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Al-Tameemi HN, Hassoun HK, Mohammed IQ, Allebban Z. MRI assessment of cervical spinal cord cross-sectional area in patients with multiple sclerosis. J Neurosci Rural Pract 2023; 14:660-666. [PMID: 38059247 PMCID: PMC10696324 DOI: 10.25259/jnrp_87_2023] [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: 02/23/2023] [Accepted: 06/30/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Spinal cord abnormalities including cervical cord atrophy are common in multiple sclerosis (MS). This study aimed to assess the cervical spinal cord cross-sectional area (CSA) using magnetic resonance imaging (MRI) in MS patients. Materials and Methods Sixty participants were enrolled in this study (16 male and 44 female), 30 patients with MS, diagnosed according to the revised McDonald criteria, and 30 apparently healthy individuals as the control group. CSA of the spinal cord was measured on axial T2-weighted images of the cervical MRI studies from C2 to C7 vertebral levels. Results There was a significant difference between MS patients and the control group in mean CSA at a different level. The mean CSA at C2, in MS cases, was significantly lower than controls (67.7 ± 9.4 mm2 vs. 81.3 ± 4.6 mm2). Similarly, the mean CSA at C7 (64.4 ± 9.9 mm2) and average C2-7 (68 ± 9.1 mm2) of MS cases were significantly lower than the control. There was a strong inverse correlation between mean cervical cord CSA and duration of the disease and disability score. The reduction in cervical cord CSA was more prominent in patients with secondary progressive MS. There was no significant difference regarding age, gender, type of treatment, or the number of cervical cord lesions. Conclusion The mean CSA was significantly lower in patients with MS than in the control group and was lesser in progressive types. Patients with a longer duration of MS and a high disability score tend to have smaller CSA.
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Affiliation(s)
- Haider N. Al-Tameemi
- Middle Euphrates Neurosciences Center, Faculty of Medicine, Kufa University, Al-Najaf, Iraq
| | - Hayder K. Hassoun
- Middle Euphrates Neurosciences Center, Faculty of Medicine, Kufa University, Al-Najaf, Iraq
| | | | - Zuhair Allebban
- Middle Euphrates Unit of Cancer Research, Kufa University College of Medicine, Al-Najaf, Iraq
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Cilingir V, Akdeniz H. The course of cervical spinal cord atrophy rate and its relationship with NEDA in relapsing remitting multiple sclerosis. Acta Neurol Belg 2022; 122:345-355. [PMID: 33475987 DOI: 10.1007/s13760-021-01595-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/08/2021] [Indexed: 11/26/2022]
Abstract
This study aimed to compare the annualized segmental cervical spinal cord atrophy rate (ASCAR) in the early and late stages of relapsing remitting multiple sclerosis (RRMS), and to investigate the relationship between ASCAR and no evidence of disease activity (NEDA) in RRMS. Participants in this study included early stage MS (EMSg) patients, late stage MS (LMSg) patients, and healthy controls. All of the included participants (n = 175 subjects) were followed up for 14 months, and an MRI was performed on each participant at the beginning and at the end of the study. Cervical spinal cord average segmental area (CSCA) was measured by a semi-automated method, and ASCAR (mm2/year) was calculated. Data from the EMSg (n = 81 subjects) and LMSg (n = 94 subjects) patient groups were compared with each other and with the control group (n = 43 subjects). Examination of the initial CSCA values revealed that the baseline CSCA of the control group was larger than that of the EMSg (p < 0.001), and the baseline CSCA of the EMSg was larger than that of the LMSg (p < 0.001). The ASCAR of the control group, LMSg, and EMSg were 0.48, 0.93, and 1.81 mm2 (p < 0.001), respectively. Regression analysis revealed that disability increase was associated with ASCAR, while MRI activity and relapse presence were unrelated to ASCAR. In both patient groups, ASCAR was slower in those who fulfilled NEDA but this relationship was not significant. Cervical spinal cord atrophy progression over time occurs at a greater rate in the early stages of RRMS disease compared to the late stages. ASCAR was unrelated to MRI activity and relapse, which are clinical markers of acute inflammation.
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Affiliation(s)
- Vedat Cilingir
- Van Yuzuncu Yil University Faculty of Medicine Neurology Department, Kampus, 65300, Tusba, Van, Turkey.
| | - Hüseyin Akdeniz
- Van Yuzuncu Yil University Faculty of Medicine Radiology Department, Van, Turkey
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Taheri K, Vavasour IM, Abel S, Lee LE, Johnson P, Ristow S, Tam R, Laule C, Ackermans NC, Schabas A, Cross H, Chan JK, Sayao AL, Bhan V, Devonshire V, Carruthers R, Li DK, Traboulsee AL, Kolind SH, Dvorak AV. Cervical Spinal Cord Atrophy can be Accurately Quantified Using Head Images. Mult Scler J Exp Transl Clin 2022; 8:20552173211070760. [PMID: 35024164 PMCID: PMC8743948 DOI: 10.1177/20552173211070760] [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: 09/02/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background Spinal cord atrophy provides a clinically relevant metric for monitoring MS. However, the spinal cord is imaged far less frequently than brain due to artefacts and acquisition time, whereas MRI of the brain is routinely performed. Objective To validate spinal cord cross-sectional area measurements from routine 3DT1 whole-brain MRI versus those from dedicated cord MRI in healthy controls and people with MS. Methods We calculated cross-sectional area at C1 and C2/3 using T2*-weighted spinal cord images and 3DT1 brain images, for 28 healthy controls and 73 people with MS. Correlations for both groups were assessed between: (1) C1 and C2/3 using cord images; (2) C1 from brain and C1 from cord; and (3) C1 from brain and C2/3 from cord. Results and Conclusion C1 and C2/3 from cord were strongly correlated in controls (r = 0.94, p<0.0001) and MS (r = 0.85, p<0.0001). There was strong agreement between C1 from brain and C2/3 from cord in controls (r = 0.84, p<0.0001) and MS (r = 0.81, p<0.0001). This supports the use of C1 cross-sectional area calculated from brain imaging as a surrogate for the traditional C2/3 cross-sectional area measure for spinal cord atrophy.
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Affiliation(s)
- Kamyar Taheri
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Irene M Vavasour
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Stephen Ristow
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Cornelia Laule
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | - Robert Carruthers
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David Kb Li
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Shannon H Kolind
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adam Vladimir Dvorak
- Department of Physics & Astronomy, University of British Columbia, Vancouver, BC, Canada
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Barreiro-González A, Sanz MT, Carratalà-Boscà S, Pérez-Miralles F, Alcalá C, Carreres-Polo J, España-Gregori E, Casanova B. Design and Validation of an Expanded Disability Status Scale Model in Multiple Sclerosis. Eur Neurol 2021; 85:112-121. [PMID: 34788755 DOI: 10.1159/000519772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to develop and validate an Expanded Disability Status Scale (EDSS) model through clinical, optical coherence tomography (OCT), and magnetic resonance imaging (MRI) measures. METHODS Sixty-four multiple sclerosis (MS) patients underwent peripapillary retinal nerve fiber layer and segmented macular layers evaluation through OCT (Spectralis, Heidelberg Engineering). Brain parenchymal fraction was quantified through Freesurfer, while cervical spinal cord (SC) volume was assessed manually guided by Spinal Cord Toolbox software analysis. EDSS, neuroradiological, and OCT assessment were carried out within 3 months. OCT parameters were calculated as the average of both nonoptic neuritis (ON) eyes, and in case the patient had previous ON, the value of the fellow non-ON eye was taken. Brain lesion volume, sex, age, disease duration, and history of disease-modifying treatment (1st or 2nd line disease-modifying treatments) were tested as covariables of the EDSS score. RESULTS EDSS values correlated with patient's age (r = 0.543, p = 0.001), SC volume (r = -0.301, p = 0.034), and ganglion cell layer (GCL, r = -0.354, p = 0.012). Using these correlations, an ordinal regression model to express probability of diverse EDSS scores were designed, the highest of which was the most probable (Nagelkerke R2 = 43.3%). Using EDSS cutoff point of 4.0 in a dichotomous model, compared to a cutoff of 2.0, permits the inclusion of GCL as a disability predictor, in addition to age and SC. CONCLUSIONS MS disability measured through EDSS is an age-dependent magnitude that is partly conditioned by SC and GCL. Further studies assessing paraclinical disability predictors are needed.
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Affiliation(s)
| | - Maria T Sanz
- Department of Mathematics Teaching, University of Valencia, Valencia, Spain
| | - Sara Carratalà-Boscà
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | - Carmen Alcalá
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Joan Carreres-Polo
- Radiology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Enrique España-Gregori
- Opthalmology Department, University and Polytechnic Hospital La Fe, Valencia, Spain.,Surgery Department, University of Valencia, Valencia, Spain
| | - Bonaventura Casanova
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain.,Medicine Department, University of Valencia, Valencia, Spain
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Toufani H, Vard A, Adibi I. A pipeline to quantify spinal cord atrophy with deep learning: Application to differentiation of MS and NMOSD patients. Phys Med 2021; 89:51-62. [PMID: 34352676 DOI: 10.1016/j.ejmp.2021.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/28/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Quantitative measurement of various anatomical regions of the brain and spinal cord (SC) in MRI images are used as unique biomarkers to consider progress and effects of demyelinating diseases of the central nervous system. This paper presents a fully-automated image processing pipeline which quantifies the SC volume of MRI images. METHODS In the proposed pipeline, after conducting some pre-processing tasks, a deep convolutional network is utilized to segment the spinal cord cross-sectional area (SCCSA) of each slice. After full segmentation, certain extra slices interpolate between each two adjacent slices using the shape-based interpolation method. Then, a 3D model of the SC is reconstructed, and, by counting the voxels of it, the SC volume is calculated. The performance of the proposed method for the SCCSA segmentation is evaluated on 140 MRI images. Subsequently, to demonstrate the application of the proposed pipeline, we study the differentiations of SC atrophy between 38 Multiple Sclerosis (MS) and 25 Neuromyelitis Optica Spectrum Disorder (NMOSD) patients. RESULTS The experimental results of the SCCSA segmentation indicate that the proposed method, adapted by Mask R-CNN, presented the most satisfactory result with the average Dice coefficient of 0.96. For this method, statistical metrics including sensitivity, specificity, accuracy, and precision are 97.51%, 99.98%, 99.92%, and 98.04% respectively. Moreover, the t-test result (p-value = 0.00089) verified a significant difference between the SC atrophy of MS and NMOSD patients. CONCLUSION The pipeline efficiently quantifies the SC volume of MRI images and can be utilized as an affordable computer-aided tool for diagnostic purposes.
