospital
- 3Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei
| | - Chao-Hung Kuo
- 1School of Medicine, National Yang-Ming University, Taipei
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
- 5Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Chieh-Ming Cheng
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
| | - Jau-Ching Wu
- 1School of Medicine, National Yang-Ming University, Taipei
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
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Gohmann R, Blume C, Zvyagintsev M, Mainz V, Clusmann H, Wiesmann M, Brockmann M, Mueller C. Cervical spondylotic myelopathy: Changes of fractional anisotropy in the spinal cord and magnetic resonance spectroscopy of the primary motor cortex in relation to clinical symptoms and their duration. Eur J Radiol 2019; 116:55-60. [DOI: 10.1016/j.ejrad.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/22/2019] [Accepted: 04/15/2019] [Indexed: 11/16/2022]
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Zhou F, Huang M, Wu L, Tan Y, Guo J, Zhang Y, He L, Gong H. Altered perfusion of the sensorimotor cortex in patients with cervical spondylotic myelopathy: an arterial spin labeling study. J Pain Res 2018; 11:181-190. [PMID: 29391824 PMCID: PMC5769569 DOI: 10.2147/jpr.s148076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective Advanced magnetic resonance imaging studies have shown functional plasticity or reorganization and metabolite alterations of N-acetyl aspartate in the sensorimotor cortex (SMC), a hallmark region and key brain network, in patients with cervical spondylotic myelopathy (CSM). However, the nature of perfusion in the SMC and the relationship between regional cerebral blood flow (CBF), motor function scores, and structural damage of the cervical cord in patients with CSM are not fully understood. Materials and methods All right-handed participants underwent pseudo-continuous arterial spin labeling pulse sequence scanning, and CBF was then calculated and compared between CSM and healthy groups. Clinical and structural associations were assessed in the SMC. Receiver operating characteristic (ROC) and leave-one-out cross-validation analyses were used to estimate the sensitivity and specificity of the significantly altered CBF in the SMC to distinguish myelopathy-related impairment. Results A total of 18 pairs of CSM patients and well-matched healthy subjects were included in the analyses. Compared with healthy subjects, CSM patients exhibited significantly decreased CBF in the left premotor ventral/precentral operculum (PMv/PrCO) and the bilateral dorsal anterior cingulate cortex (dACC); and increased CBF in the left paracentral lobule (PCL), the right PCL/supplementary motor area (PCL/SMA), and the right postcentral gyrus (PoCG; Gaussian random field correction at P<0.01). In the CSM group, the CBF values in the right PoCG were negatively correlated with Japanese Orthopaedic Association scores, and the CBF values in several regions were negatively correlated with Neck Disability Index scores. Finally, the ROC analysis revealed that significantly increased CBF in the left PCL, the right PCL/SMA, and the right PoCG discriminated patients with myelopathy-related impairment from healthy subjects. Conclusion Regional CBF was reduced in operculum-integrated (PMv/PrCO) and motor control (dACC) regions but increased in sensory (PoCG) and motor-sensory processing (PCL/SMA) regions in patients with CSM.
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Affiliation(s)
- Fuqing Zhou
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Muhua Huang
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Lin Wu
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Yongming Tan
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Jianqiang Guo
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Yong Zhang
- Department of Pain Clinic, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Laichang He
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
| | - Honghan Gong
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi Province, People's Republic of China
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