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Affiliation(s)
- Hediyeh Toufani
- Department of Bioelectrics and Biomedical Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Vard
- Department of Bioelectrics and Biomedical Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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A matter of atrophy: differential impact of brain and spine damage on disability worsening in multiple sclerosis. J Neurol 2021; 268:4698-4706. [PMID: 33942160 PMCID: PMC8563557 DOI: 10.1007/s00415-021-10576-9] [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: 02/05/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
As atrophy represents the most relevant driver of progression in multiple sclerosis (MS), we investigated the impact of different patterns of brain and spinal cord atrophy on disability worsening in MS. We acquired clinical and MRI data from 90 patients with relapsing–remitting MS and 24 healthy controls (HC). Clinical progression at follow-up (mean 3.7 years) was defined according to the Expanded Disability Status Scale-Plus. Brain and spinal cord volumes were computed on MRI brain scans. After normalizing each participants’ brain and spine volume to the mean of the HC, z-score cut-offs were applied to separate pathologically atrophic from normal brain and spine volumes (accepting a 2.5% error probability). Accordingly, MS patients were classified into four groups (Group I: no brain or spinal cord atrophy N = 40, Group II: brain atrophy/no spinal cord atrophy N = 11, Group III: no brain atrophy/ spinal cord atrophy N = 32, Group IV: both brain and spinal cord atrophy N = 7). All patients’ groups showed significantly lower brain volume than HC (p < 0.0001). Group III and IV showed lower spine volume than HC (p < 0.0001 for both). Higher brain lesion load was identified in Group II (p = 0.049) and Group IV (p = 0.023) vs Group I, and in Group IV (p = 0.048) vs Group III. Spinal cord atrophy (OR = 3.75, p = 0.018) and brain + spinal cord atrophy (OR = 5.71, p = 0.046) were significant predictors of disability progression. The presence of concomitant brain and spinal cord atrophy is the strongest correlate of progression over time. Isolated spinal cord atrophy exerts a similar effect, confirming the leading role of spinal cord atrophy in the determination of motor disability.
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Mina Y, Azodi S, Dubuche T, Andrada F, Osuorah I, Ohayon J, Cortese I, Wu T, Johnson KR, Reich DS, Nair G, Jacobson S. Cervical and thoracic cord atrophy in multiple sclerosis phenotypes: Quantification and correlation with clinical disability. NEUROIMAGE-CLINICAL 2021; 30:102680. [PMID: 34215150 PMCID: PMC8131917 DOI: 10.1016/j.nicl.2021.102680] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/01/2022]
Abstract
Spinal cord atrophy is prevalent across multiple sclerosis phenotypes. It correlates with disability, especially in relapsing-remitting patients. This correlation can be demonstrated both cross-sectionally and longitudinally. Cervical atrophy is highly associated with disability and disease progression. Thoracic atrophy contributes to improved correlation and radiological subgrouping.
Objective We sought to characterize spinal cord atrophy along the entire spinal cord in the major multiple sclerosis (MS) phenotypes, and evaluate its correlation with clinical disability. Methods Axial T1-weighted images were automatically reformatted at each point along the cord. Spinal cord cross‐sectional area (SCCSA) were calculated from C1-T10 vertebral body levels and profile plots were compared across phenotypes. Average values from C2-3, C4-5, and T4-9 regions were compared across phenotypes and correlated with clinical scores, and then categorized as atrophic/normal based on z-scores derived from controls, to compare clinical scores between subgroups. In a subset of relapsing-remitting cases with longitudinal scans these regions were compared to change in clinical scores. Results The cross-sectional study consisted of 149 adults diagnosed with relapsing-remitting MS (RRMS), 49 with secondary-progressive MS (SPMS), 58 with primary-progressive MS (PPMS) and 48 controls. The longitudinal study included 78 RRMS cases. Compared to controls, all MS groups had smaller average regions except RRMS in T4-9 region. In all MS groups, SCCSA from all regions, particularly the cervical cord, correlated with most clinical measures. In the RRMS cohort, 22% of cases had at least one atrophic region, whereas in progressive MS the rate was almost 70%. Longitudinal analysis showed correlation between clinical disability and cervical cord thinning. Conclusions Spinal cord atrophy was prevalent across MS phenotypes, with regional measures from the RRMS cohort and the progressive cohort, including SPMS and PPMS, being correlated with disability. Longitudinal changes in the spinal cord were documented in RRMS cases, making it a potential marker for disease progression. While cervical SCCSA correlated with most disability and progression measures, inclusion of thoracic measurements improved this correlation and allowed for better subgrouping of spinal cord phenotypes. Cord atrophy is an important and easily obtainable imaging marker of clinical and sub-clinical progression in all MS phenotypes, and such measures can play a key role in patient selection for clinical trials.
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Affiliation(s)
- Yair Mina
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shila Azodi
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Tsemacha Dubuche
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Frances Andrada
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Ikesinachi Osuorah
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Joan Ohayon
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Irene Cortese
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Tianxia Wu
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Kory R Johnson
- Bioinformatics Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Govind Nair
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Quantitative MRI Core Facility, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
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Bautin P, Cohen-Adad J. Minimum detectable spinal cord atrophy with automatic segmentation: Investigations using an open-access dataset of healthy participants. NEUROIMAGE: CLINICAL 2021; 32:102849. [PMID: 34624638 PMCID: PMC8503570 DOI: 10.1016/j.nicl.2021.102849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/07/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Abstract
Evaluate the robustness of an automated analysis pipeline for detecting SC atrophy. Simulate spinal cord atrophy and scan-rescan variability. Fully automated analysis method available on an open access database. Evaluation of sample size and inter/intra-subject variability for T1w and T2w images.
Spinal cord atrophy is a well-known biomarker in multiple sclerosis (MS) and other diseases. It is measured by segmenting the spinal cord on an MRI image and computing the average cross-sectional area (CSA) over a few slices. Introduced about 25 years ago, this procedure is highly sensitive to the quality of the segmentation and is prone to rater-bias. Recently, fully-automated spinal cord segmentation methods, which remove the rater-bias and enable the automated analysis of large populations, have been introduced. A lingering question related to these automated methods is: How reliable are they at detecting atrophy? In this study, we evaluated the precision and accuracy of automated atrophy measurements by simulating scan-rescan experiments. Spinal cord MRI data from the open-access spine-generic project were used. The dataset aggregates 42 sites worldwide and consists of 260 healthy subjects and includes T1w and T2w contrasts. To simulate atrophy, each volume was globally rescaled at various scaling factors. Moreover, to simulate patient repositioning, random rigid transformations were applied. Using the DeepSeg algorithm from the Spinal Cord Toolbox, the spinal cord was segmented and vertebral levels were identified. Then, the average CSA between C3-C5 vertebral levels was computed for each Monte Carlo sample, allowing us to derive measures of atrophy, intra/inter-subject variability, and sample-size calculations. The minimum sample size required to detect an atrophy of 2% between unpaired study arms, commonly seen in MS studies, was 467 +/− 13.9 using T1w and 467 +/− 3.2 using T2w images. The minimum sample size to detect a longitudinal atrophy (between paired study arms) of 0.8% was 60 +/− 25.1 using T1w and 10 +/− 1.2 using T2w images. At the intra-subject level, the estimated CSA, observed in this study, showed good precision compared to other studies with COVs (across Monte Carlo transformations) of 0.8% for T1w and 0.6% for T2w images. While these sample sizes seem small, we would like to stress that these results correspond to a “best case” scenario, in that the dataset used here was of particularly good quality and the model for simulating atrophy does not encompass all the variability met in real-life datasets. The simulated atrophy and scan-rescan variability may over-simplify the biological reality. The proposed framework is open-source and available at https://csa-atrophy.readthedocs.io/.
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Affiliation(s)
- Paul Bautin
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada; Mila - Quebec AI Institute, Montreal, QC, Canada.
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Lersy F, Noblet V, Willaume T, Collongues N, Kremer L, Fleury M, de Seze J, Kremer S. Identification and measurement of cervical spinal cord atrophy in neuromyelitis optica spectrum disorders (NMOSD) and correlation with clinical characteristics and cervical spinal cord MRI data. Rev Neurol (Paris) 2020; 177:85-92. [PMID: 32753321 DOI: 10.1016/j.neurol.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The spinal cord is one of the two main targets of neuromyelitis optica (NMO). The aim of this study was to highlight cervical spinal cord atrophy in NMO patients as compared to controls and to assess correlations between atrophy and clinical characteristics and cervical spinal cord MRI data. METHODS This prospective study investigated 15 patients with a diagnosis of NMOSD and 15 healthy controls. The whole cervical spinal cord was explored by MRI. The cross-sectional area (CSA) was estimate at every level of cup. This measurement was then averaged on the whole cervical spinal cord, providing a single measurement for every subject, denoted as mean CSA. RESULTS Mean CSA was 68.5 mm2 in the population of NMO patients and 72.8 mm2 in the population of healthy subjects. NMO patients had significantly smaller cervical spinal cord area than healthy controls (T test=0.009). Cervical spinal cord atrophy was associated with clinical signs of medullary involvement (T test=0.0006). There was a tendency toward a relation between cervical spinal cord atrophy and the Expanded Disability Status Scale (EDSS) (T test=0.07). This correlation seems statistically significant (T test<0.05) at the level of the upper cervical spinal cord (C2-C3) CONCLUSION: This study provides the first evidence of cervical spinal cord atrophy in NMOSD by studying the entire cervical spinal cord. Upper cervical spinal cord atrophy was substantially correlated to clinical disability and seems more involved in the development of clinical disability in NMOSD patients in comparison to the lower cervical spinal cord.
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Affiliation(s)
- F Lersy
- University hospital of Strasboug, France.
| | - V Noblet
- University hospital of Strasboug, France
| | - T Willaume
- University hospital of Strasboug, France
| | | | - L Kremer
- University hospital of Strasboug, France
| | - M Fleury
- University hospital of Strasboug, France
| | - J de Seze
- University hospital of Strasboug, France
| | - S Kremer
- University hospital of Strasboug, France
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10
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Aged hind-limb clasping experimental autoimmune encephalomyelitis models aspects of the neurodegenerative process seen in multiple sclerosis. Proc Natl Acad Sci U S A 2019; 116:22710-22720. [PMID: 31641069 DOI: 10.1073/pnas.1915141116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Experimental autoimmune encephalomyelitis (EAE) is the most common model of multiple sclerosis (MS). This model has been instrumental in understanding the events that lead to the initiation of central nervous system (CNS) autoimmunity. Though EAE has been an effective screening tool for identifying novel therapies for relapsing-remitting MS, it has proven to be less successful in identifying therapies for progressive forms of this disease. Though axon injury occurs in EAE, it is rapid and acute, making it difficult to intervene for the purpose of evaluating neuroprotective therapies. Here, we describe a variant of spontaneous EAE in the 2D2 T cell receptor transgenic mouse (2D2+ mouse) that presents with hind-limb clasping upon tail suspension and is associated with T cell-mediated inflammation in the posterior spinal cord and spinal nerve roots. Due to the mild nature of clinical signs in this model, we were able to maintain cohorts of mice into middle age. Over 9 mo, these mice exhibited a relapsing-remitting course of hind-limb clasping with the development of progressive motor deficits. Using a combined approach of ex vivo magnetic resonance (MR) imaging and histopathological analysis, we observed neurological progression to associate with spinal cord atrophy, synapse degradation, and neuron loss in the gray matter, as well as ongoing axon injury in the white matter of the spinal cord. These findings suggest that mild EAE coupled with natural aging may be a solution to better modeling the neurodegenerative processes seen in MS.
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Papinutto N, Asteggiano C, Bischof A, Gundel TJ, Caverzasi E, Stern WA, Bastianello S, Hauser SL, Henry RG. Intersubject Variability and Normalization Strategies for Spinal Cord Total Cross-Sectional and Gray Matter Areas. J Neuroimaging 2019; 30:110-118. [PMID: 31571307 DOI: 10.1111/jon.12666] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/02/2019] [Accepted: 09/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE The quantification of spinal cord (SC) atrophy by MRI has assumed an important role in assessment of neuroinflammatory/neurodegenerative diseases and traumatic SC injury. Recent technical advances make possible the quantification of gray matter (GM) and white matter tissues in clinical settings. However, the goal of a reliable diagnostic, prognostic or predictive marker is still elusive, in part due to large intersubject variability of SC areas. Here, we investigated the sources of this variability and explored effective strategies to reduce it. METHODS One hundred twenty-nine healthy subjects (mean age: 41.0 ± 15.9) underwent MRI on a Siemens 3T Skyra scanner. Two-dimensional PSIR at the C2-C3 vertebral level and a sagittal 1 mm3 3D T1-weighted brain acquisition extended to the upper cervical cord were acquired. Total cross-sectional area and GM area were measured at C2-C3, as well as measures of the vertebra, spinal canal and the skull. Correlations between the different metrics were explored using Pearson product-moment coefficients. The most promising metrics were used to normalize cord areas using multiple regression analyses. RESULTS The most effective normalization metrics were the V-scale (from SienaX) and the product of the C2-C3 spinal canal diameters. Normalization methods based on these metrics reduced the intersubject variability of cord areas of up to 17.74%. The measured cord areas had a statistically significant sex difference, while the effect of age was moderate. CONCLUSIONS The present work explored in a large cohort of healthy subjects the source of intersubject variability of SC areas and proposes effective normalization methods for its reduction.
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Affiliation(s)
- Nico Papinutto
- Department of Neurology, University of California, San Francisco, CA
| | - Carlo Asteggiano
- Department of Neurology, University of California, San Francisco, CA.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Antje Bischof
- Department of Neurology, University of California, San Francisco, CA
| | - Tristan J Gundel
- Department of Neurology, University of California, San Francisco, CA
| | - Eduardo Caverzasi
- Department of Neurology, University of California, San Francisco, CA.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - William A Stern
- Department of Neurology, University of California, San Francisco, CA
| | - Stefano Bastianello
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stephen L Hauser
- Department of Neurology, University of California, San Francisco, CA
| | - Roland G Henry
- Department of Neurology, University of California, San Francisco, CA
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12
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Zurawski J, Glanz BI, Healy BC, Tauhid S, Khalid F, Chitnis T, Weiner HL, Bakshi R. The impact of cervical spinal cord atrophy on quality of life in multiple sclerosis. J Neurol Sci 2019; 403:38-43. [PMID: 31207364 DOI: 10.1016/j.jns.2019.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/04/2019] [Accepted: 04/15/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Spinal cord demyelination is common in multiple sclerosis (MS) and has been linked to increased disability and progressive clinical course. Spinal cord atrophy shows an especially close relationship to MS-related physical disability, though the relationship between spinal cord lesions/atrophy and health-related quality of life (QOL) has not been explored. METHODS 62 patients (53 relapsing MS, 7 secondary progressive, 2 clinically isolated syndrome) from our center underwent 3 T MRI within 30 days of clinical examination and QOL assessment. Upper cervical (C1-C3) spinal cord area (UCCA) was obtained from 3D high-resolution MPRAGE sequences (1 mm isotropic voxels). Cervical spinal cord (C1-C7) lesion count, and cervical and brain T2 hyperintense lesion volumes were calculated. Brain parenchymal fraction (BPF) was obtained from an automated segmentation pipeline. Spearman correlations were assessed between MRI and clinical data. Partial Spearman correlations adjusting for age, disease duration, and BPF assessed the independent association between MRI variables and QOL domains. RESULTS UCCA showed an inverse relationship with age (r = -0.330, p = .009), disease duration, (r = -0.444, p < .001), and nine-hole peg test (r = -0.353, p = .005). The Upper Extremity Function QOL domain showed the strongest relationship to UCCA (r = 0.333, p = .008), with Lower Extremity Function QOL (r = 0.234, p = .067) and Satisfaction with Social Roles and Activities (r = 0.245, p = .055) correlations bordering significance. The association between UCCA and Upper Extremity QOL remained significant after adjustment for BPF, age, and disease duration. QOL domains reflective of psychological health (Depression, Anxiety, Emotional and Behavioral Dyscontrol, Positive Affect and Wellbeing) showed no relationship to UCCA. Cervical and brain lesion volume related to impairment in Stigma while cervical lesion count was unrelated to NeuroQOL impairment. Brain atrophy correlated with conventional markers of disability and cognition but did not have a significant relationship to QOL. CONCLUSION Cervical spinal cord volume is independently associated with impaired upper extremity-related QOL in patients with MS. These findings suggest specific clinical relevance of MS-related spinal cord atrophy as compared to brain or cervical spinal cord lesions, or whole brain atrophy.
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Affiliation(s)
- Jonathan Zurawski
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Bonnie I Glanz
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Shahamat Tauhid
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fariha Khalid
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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Casserly C, Seyman EE, Alcaide-Leon P, Guenette M, Lyons C, Sankar S, Svendrovski A, Baral S, Oh J. Spinal Cord Atrophy in Multiple Sclerosis: A Systematic Review and Meta-Analysis. J Neuroimaging 2018; 28:556-586. [PMID: 30102003 DOI: 10.1111/jon.12553] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/12/2018] [Accepted: 07/16/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND PURPOSE Spinal cord atrophy (SCA) is an important emerging outcome measure in multiple sclerosis (MS); however, there is limited consensus on the magnitude and rate of atrophy. The objective of this study was to synthesize the available data on measures of SCA in MS. METHODS Using published guidelines, relevant literature databases were searched between 1977 and 2017 for case-control or cohort studies reporting a quantitative measure of SCA in MS patients. Random-effects models pooled cross-sectional measures and longitudinal rates of SCA in MS and healthy controls (HCs). Student's t-test assessed differences between pooled measures in patient subgroups. Heterogeneity was assessed using DerSimonian and Laird's Q-test and the I 2 -index. RESULTS A total of 1,465 studies were retrieved including 94 that met inclusion and exclusion criteria. Pooled estimates of mean cervical spinal cord (SC) cross-sectional area (CSA) in all MS patients, relapsing-remitting MS (RRMS), all progressive MS, secondary progressive MS (SPMS), primary-progressive MS (PPMS), and HC were: 73.07 mm2 (95% CI [71.52-74.62]), 78.88 mm2 (95% CI [76.92-80.85]), 69.72 mm2 (95% CI [67.96-71.48]), 68.55 mm2 (95% CI [65.43-71.66]), 70.98 mm2 (95% CI [68.78-73.19]), and 80.87 mm2 (95% C I [78.70-83.04]), respectively. Pooled SC-CSA was greater in HC versus MS (P < .001) and RRMS versus progressive MS (P < .001). SCA showed moderate correlations with global disability in cross-sectional studies (r-value with disability score range [-.75 to -.22]). In longitudinal studies, the pooled annual rate of SCA was 1.78%/year (95%CI [1.28-2.27]). CONCLUSIONS The SC is atrophied in MS. The magnitude of SCA is greater in progressive versus relapsing forms and correlates with clinical disability. The pooled estimate of annual rate of SCA is greater than reported rates of brain atrophy in MS. These results demonstrate that SCA is highly relevant as an imaging outcome in MS clinical trials.
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Affiliation(s)
- Courtney Casserly
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Neurology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Estelle E Seyman
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paula Alcaide-Leon
- Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Guenette
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Carrie Lyons
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Sankar
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anton Svendrovski
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Neurology, Johns Hopkins University, Baltimore, MD
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14
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Dostál M, Keřkovský M, Korit′áková E, Němcová E, Stulík J, Staňková M, Bernard V. Analysis of diffusion tensor measurements of the human cervical spinal cord based on semiautomatic segmentation of the white and gray matter. J Magn Reson Imaging 2018; 48:1217-1227. [DOI: 10.1002/jmri.26166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/10/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Marek Dostál
- Department of Biophysics, Faculty of Medicine; Masaryk University; Brno Czech Republic
- Department of Radiology; University Hospital Brno and Masaryk University; Brno Czech Republic
| | - Miloš Keřkovský
- Department of Radiology; University Hospital Brno and Masaryk University; Brno Czech Republic
| | - Eva Korit′áková
- Institute of Biostatistics and Analyses, Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Eva Němcová
- Department of Radiology; University Hospital Brno and Masaryk University; Brno Czech Republic
| | - Jakub Stulík
- Department of Radiology; University Hospital Brno and Masaryk University; Brno Czech Republic
| | - Monika Staňková
- Department of Radiology; University Hospital Brno and Masaryk University; Brno Czech Republic
| | - Vladan Bernard
- Department of Biophysics, Faculty of Medicine; Masaryk University; Brno Czech Republic
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15
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Sinnecker T, Granziera C, Wuerfel J, Schlaeger R. Future Brain and Spinal Cord Volumetric Imaging in the Clinic for Monitoring Treatment Response in MS. Curr Treat Options Neurol 2018; 20:17. [PMID: 29679165 DOI: 10.1007/s11940-018-0504-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Volumetric analysis of brain imaging has emerged as a standard approach used in clinical research, e.g., in the field of multiple sclerosis (MS), but its application in individual disease course monitoring is still hampered by biological and technical limitations. This review summarizes novel developments in volumetric imaging on the road towards clinical application to eventually monitor treatment response in patients with MS. RECENT FINDINGS In addition to the assessment of whole-brain volume changes, recent work was focused on the volumetry of specific compartments and substructures of the central nervous system (CNS) in MS. This included volumetric imaging of the deep brain structures and of the spinal cord white and gray matter. Volume changes of the latter indeed independently correlate with clinical outcome measures especially in progressive MS. Ultrahigh field MRI and quantitative MRI added to this trend by providing a better visualization of small compartments on highly resolving MR images as well as microstructural information. New developments in volumetric imaging have the potential to improve sensitivity as well as specificity in detecting and hence monitoring disease-related CNS volume changes in MS.
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Affiliation(s)
- Tim Sinnecker
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Medical Image Analysis Center Basel AG, Basel, Switzerland
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center Basel AG, Basel, Switzerland
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Ultrahigh Field Facility, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Regina Schlaeger
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
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16
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Sheykhansari S, Kozielski K, Bill J, Sitti M, Gemmati D, Zamboni P, Singh AV. Redox metals homeostasis in multiple sclerosis and amyotrophic lateral sclerosis: a review. Cell Death Dis 2018; 9:348. [PMID: 29497049 PMCID: PMC5832817 DOI: 10.1038/s41419-018-0379-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/13/2017] [Accepted: 12/27/2017] [Indexed: 12/12/2022]
Abstract
The effect of redox metals such as iron and copper on multiple sclerosis and amyotrophic lateral sclerosis has been intensively studied. However, the origin of these disorders remains uncertain. This review article critically describes the physiology of redox metals that produce oxidative stress, which in turn leads to cascades of immunomodulatory alteration of neurons in multiple sclerosis and amyotrophic lateral sclerosis. Iron and copper overload has been well established in motor neurons of these diseases’ lesions. On the other hand, the role of other metals like cadmium participating indirectly in the redox cascade of neurobiological mechanism is less studied. In the second part of this review, we focus on this less conspicuous correlation between cadmium as an inactive-redox metal and multiple sclerosis and amyotrophic lateral sclerosis, providing novel treatment modalities and approaches as future prospects.
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Affiliation(s)
- Sahar Sheykhansari
- Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, Stuttgart, 70569, Germany
| | - Kristen Kozielski
- Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, Stuttgart, 70569, Germany
| | - Joachim Bill
- Institute for Materials Science, University of Stuttgart, Heisenbergstr. 3, Stuttgart, 70569, Germany
| | - Metin Sitti
- Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, Stuttgart, 70569, Germany
| | - Donato Gemmati
- Hemostasis & Thrombosis Center - Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Translational Surgery Unit, Azienda Ospedaliera Universitaria di Ferrara, via Aldo Moro 8, 44124, Ferrara, Italy.
| | - Ajay Vikram Singh
- Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, Stuttgart, 70569, Germany.
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17
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Zeydan B, Gu X, Atkinson EJ, Keegan BM, Weinshenker BG, Tillema JM, Pelletier D, Azevedo CJ, Lebrun-Frenay C, Siva A, Okuda DT, Kantarci K, Kantarci OH. Cervical spinal cord atrophy: An early marker of progressive MS onset. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e435. [PMID: 29435472 PMCID: PMC5795903 DOI: 10.1212/nxi.0000000000000435] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/28/2017] [Indexed: 11/15/2022]
Abstract
Objective To assess whether cervical spinal cord atrophy heralds the onset of progressive MS. Methods We studied 34 individuals with radiologically isolated syndrome (RIS) and 31 patients with relapsing-remitting MS (RRMS) age matched to 25 patients within a year of onset of secondary progressive MS (SPMS). Two raters independently measured (twice per rater) the cervical spinal cord average segmental area (CASA) (mm2) of axial T2-weighted images between C2 and C7 landmarks. The midsagittal T2-weighted image from the end of C2 to the end of C7 vertebra was used to measure the cervical spine (c-spine) length (mm). Sex, age at cervical MRI, number and location of cervical spinal cord lesions, c-spine length, and diagnoses were analyzed against the outcome measures of CASA and C2 and C7 slice segmental areas. Results Intrarater and interrater agreement was excellent (intraclass correlation coefficient >0.97). The CASA area (p = 0.03) and C7 area (p = 0.002) were smaller in SPMS compared with RRMS. The C2 area (p = 0.027), CASA (p = 0.004), and C7 area (p = 0.003) were smaller in SPMS compared with RIS. The C2 area did not differ between SPMS and RRMS (p = 0.09). The C2 area (p = 0.349), CASA (p = 0.136), and C7 area (p = 0.228) did not differ between RIS and MS (SPMS and RRMS combined). In the multivariable model, ≥2 cervical spinal cord lesions were associated with the C2 area (p = 0.008), CASA (p = 0.009), and C7 area independent of disease course (p = 0.017). Progressive disease course was associated with the C7 area independent of the cervical spinal cord lesion number (p = 0.004). Conclusion Cervical spinal cord atrophy is evident at the onset of progressive MS and seems partially independent of the number of cervical spinal cord lesions. Classification of evidence This study provides Class III evidence that MRI cervical spinal cord atrophy distinguishes patients at the onset of progressive MS from those with RIS and RRMS.
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Affiliation(s)
- Burcu Zeydan
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Xinyi Gu
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Elizabeth J Atkinson
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - B Mark Keegan
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Brian G Weinshenker
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Jan-Mendelt Tillema
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Daniel Pelletier
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Christina J Azevedo
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Christine Lebrun-Frenay
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Aksel Siva
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Darin T Okuda
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Kejal Kantarci
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Orhun H Kantarci
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
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18
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Aymerich FX, Auger C, Alonso J, Alberich M, Sastre-Garriga J, Tintoré M, Montalban X, Rovira A. Cervical Cord Atrophy and Long-Term Disease Progression in Patients with Primary-Progressive Multiple Sclerosis. AJNR Am J Neuroradiol 2017; 39:399-404. [PMID: 29284602 DOI: 10.3174/ajnr.a5495] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/16/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cervical cord atrophy has been associated with clinical disability in multiple sclerosis and is proposed as an outcome measure of neurodegeneration. The aim of this study was to quantify the development of cervical cord atrophy and to evaluate its association with disability progression in patients with primary-progressive multiple sclerosis. MATERIALS AND METHODS Thirty-one patients with primary-progressive multiple sclerosis underwent 1.5T brain and spinal cord MR imaging at baseline and 6-7 years later. The cervical spinal cord from C1 to C5 was segmented to evaluate the normalized overall cross-sectional area and the cross-sectional area of C2-C3, C3-C4, and C4-C5. The annualized rates of normalized cross-sectional area loss were also evaluated. To estimate clinical progression, we determined the Expanded Disability Status Scale score at baseline and at 2 and 14 years after baseline to compute the normalized area under the curve of the Expanded Disability Status Scale and the Expanded Disability Status Scale changes from baseline to the follow-up time points. Associations between the cord cross-sectional area and brain MR imaging and clinical measures were also investigated. Finally, the value of all these measures for predicting long-term disability was evaluated. RESULTS Some normalized cross-sectional area measurements showed moderate correlations with the normalized area under the curve of the Expanded Disability Status Scale, ranging from -0.439 to -0.359 (P < .05). Moreover, the annualized rate of the normalized mean cross-sectional area loss and the baseline Expanded Disability Status Scale were independent predictors of long-term disability progression. CONCLUSIONS These data indicate that development of cervical cord atrophy is associated with progression of disability and is predictive of this event in patients with primary-progressive MS.
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Affiliation(s)
- F X Aymerich
- From the Magnetic Resonance Unit (F.X.A., C.A., J.A., M.A., A.R.), Department of Radiology .,Department of Automatic Control (F.X.A.), Universitat Politècnica de Catalunya-Barcelona Tech, Barcelona, Spain
| | - C Auger
- From the Magnetic Resonance Unit (F.X.A., C.A., J.A., M.A., A.R.), Department of Radiology
| | - J Alonso
- From the Magnetic Resonance Unit (F.X.A., C.A., J.A., M.A., A.R.), Department of Radiology
| | - M Alberich
- From the Magnetic Resonance Unit (F.X.A., C.A., J.A., M.A., A.R.), Department of Radiology
| | - J Sastre-Garriga
- Centre d'Esclerosi Múltiple de Catalunya (J.S.-G., M.T., X.M.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Tintoré
- Centre d'Esclerosi Múltiple de Catalunya (J.S.-G., M.T., X.M.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- Centre d'Esclerosi Múltiple de Catalunya (J.S.-G., M.T., X.M.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Rovira
- From the Magnetic Resonance Unit (F.X.A., C.A., J.A., M.A., A.R.), Department of Radiology
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19
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Azodi S, Nair G, Enose-Akahata Y, Charlip E, Vellucci A, Cortese I, Dwyer J, Billioux BJ, Thomas C, Ohayon J, Reich DS, Jacobson S. Imaging spinal cord atrophy in progressive myelopathies: HTLV-I-associated neurological disease (HAM/TSP) and multiple sclerosis (MS). Ann Neurol 2017; 82:719-728. [PMID: 29024167 DOI: 10.1002/ana.25072] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/08/2017] [Accepted: 10/05/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previous work measures spinal cord thinning in chronic progressive myelopathies, including human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and multiple sclerosis (MS). Quantitative measurements of spinal cord atrophy are important in fully characterizing these and other spinal cord diseases. We aimed to investigate patterns of spinal cord atrophy and correlations with clinical markers. METHODS Spinal cord cross-sectional area was measured in individuals (24 healthy controls [HCs], 17 asymptomatic carriers of HTLV-1 (AC), 47 HAM/TSP, 74 relapsing-remitting MS [RRMS], 17 secondary progressive MS [SPMS], and 40 primary progressive MS [PPMS]) from C1 to T10. Clinical disability scores, viral markers, and immunological parameters were obtained for patients and correlated with representative spinal cord cross-sectional area regions at the C2 to C3, C4 to C5, and T4 to T9 levels. In 2 HAM/TSP patients, spinal cord cross-sectional area was measured over 3 years. RESULTS All spinal cord regions are thinner in HAM/TSP (56 mm2 [standard deviation, 10], 59 [10], 23 [5]) than in HC (76 [7], 83 [8], 38 [4]) and AC (71 [7], 78 [9], 36 [7]). SPMS (62 [9], 66 [9], 32 [6]) and PPMS (65 [11], 68 [10], 35 [7]) have thinner cervical cords than HC and RRMS (73 [9], 77 [10], 37 [6]). Clinical disability scores (Expanded Disability Status Scale [p = 0.009] and Instituto de Pesquisas de Cananeia [p = 0.03]) and CD8+ T-cell frequency (p = 0.04) correlate with T4 to T9 spinal cord cross-sectional area in HAM/TSP. Higher cerebrospinal fluid HTLV-1 proviral load (p = 0.01) was associated with thinner spinal cord cross-sectional area. Both HAM/TSP patients followed longitudinally showed thoracic thinning followed by cervical thinning. INTERPRETATION Group average spinal cord cross-sectional area in HAM/TSP and progressive MS show spinal cord atrophy. We further hypothesize in HAM/TSP that is possible that neuroglial loss from a thoracic inflammatory process results in anterograde and retrograde degeneration of axons, leading to the temporal progression of thoracic to cervical atrophy described here. Ann Neurol 2017;82:719-728.
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Affiliation(s)
- Shila Azodi
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Govind Nair
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Yoshimi Enose-Akahata
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Emily Charlip
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Ashley Vellucci
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Irene Cortese
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Jenifer Dwyer
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - B Jeanne Billioux
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Chevaz Thomas
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Joan Ohayon
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD
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20
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Rocca MA, Comi G, Filippi M. The Role of T1-Weighted Derived Measures of Neurodegeneration for Assessing Disability Progression in Multiple Sclerosis. Front Neurol 2017; 8:433. [PMID: 28928705 PMCID: PMC5591328 DOI: 10.3389/fneur.2017.00433] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/08/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction Multiple sclerosis (MS) is characterised by the accumulation of permanent neurological disability secondary to irreversible tissue loss (neurodegeneration) in the brain and spinal cord. MRI measures derived from T1-weighted image analysis (i.e., black holes and atrophy) are correlated with pathological measures of irreversible tissue loss. Quantifying the degree of neurodegeneration in vivo using MRI may offer a surrogate marker with which to predict disability progression and the effect of treatment. This review evaluates the literature examining the association between MRI measures of neurodegeneration derived from T1-weighted images and disability in MS patients. Methods A systematic PubMed search was conducted in January 2017 to identify MRI studies in MS patients investigating the relationship between “black holes” and/or atrophy in the brain and spinal cord, and disability. Results were limited to human studies published in English in the previous 10 years. Results A large number of studies have evaluated the association between the previous MRI measures and disability. These vary considerably in terms of study design, duration of follow-up, size, and phenotype of the patient population. Most, although not all, have shown that there is a significant correlation between disability and black holes in the brain, as well as atrophy of the whole brain and grey matter. The results for brain white matter atrophy are less consistently positive, whereas studies evaluating spinal cord atrophy consistently showed a significant correlation with disability. Newer ways of measuring atrophy, thanks to the development of segmentation and voxel-wise methods, have allowed us to assess the involvement of strategic regions of the CNS (e.g., thalamus) and to map the regional distribution of damage. This has resulted in better correlations between MRI measures and disability and in the identification of the critical role played by some CNS structures for MS clinical manifestations. Conclusion The evaluation of MRI measures of atrophy as predictive markers of disability in MS is a highly active area of research. At present, measurement of atrophy remains within the realm of clinical studies, but its utility in clinical practice has been recognized and barriers to its implementation are starting to be addressed.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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21
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Prados F, Ashburner J, Blaiotta C, Brosch T, Carballido-Gamio J, Cardoso MJ, Conrad BN, Datta E, Dávid G, Leener BD, Dupont SM, Freund P, Wheeler-Kingshott CAMG, Grussu F, Henry R, Landman BA, Ljungberg E, Lyttle B, Ourselin S, Papinutto N, Saporito S, Schlaeger R, Smith SA, Summers P, Tam R, Yiannakas MC, Zhu A, Cohen-Adad J. Spinal cord grey matter segmentation challenge. Neuroimage 2017; 152:312-329. [PMID: 28286318 PMCID: PMC5440179 DOI: 10.1016/j.neuroimage.2017.03.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/27/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022] Open
Abstract
An important image processing step in spinal cord magnetic resonance imaging is the ability to reliably and accurately segment grey and white matter for tissue specific analysis. There are several semi- or fully-automated segmentation methods for cervical cord cross-sectional area measurement with an excellent performance close or equal to the manual segmentation. However, grey matter segmentation is still challenging due to small cross-sectional size and shape, and active research is being conducted by several groups around the world in this field. Therefore a grey matter spinal cord segmentation challenge was organised to test different capabilities of various methods using the same multi-centre and multi-vendor dataset acquired with distinct 3D gradient-echo sequences. This challenge aimed to characterize the state-of-the-art in the field as well as identifying new opportunities for future improvements. Six different spinal cord grey matter segmentation methods developed independently by various research groups across the world and their performance were compared to manual segmentation outcomes, the present gold-standard. All algorithms provided good overall results for detecting the grey matter butterfly, albeit with variable performance in certain quality-of-segmentation metrics. The data have been made publicly available and the challenge web site remains open to new submissions. No modifications were introduced to any of the presented methods as a result of this challenge for the purposes of this publication.
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Affiliation(s)
- Ferran Prados
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK; NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, Russell Square, London WC1B 5EH, UK.
| | - John Ashburner
- Wellcome Trust Centre for Neuroimaging, University College London, Queen Square, London WC1N 3BG, UK
| | - Claudia Blaiotta
- Wellcome Trust Centre for Neuroimaging, University College London, Queen Square, London WC1N 3BG, UK
| | - Tom Brosch
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada V6T 1Z4
| | | | - Manuel Jorge Cardoso
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK; Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Benjamin N Conrad
- Department of Electrical Engineering, Computer Science, Biomedical Engineering, Radiology and Radiological Sciences, Institute of Image Science at Vanderbilt University, Nashville, TN, USA
| | - Esha Datta
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gergely Dávid
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Sara M Dupont
- NeuroPoly Lab, Polytechnique Montreal, Montreal, QC, Canada
| | - Patrick Freund
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Switzerland
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, Russell Square, London WC1B 5EH, UK; Brain MRI 3T Centre, C. Mondino National Neurological Institute, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Italy
| | - Francesco Grussu
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, Russell Square, London WC1B 5EH, UK
| | - Roland Henry
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Bennett A Landman
- Department of Electrical Engineering, Computer Science, Biomedical Engineering, Radiology and Radiological Sciences, Institute of Image Science at Vanderbilt University, Nashville, TN, USA
| | - Emil Ljungberg
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 2B5
| | - Bailey Lyttle
- Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK; Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Nico Papinutto
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Regina Schlaeger
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Seth A Smith
- Department of Radiology and Radiological Sciences, Biomedical Engineering, Ophthalmology, Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Paul Summers
- Department of Radiology, European Institute of Oncology, University of Modena and Reggio Emilia, 41121, Modena, MO, Italy
| | - Roger Tam
- Department of Radiology, UBC MS/MRI Research Group, University of British Columbia, Vancouver, BC, Canada V6T 2B5
| | - Marios C Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, Russell Square, London WC1B 5EH, UK
| | - Alyssa Zhu
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Julien Cohen-Adad
- NeuroPoly Lab, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada.
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22
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Vågberg M, Granåsen G, Svenningsson A. Brain Parenchymal Fraction in Healthy Adults-A Systematic Review of the Literature. PLoS One 2017; 12:e0170018. [PMID: 28095463 PMCID: PMC5240949 DOI: 10.1371/journal.pone.0170018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/26/2016] [Indexed: 01/18/2023] Open
Abstract
Brain atrophy is an important feature of many neurodegenerative disorders. It can be described in terms of change in the brain parenchymal fraction (BPF). In order to interpret the BPF in disease, knowledge on the BPF in healthy individuals is required. The aim of this study was to establish a normal range of values for the BPF of healthy individuals via a systematic review of the literature. The databases PubMed and Scopus were searched and 95 articles, including a total of 9269 individuals, were identified including the required data. We present values of BPF from healthy individuals stratified by age and post-processing method. The mean BPF correlated with mean age and there were significant differences in age-adjusted mean BPF between methods. This study contributes to increased knowledge about BPF in healthy individuals, which may assist in the interpretation of BPF in the setting of disease. We highlight the differences between post-processing methods and the need for a consensus gold standard.
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Affiliation(s)
- Mattias Vågberg
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Gabriel Granåsen
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anders Svenningsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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23
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Fully automated grey and white matter spinal cord segmentation. Sci Rep 2016; 6:36151. [PMID: 27786306 PMCID: PMC5082365 DOI: 10.1038/srep36151] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/06/2016] [Indexed: 12/03/2022] Open
Abstract
Axonal loss in the spinal cord is one of the main contributing factors to irreversible clinical disability in multiple sclerosis (MS). In vivo axonal loss can be assessed indirectly by estimating a reduction in the cervical cross-sectional area (CSA) of the spinal cord over time, which is indicative of spinal cord atrophy, and such a measure may be obtained by means of image segmentation using magnetic resonance imaging (MRI). In this work, we propose a new fully automated spinal cord segmentation technique that incorporates two different multi-atlas segmentation propagation and fusion techniques: The Optimized PatchMatch Label fusion (OPAL) algorithm for localising and approximately segmenting the spinal cord, and the Similarity and Truth Estimation for Propagated Segmentations (STEPS) algorithm for segmenting white and grey matter simultaneously. In a retrospective analysis of MRI data, the proposed method facilitated CSA measurements with accuracy equivalent to the inter-rater variability, with a Dice score (DSC) of 0.967 at C2/C3 level. The segmentation performance for grey matter at C2/C3 level was close to inter-rater variability, reaching an accuracy (DSC) of 0.826 for healthy subjects and 0.835 people with clinically isolated syndrome MS.
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24
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De Leener B, Taso M, Cohen-Adad J, Callot V. Segmentation of the human spinal cord. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 29:125-53. [PMID: 26724926 DOI: 10.1007/s10334-015-0507-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 12/14/2022]
Abstract
Segmenting the spinal cord contour is a necessary step for quantifying spinal cord atrophy in various diseases. Delineating gray matter (GM) and white matter (WM) is also useful for quantifying GM atrophy or for extracting multiparametric MRI metrics into specific WM tracts. Spinal cord segmentation in clinical research is not as developed as brain segmentation, however with the substantial improvement of MR sequences adapted to spinal cord MR investigations, the field of spinal cord MR segmentation has advanced greatly within the last decade. Segmentation techniques with variable accuracy and degree of complexity have been developed and reported in the literature. In this paper, we review some of the existing methods for cord and WM/GM segmentation, including intensity-based, surface-based, and image-based methods. We also provide recommendations for validating spinal cord segmentation techniques, as it is important to understand the intrinsic characteristics of the methods and to evaluate their performance and limitations. Lastly, we illustrate some applications in the healthy and pathological spinal cord. One conclusion of this review is that robust and automatic segmentation is clinically relevant, as it would allow for longitudinal and group studies free from user bias as well as reproducible multicentric studies in large populations, thereby helping to further our understanding of the spinal cord pathophysiology and to develop new criteria for early detection of subclinical evolution for prognosis prediction and for patient management. Another conclusion is that at the present time, no single method adequately segments the cord and its substructure in all the cases encountered (abnormal intensities, loss of contrast, deformation of the cord, etc.). A combination of different approaches is thus advised for future developments, along with the introduction of probabilistic shape models. Maturation of standardized frameworks, multiplatform availability, inclusion in large suite and data sharing would also ultimately benefit to the community.
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Affiliation(s)
- Benjamin De Leener
- Neuroimaging Research Laboratory (NeuroPoly), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
| | - Manuel Taso
- Aix Marseille Université, IFSTTAR, LBA UMR_T 24, Marseille, France.,Aix Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France.,APHM, Hôpital de la Timone, Pôle d'imagerie médicale, CEMEREM, Marseille, France
| | - Julien Cohen-Adad
- Neuroimaging Research Laboratory (NeuroPoly), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
| | - Virginie Callot
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France. .,APHM, Hôpital de la Timone, Pôle d'imagerie médicale, CEMEREM, Marseille, France.
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25
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Liu Y, Lukas C, Steenwijk MD, Daams M, Versteeg A, Duan Y, Li K, Weiler F, Hahn HK, Wattjes MP, Barkhof F, Vrenken H. Multicenter Validation of Mean Upper Cervical Cord Area Measurements from Head 3D T1-Weighted MR Imaging in Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2015; 37:749-54. [PMID: 26659338 DOI: 10.3174/ajnr.a4635] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 08/27/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spinal cord atrophy is a common and clinically relevant characteristic in multiple sclerosis. We aimed to perform a multicenter validation study of mean upper cervical cord area measurements in patients with multiple sclerosis and healthy controls from head MR images and to explore the effect of gadolinium administration on mean upper cervical cord area measurements. MATERIALS AND METHODS We recruited 97 subjects from 3 centers, including 60 patients with multiple sclerosis of different disease types and 37 healthy controls. Both cervical cord and head 3D T1-weighted images were acquired. In 11 additional patients from 1 center, head images before and after gadolinium administration and cervical cord images after gadolinium administration were acquired. The mean upper cervical cord area was compared between cervical cord and head images by using intraclass correlation coefficients (ICC) for both consistency (ICCconsist) and absolute (ICCabs) agreement. RESULTS There was excellent agreement of mean upper cervical cord area measurements from head and cervical cord images in the entire group (ICCabs = 0.987) and across centers and disease subtypes. The mean absolute difference between the mean upper cervical cord area measured from head and cervical cord images was 2 mm(2) (2.3%). Additionally, excellent agreement was found between the mean upper cervical cord area measured from head images with and without gadolinium administration (ICCabs = 0.991) and between the cervical cord and head images with gadolinium administration (ICCabs = 0.992). CONCLUSIONS Excellent agreement between mean upper cervical cord area measurements on head and cervical cord images was observed in this multicenter study, implying that upper cervical cord atrophy can be reliably measured from head images. Postgadolinium head or cervical cord images may also be suitable for measuring mean upper cervical cord area.
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Affiliation(s)
- Y Liu
- From the Department of Radiology (Y.L., Y.D., K.L.), Xuanwu Hospital, Capital Medical University, Beijing, P.R. China Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam Department of Neurology and Tianjin Neurological Institute (Y.L.), Tianjin Medical University, General Hospital, Tianjin, P.R. China
| | - C Lukas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - M D Steenwijk
- Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam
| | - M Daams
- Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam Department of Anatomy and Neurosciences (M.D.), Section of Clinical Neuroscience
| | - A Versteeg
- Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam
| | - Y Duan
- From the Department of Radiology (Y.L., Y.D., K.L.), Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - K Li
- From the Department of Radiology (Y.L., Y.D., K.L.), Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - F Weiler
- Fraunhofer MEVIS, Institute for Medical Image Computing (F.W., H.K.H.), Bremen, Germany
| | - H K Hahn
- Fraunhofer MEVIS, Institute for Medical Image Computing (F.W., H.K.H.), Bremen, Germany
| | - M P Wattjes
- Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam
| | - F Barkhof
- Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam
| | - H Vrenken
- Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam Department of Physics and Medical Technology (H.V.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
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26
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Kim G, Khalid F, Oommen VV, Tauhid S, Chu R, Horsfield MA, Healy BC, Bakshi R. T1- vs. T2-based MRI measures of spinal cord volume in healthy subjects and patients with multiple sclerosis. BMC Neurol 2015; 15:124. [PMID: 26227960 PMCID: PMC4521382 DOI: 10.1186/s12883-015-0387-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background The reliable and efficient measurement of spinal cord atrophy is of growing interest in monitoring disease progression in multiple sclerosis (MS). Methods We compared T1- and T2-weighted MRI for measuring cervical spinal cord volume in 31 patients with MS and 18 age-matched controls (NC) from T1-weighted gradient recalled echo and T2-weighted fast spin-echo 1.5 T axial acquisitions. The two sequences were matched on slice thickness, signal averages and voxel size. An active surface software tool determined the normalized mean cervical cord cross-sectional area. Results T1-derived cord areas were higher than T2 areas in the whole cohort (estimated mean difference = 7.03 mm2 (8.89 %); 95 % Confidence Interval (CI): 5.91, 8.14; p < 0.0001) and in both groups separately. There were trends for lower spinal cord areas in MS vs. NC with both sequences. For the T1 cord area, the mean difference was 3.7 mm2 (4.55 %) (95 % CI: −1.36, 8.78; p = 0.15). For the T2 cord area, the difference was larger [mean difference 4.9 mm2 (6.52 %) (95 % CI: −0.83, 10.67); p = 0.091]. The T1 and T2 cord areas showed similar weak to moderate correlations with measures of clinical status and T2 spinal cord lesion volume in the MS group. Superficial spinal cord T2 lesions had no apparent confounding effect on the outlining tool. The mean intra-rater and inter-rater coefficients of variation ranged from 0.27 to 0.91 % for T1- and 0.66 to 0.99 % for T2-derived cord areas. Conclusion T2-weighted images may prove efficient for measuring cervical spinal cord atrophy in MS, with the added advantage of lesion detectability.
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Affiliation(s)
- Gloria Kim
- Departments of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA.
| | - Fariha Khalid
- Departments of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA.
| | - Vinit V Oommen
- Departments of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA.
| | - Shahamat Tauhid
- Departments of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA.
| | - Renxin Chu
- Departments of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA.
| | - Mark A Horsfield
- Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, Leicester, UK.
| | - Brian C Healy
- Departments of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA.
| | - Rohit Bakshi
- Departments of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA. .,Departments of Radiology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA. .,Laboratory for Neuroimaging Research, One Brookline Place, Brookline, MA, 02445, USA.
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27
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Lukas C, Knol DL, Sombekke MH, Bellenberg B, Hahn HK, Popescu V, Weier K, Radue EW, Gass A, Kappos L, Naegelin Y, Uitdehaag BMJ, Geurts JJG, Barkhof F, Vrenken H. Cervical spinal cord volume loss is related to clinical disability progression in multiple sclerosis. J Neurol Neurosurg Psychiatry 2015; 86:410-8. [PMID: 24973341 DOI: 10.1136/jnnp-2014-308021] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the temporal evolution of spinal cord (SC) atrophy in multiple sclerosis (MS), and its association with clinical progression in a large MS cohort. METHODS A total of 352 patients from two centres with MS (relapsing remitting MS (RRMS): 256, secondary progressive MS (SPMS): 73, primary progressive MS (PPMS): 23) were included. Clinical and MRI parameters were obtained at baseline, after 12 months and 24 months of follow-up. In addition to conventional brain and SC MRI parameters, the annualised percentage brain volume change and the annualised percentage upper cervical cord cross-sectional area change (aUCCA) were quantified. Main outcome measure was disease progression, defined by expanded disability status scale increase after 24 months. RESULTS UCCA was lower in SPMS and PPMS compared with RRMS for all time points. aUCCA over 24 months was highest in patients with SPMS (-2.2% per year) and was significantly higher in patients with disease progression (-2.3% per year) than in stable patients (-1.2% per year; p=0.003), while annualised percentage brain volume change did not differ between subtypes (RRMS: -0.42% per year; SPMS -0.6% per year; PPMS: -0.46% per year) nor between progressive and stable patients (p=0.055). Baseline UCCA and aUCCA over 24 months were found to be relevant contributors of expanded disability status scale at month-24, while baseline UCCA as well as number of SC segments involved by lesions at baseline but not aUCCA were relevant contributors of disease progression. CONCLUSIONS SC MRI parameters including baseline UCCA and SC lesions were significant MRI predictors of disease progression. Progressive 24-month upper SC atrophy occurred in all MS subtypes, and was faster in patients exhibiting disease progression at month-24.
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Affiliation(s)
- Carsten Lukas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Dirk L Knol
- Department of Epidemiology and Biostatistics, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Madeleine H Sombekke
- Department of Neurology, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Barbara Bellenberg
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Horst K Hahn
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | - Veronica Popescu
- Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Katrin Weier
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ernst W Radue
- Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland
| | - Achim Gass
- Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Jeroen J G Geurts
- Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands. Department of Anatomy and Neurosciences, section of Clinical Neuroscience, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Hugo Vrenken
- Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands. Department of Physics and Medical Technology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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28
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El Mendili MM, Chen R, Tiret B, Villard N, Trunet S, Pélégrini-Issac M, Lehéricy S, Pradat PF, Benali H. Fast and accurate semi-automated segmentation method of spinal cord MR images at 3T applied to the construction of a cervical spinal cord template. PLoS One 2015; 10:e0122224. [PMID: 25816143 PMCID: PMC4376938 DOI: 10.1371/journal.pone.0122224] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 02/19/2015] [Indexed: 12/11/2022] Open
Abstract
Objective To design a fast and accurate semi-automated segmentation method for spinal cord 3T MR images and to construct a template of the cervical spinal cord. Materials and Methods A semi-automated double threshold-based method (DTbM) was proposed enabling both cross-sectional and volumetric measures from 3D T2-weighted turbo spin echo MR scans of the spinal cord at 3T. Eighty-two healthy subjects, 10 patients with amyotrophic lateral sclerosis, 10 with spinal muscular atrophy and 10 with spinal cord injuries were studied. DTbM was compared with active surface method (ASM), threshold-based method (TbM) and manual outlining (ground truth). Accuracy of segmentations was scored visually by a radiologist in cervical and thoracic cord regions. Accuracy was also quantified at the cervical and thoracic levels as well as at C2 vertebral level. To construct a cervical template from healthy subjects’ images (n=59), a standardization pipeline was designed leading to well-centered straight spinal cord images and accurate probability tissue map. Results Visual scoring showed better performance for DTbM than for ASM. Mean Dice similarity coefficient (DSC) was 95.71% for DTbM and 90.78% for ASM at the cervical level and 94.27% for DTbM and 89.93% for ASM at the thoracic level. Finally, at C2 vertebral level, mean DSC was 97.98% for DTbM compared with 98.02% for TbM and 96.76% for ASM. DTbM showed similar accuracy compared with TbM, but with the advantage of limited manual interaction. Conclusion A semi-automated segmentation method with limited manual intervention was introduced and validated on 3T images, enabling the construction of a cervical spinal cord template.
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Affiliation(s)
- Mohamed-Mounir El Mendili
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
- * E-mail:
| | - Raphaël Chen
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Brice Tiret
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Noémie Villard
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Stéphanie Trunet
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neuroradiologie, F-75013, Paris, Île de France, France
| | - Mélanie Pélégrini-Issac
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Stéphane Lehéricy
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neuroradiologie, F-75013, Paris, Île de France, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S975, Inserm U975, CNRS UMR7225, Centre de recherche de l’Institut du Cerveau et de la Moelle épinière—CRICM, Centre de Neuroimagerie de Recherche—CENIR, F-75013, Paris, Île de France, France
| | - Pierre-François Pradat
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Département des Maladies du Système Nerveux, F-75013, Paris, Île de France, France
| | - Habib Benali
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
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Age, gender and normalization covariates for spinal cord gray matter and total cross-sectional areas at cervical and thoracic levels: A 2D phase sensitive inversion recovery imaging study. PLoS One 2015; 10:e0118576. [PMID: 25781178 PMCID: PMC4363673 DOI: 10.1371/journal.pone.0118576] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/13/2015] [Indexed: 11/24/2022] Open
Abstract
The source of inter-subject variability and the influence of age and gender on morphometric characteristics of the spinal cord, such as the total cross-sectional area (TCA), the gray matter (GM) and white matter (WM) areas, currently remain under investigation. Understanding the effect of covariates such as age, gender, brain volumes, and skull- and vertebra-derived metrics on cervical and thoracic spinal cord TCA and GM areas in healthy subjects would be fundamental for exploring compartment specific changes in neurological diseases affecting the spinal cord. Using Magnetic Resonance Imaging at 3T we investigated 32 healthy subjects using a 2D phase sensitive inversion recovery sequence and we measured TCA, GM and WM areas at 4 cervical and thoracic levels of the spinal cord. We assessed age and gender relationships of cord measures and explored associations between cord measures and a) brain volumes and b) skull- and vertebra-derived metrics. Age and gender had a significant effect on TCA, WM and GM areas (with women and elderly having smaller values than men and younger people respectively), but not on the GM area/TCA ratio. The total intracranial volume and C3 vertebra dimensions showed the highest correlations with cord measures. When used in multi-regression models, they reduced cord areas group variability by approximately a third. Age and gender influences on cord measures and normalization strategies here presented might be of use in the study of compartment specific changes in various neurological diseases affecting the spinal cord.
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30
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Bernitsas E, Bao F, Seraji-Bozorgzad N, Chorostecki J, Santiago C, Tselis A, Caon C, Zak I, Millis S, Khan O. Spinal cord atrophy in multiple sclerosis and relationship with disability across clinical phenotypes. Mult Scler Relat Disord 2014; 4:47-51. [PMID: 25787052 DOI: 10.1016/j.msard.2014.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/28/2014] [Accepted: 11/07/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies have shown a relationship between spinal cord atrophy and clinical disability in patients with multiple sclerosis (MS). OBJECTIVES We examined the correlation between cervical cord cross-sectional area at the C2 vertebral level (CSA-C2) and the expanded disability status scale (EDSS) in patients with relapsing-remitting and progressive forms of MS. The latter included both secondary and primary progressive MS patients. METHODS A total of 150 patients with MS were recruited from the Wayne State University MS clinic. Ninety-three had relapsing-remitting MS and 57 patients had progressive MS. MRI scan of the cervical cord was obtained for each patient. Correlation studies and multivariate regression analysis was performed, blinded to clinical status. RESULTS The mean age was 41.3 year old, 64.6% were women, mean disease duration was 11.2 years, CSA-C2 was 80.2mm(2) and mean EDSS was 3.8. There was significant correlation between CSA-C2 and EDSS (r -0.75, p<0.0001). Sub-group analysis showed CSA-C2 was 68.6mm(2) and 87.3mm(2) in the progressive and relapsing-remitting groups, respectively (p<0.0001). Multivariable regression showed that CSA-C2 was a significant predictor of disability independent of disease duration, and phenotype. CONCLUSIONS Our study demonstrates that CSA-C2 has a strong correlation with clinical disability in both RRMS and progressive MS. Greater spinal cord atrophy was seen in patients with progressive than relapsing-remitting MS. CSA-C2, disease duration, and phenotype are independent predictors of disability.
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Affiliation(s)
- Evanthia Bernitsas
- Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA
| | - Fen Bao
- The Sastry Foundation Advanced Imaging Laboratory, Department of Neurology, Wayne State University School of Medicine, Detroit, USA
| | - Navid Seraji-Bozorgzad
- Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA; The Sastry Foundation Advanced Imaging Laboratory, Department of Neurology, Wayne State University School of Medicine, Detroit, USA
| | - Jessica Chorostecki
- Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA; The Sastry Foundation Advanced Imaging Laboratory, Department of Neurology, Wayne State University School of Medicine, Detroit, USA
| | - Carla Santiago
- Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA; The Sastry Foundation Advanced Imaging Laboratory, Department of Neurology, Wayne State University School of Medicine, Detroit, USA
| | - Alexandros Tselis
- Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA
| | - Christina Caon
- Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA
| | - Imad Zak
- Department of Radiology, Wayne State University School of Medicine, Detroit, USA
| | - Scott Millis
- Division of Clinical Research & Biostatistics, Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, USA
| | - Omar Khan
- Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA; The Sastry Foundation Advanced Imaging Laboratory, Department of Neurology, Wayne State University School of Medicine, Detroit, USA.
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31
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Biberacher V, Boucard CC, Schmidt P, Engl C, Buck D, Berthele A, Hoshi MM, Zimmer C, Hemmer B, Mühlau M. Atrophy and structural variability of the upper cervical cord in early multiple sclerosis. Mult Scler 2014; 21:875-84. [PMID: 25139943 DOI: 10.1177/1352458514546514] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 07/21/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Despite agreement about spinal cord atrophy in progressive forms of multiple sclerosis (MS), data on clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS) are conflicting. OBJECTIVE To determine the onset of spinal cord atrophy in the disease course of MS. METHODS Structural brain magnetic resonance imaging (MRI) was acquired from 267 patients with CIS (85) or RRMS (182) and 64 healthy controls (HCs). The upper cervical cord cross-sectional area (UCCA) was determined at the level of C2/C3 by a segmentation tool and adjusted for focal MS lesions. The coefficient of variation (CV) was calculated from all measurements between C2/C3 and 13 mm above as a measure of structural variability. RESULTS Compared to HCs (76.1±6.9 mm(2)), UCCA was significantly reduced in CIS patients (73.5±5.8 mm(2), p=0.018) and RRMS patients (72.4±7.0 mm(2), p<0.001). Structural variability was higher in patients than in HCs, particularly but not exclusively in case of focal lesions (mean CV HCs/patients without/with lesions: 2.13%/2.55%/3.32%, all p-values<0.007). UCCA and CV correlated with Expanded Disability Status Scale (EDSS) scores (r =-0.131/0.192, p=0.044/<0.001) and disease duration (r=-0.134/0.300, p=0.039/< 0.001). CV additionally correlated with hand and arm function (r=0.180, p=0.014). CONCLUSION In MS, cervical cord atrophy already occurs in CIS. In early stages, structural variability may be a more meaningful marker of spinal cord pathology than atrophy.
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Affiliation(s)
- Viola Biberacher
- Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany
| | - Christine C Boucard
- Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany
| | - Paul Schmidt
- Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany/Ludwig-Maximilians-University München, Germany
| | - Christina Engl
- Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany
| | - Dorothea Buck
- Department of Neurology, Technische Universität München, Germany
| | - Achim Berthele
- Department of Neurology, Technische Universität München, Germany
| | | | | | - Bernhard Hemmer
- Technische Universität München, Germany/Munich Cluster for Systems Neurology (SyNergy), Germany
| | - Mark Mühlau
- Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany/Munich Cluster for Systems Neurology (SyNergy), Germany
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32
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Daams M, Weiler F, Steenwijk MD, Hahn HK, Geurts JJ, Vrenken H, van Schijndel RA, Balk LJ, Tewarie PK, Tillema JM, Killestein J, Uitdehaag BM, Barkhof F. Mean upper cervical cord area (MUCCA) measurement in long-standing multiple sclerosis: relation to brain findings and clinical disability. Mult Scler 2014; 20:1860-5. [PMID: 24812042 DOI: 10.1177/1352458514533399] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The majority of patients with multiple sclerosis (MS) present with spinal cord pathology. Spinal cord atrophy is thought to be a marker of disease severity, but in long-disease duration its relation to brain pathology and clinical disability is largely unknown. OBJECTIVE Our aim was to investigate mean upper cervical cord area (MUCCA) in patients with long-standing MS and assess its relation to brain magnetic resonance imaging (MRI) measures and clinical disability. METHODS MUCCA was measured in 196 MS patients and 55 healthy controls using 3DT1-weighted cervical images obtained at 3T MRI. Clinical disability was measured using the Expanded Disability Status Scale (EDSS), Nine-Hole-Peg test (9-HPT), and 25 feet Timed Walk Test (TWT). Stepwise linear regression was performed to assess the association between MUCCA and MRI measures, and between MUCCA and clinical disability. RESULTS MUCCA was smaller (mean 11.7%) in MS patients compared with healthy controls (72.56±9.82 and 82.24±7.80 mm2 respectively; p<0.001), most prominently in male patients. MUCCA was associated with normalized brain volume, and number of cervical cord lesions. MUCCA was independently associated with EDSS, TWT, and 9-HPT. CONCLUSION MUCCA was reduced in MS patients compared with healthy controls. It provides a relevant marker for clinical disability in long-standing disease, independent of other MRI measures.
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Affiliation(s)
- Marita Daams
- VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Florian Weiler
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | - Martijn D Steenwijk
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Horst K Hahn
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | - Jeroen Jg Geurts
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Hugo Vrenken
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Lisanne J Balk
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Prejaas K Tewarie
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan-Mendelt Tillema
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/ Mayo Clinic, Rochester, MN, USA
| | - Joep Killestein
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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33
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Oh J, Seigo M, Saidha S, Sotirchos E, Zackowski K, Chen M, Prince J, Diener-West M, Calabresi PA, Reich DS. Spinal cord normalization in multiple sclerosis. J Neuroimaging 2014; 24:577-584. [PMID: 24593281 DOI: 10.1111/jon.12097] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 10/06/2013] [Accepted: 11/19/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Spinal cord (SC) pathology is common in multiple sclerosis (MS), and measures of SC-atrophy are increasingly utilized. Normalization reduces biological variation of structural measurements unrelated to disease, but optimal parameters for SC volume (SCV)-normalization remain unclear. Using a variety of normalization factors and clinical measures, we assessed the effect of SCV normalization on detecting group differences and clarifying clinical-radiological correlations in MS. METHODS 3T cervical SC-MRI was performed in 133 MS cases and 11 healthy controls (HC). Clinical assessment included expanded disability status scale (EDSS), MS functional composite (MSFC), quantitative hip-flexion strength ("strength"), and vibration sensation threshold ("vibration"). SCV between C3 and C4 was measured and normalized individually by subject height, SC-length, and intracranial volume (ICV). RESULTS There were group differences in raw-SCV and after normalization by height and length (MS vs. HC; progressive vs. relapsing MS-subtypes, P < .05). There were correlations between clinical measures and raw-SCV (EDSS:r = -.20; MSFC:r = .16; strength:r = .35; vibration:r = -.19). Correlations consistently strengthened with normalization by length (EDSS:r = -.43; MSFC:r = .33; strength:r = .38; vibration:r = -.40), and height (EDSS:r = -.26; MSFC:r = .28; strength:r = .22; vibration:r = -.29), but diminished with normalization by ICV (EDSS:r = -.23; MSFC:r = -.10; strength:r = .23; vibration:r = -.35). In relapsing MS, normalization by length allowed statistical detection of correlations that were not apparent with raw-SCV. CONCLUSIONS SCV-normalization by length improves the ability to detect group differences, strengthens clinical-radiological correlations, and is particularly relevant in settings of subtle disease-related SC-atrophy in MS. SCV-normalization by length may enhance the clinical utility of measures of SC-atrophy.
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Affiliation(s)
- Jiwon Oh
- Department of Neurology, Johns Hopkins University
| | | | - Shiv Saidha
- Department of Neurology, Johns Hopkins University
| | | | - Kathy Zackowski
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University.,Motion Analysis Laboratory, Kennedy Krieger Institute
| | - Min Chen
- Department of Electrical and Computer Engineering, Johns Hopkins University
| | - Jerry Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University.,Department of Computer Science, Johns Hopkins University
| | | | | | - Daniel S Reich
- Department of Neurology, Johns Hopkins University.,Department of Biostatistics, Johns Hopkins University.,Department of Radiology and Radiological Science, Johns Hopkins University.,Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke
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El Mendili MM, Chen R, Tiret B, Pélégrini-Issac M, Cohen-Adad J, Lehéricy S, Pradat PF, Benali H. Validation of a semiautomated spinal cord segmentation method. J Magn Reson Imaging 2014; 41:454-9. [PMID: 24436309 DOI: 10.1002/jmri.24571] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/03/2014] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To validate semiautomated spinal cord segmentation in healthy subjects and patients with neurodegenerative diseases and trauma. MATERIALS AND METHODS Forty-nine healthy subjects, as well as 29 patients with amyotrophic lateral sclerosis, 19 with spinal muscular atrophy, and 14 with spinal cord injuries were studied. Cord area was measured from T2 -weighted 3D turbo spin echo images (cord levels from C2 to T9) using the semiautomated segmentation method of Losseff et al (Brain [1996] 119(Pt 3):701-708), compared with manual segmentation. Reproducibility was evaluated using the inter- and intraobserver coefficient of variation (CoV). Accuracy was assessed using the Dice similarity coefficient (DSC). Robustness to initialization was assessed by simulating modifications to the contours drawn manually prior to segmentation. RESULTS Mean interobserver CoV was 4.00% for manual segmentation (1.90% for Losseff's method) in the cervical region and 5.62% (respectively 2.19%) in the thoracic region. Mean intraobserver CoV was 2.34% for manual segmentation (1.08% for Losseff's method) in the cervical region and 2.35% (respectively 1.34%) in the thoracic region. DSC was high (0.96) in both cervical and thoracic regions. DSC remained higher than 0.8 even when modifying initial contours by 50%. CONCLUSION The semiautomated segmentation method showed high reproducibility and accuracy in measuring spinal cord area.
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Affiliation(s)
- Mohamed-Mounir El Mendili
- Inserm U678, UPMC Univ Paris 6 UMR-S 678, Laboratoire d'imagerie fonctionnelle, Paris, France; Univ Paris 11, IFR 49, Institut fédératif de recherche en imagerie neurofonctionnelle, DSV/I2BM Neurospin, Gif-sur-Yvette, France
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Lukas C, Sombekke MH, Bellenberg B, Hahn HK, Popescu V, Bendfeldt K, Radue EW, Gass A, Borgwardt SJ, Kappos L, Naegelin Y, Knol DL, Polman CH, Geurts JJG, Barkhof F, Vrenken H. Relevance of Spinal Cord Abnormalities to Clinical Disability in Multiple Sclerosis: MR Imaging Findings in a Large Cohort of Patients. Radiology 2013. [DOI: 10.1148/radiol.13122566] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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36
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Naismith RT, Xu J, Klawiter EC, Lancia S, Tutlam NT, Wagner JM, Qian P, Trinkaus K, Song SK, Cross AH. Spinal cord tract diffusion tensor imaging reveals disability substrate in demyelinating disease. Neurology 2013; 80:2201-9. [PMID: 23667060 DOI: 10.1212/wnl.0b013e318296e8f1] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study assessed the tissue integrity of major cervical cord tracts by using diffusion tensor imaging (DTI) to determine the relationship with specific clinical functions carried by those tracts. METHODS This was a cross-sectional study of 37 patients with multiple sclerosis or neuromyelitis optica with remote cervical cord disease. Finger vibratory thresholds, 25-foot timed walk (25FTW), 9-hole peg test (9HPT), and Expanded Disability Status Scale were determined. DTI covered cervical regions C1 through C6 with 17 5-mm slices (0.9 × 0.9 mm in-plane resolution). Regions of interest included posterior columns (PCs) and lateral corticospinal tracts (CSTs). Hierarchical linear mixed-effect modeling included covariates of disease subtype (multiple sclerosis vs neuromyelitis optica), disease duration, and sex. RESULTS Vibration thresholds were associated with radial diffusivity (RD) and fractional anisotropy (FA) in the PCs (both p < 0.01), but not CSTs (RD, p = 0.29; FA, p = 0.14). RD and FA in PCs, and RD in CSTs were related to 9HPT (each p < 0.0001). 25FTW was associated with RD and FA in PCs (p < 0.0001) and RD in CSTs (p = 0.008). Expanded Disability Status Scale was related to RD and FA in PCs and CSTs (p < 0.0001). Moderate/severe impairments in 9HPT (p = 0.006) and 25FTW (p = 0.017) were more likely to show combined moderate/severe tissue injury within both PCs and CSTs by DTI. CONCLUSIONS DTI can serve as an imaging biomarker of spinal cord tissue injury at the tract level. RD and FA demonstrate strong and consistent relationships with clinical outcomes, specific to the clinical modality.
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Kearney H, Yiannakas MC, Abdel-Aziz K, Wheeler-Kingshott CAM, Altmann DR, Ciccarelli O, Miller DH. Improved MRI quantification of spinal cord atrophy in multiple sclerosis. J Magn Reson Imaging 2013; 39:617-23. [PMID: 23633384 DOI: 10.1002/jmri.24194] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 04/05/2013] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To identify an improved method for measuring spinal cord cross-sectional area (CSA) using magnetic resonance imaging (MRI) in multiple sclerosis (MS). MATERIALS AND METHODS MRI was performed on 15 controls and 15 MS patients and repeated in nine controls and nine patients after 6 months. At this timepoint, an additional scan was acquired to evaluate scan-rescan reproducibility. Two sequences were acquired in the cervical cord: 3D phase sensitive inversion recovery (PSIR) and 3D magnetization prepared rapid acquisition T1-weighted gradient echo. CSA was outlined at C2-C3 using two methods: a semiautomated edge detection method and active surface model (ASM). We evaluated reproducibility for all combinations of sequences and analysis methods using coefficient of variation (COV) and intraclass correlation coefficient and performed sample size calculations for clinical trials to reduce longitudinal cord atrophy. RESULTS PSIR/ASM combination provided the lowest values of COV for intrarater, interrater, scan-rescan reproducibility (0.002%, 0.03%, and 0.1% respectively). At 6-month follow-up no significant changes were seen in CSA of controls, and a trend towards significance was observed in patients. CONCLUSION PSIR/ASM proved more reproducible than established methods of evaluating CSA in MS and also provides the lowest number of subjects per arm for 6-month and 1-year clinical trials.
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Affiliation(s)
- Hugh Kearney
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, UK
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38
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Bao YF, Tang WJ, Zhu DQ, Li YX, Zee CS, Chen XJ, Geng DY. Sensory neuronopathy involves the spinal cord and brachial plexus: a quantitative study employing multiple-echo data image combination (MEDIC) and turbo inversion recovery magnitude (TIRM). Neuroradiology 2012; 55:41-8. [DOI: 10.1007/s00234-012-1085-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/14/2012] [Indexed: 11/25/2022]
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39
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Giulietti G, Summers PE, Ferraro D, Porro CA, Maraviglia B, Giove F. Semiautomated segmentation of the human spine based on echoplanar images. Magn Reson Imaging 2011; 29:1429-36. [DOI: 10.1016/j.mri.2011.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 08/15/2011] [Accepted: 08/22/2011] [Indexed: 10/14/2022]
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Healy BC, Arora A, Hayden DL, Ceccarelli A, Tauhid SS, Neema M, Bakshi R. Approaches to normalization of spinal cord volume: application to multiple sclerosis. J Neuroimaging 2011; 22:e12-9. [PMID: 21854479 DOI: 10.1111/j.1552-6569.2011.00629.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND PURPOSE To determine the proper method for the normalization of spinal cord volume. MATERIALS AND METHODS A group of 34 multiple sclerosis (MS) patients (28 relapsing and 6 progressive) and 15 healthy controls had whole spinal cord 3-mm thick T2-weighted axial fast spin-echo magnetic resonance imaging (MRI) images obtained at 3T. For each participant, four volumes were measured (C2-3 volume, cervical cord volume, thoracic cord volume, and whole cord volume). The volumes were normalized by the number of slices and three potential measures of body size (intracranial volume [ICV], body mass index, and body surface area) using the proportional method. RESULTS All raw volumes and volumes normalized by number of slices or ICV were significantly lower in progressive MS patients compared to relapsing MS patients/healthy controls (P < .05). In addition, C2-3 volume and cervical cord volume were significantly correlated with Expanded Disability Status Scale score (P < .05). All regional volumes showed high intercorrelation, and normalization by the number of slices significantly increased some correlations. Regarding reliability, whole cord volume regardless of normalization technique had lower coefficient of variation than C2-3 volume. CONCLUSIONS Since normalization factor had limited impact on reliability and the ability to detect differences, normalization by the number of slices is recommended.
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Affiliation(s)
- Brian C Healy
- Department of Neurology, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, USA.
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Klein JP, Arora A, Neema M, Healy BC, Tauhid S, Goldberg-Zimring D, Chavarro-Nieto C, Stankiewicz JM, Cohen AB, Buckle GJ, Houtchens MK, Ceccarelli A, Dell'Oglio E, Guttmann CRG, Alsop DC, Hackney DB, Bakshi R. A 3T MR imaging investigation of the topography of whole spinal cord atrophy in multiple sclerosis. AJNR Am J Neuroradiol 2011; 32:1138-42. [PMID: 21527570 DOI: 10.3174/ajnr.a2459] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spinal cord atrophy is a common feature of MS. However, it is unknown which cord levels are most susceptible to atrophy. We performed whole cord imaging to identify the levels most susceptible to atrophy in patients with MS versus controls and also tested for differences among MS clinical phenotypes. MATERIALS AND METHODS Thirty-five patients with MS (2 with CIS, 27 with RRMS, 2 with SPMS, and 4 with PPMS phenotypes) and 27 healthy controls underwent whole cord 3T MR imaging. The spinal cord contour was segmented and assigned to bins representing each C1 to T12 vertebral level. Volumes were normalized, and group comparisons were age-adjusted. RESULTS There was a trend toward decreased spinal cord volume at the upper cervical levels in PPMS/SPMS versus controls. A trend toward increased spinal cord volume throughout the cervical and thoracic cord in RRMS/CIS versus controls reached statistical significance at the T10 vertebral level. A statistically significant decrease was found in spinal cord volume at the upper cervical levels in PPMS/SPMS versus RRMS/CIS. CONCLUSIONS Opposing pathologic factors impact spinal cord volume measures in MS. Patients with PPMS demonstrated a trend toward upper cervical cord atrophy. However patients with RRMS showed a trend toward increased volume at the cervical and thoracic levels, which most likely reflects inflammation or edema-related cord expansion. With the disease causing both expansion and contraction of the cord, the specificity of spinal cord volume measures for neuroprotective therapeutic effect may be limited.
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Affiliation(s)
- J P Klein
- Laboratory for Neuroimaging Research, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Cohen AB, Neema M, Arora A, Dell'oglio E, Benedict RHB, Tauhid S, Goldberg-Zimring D, Chavarro-Nieto C, Ceccarelli A, Klein JP, Stankiewicz JM, Houtchens MK, Buckle GJ, Alsop DC, Guttmann CRG, Bakshi R. The relationships among MRI-defined spinal cord involvement, brain involvement, and disability in multiple sclerosis. J Neuroimaging 2011; 22:122-8. [PMID: 21447024 DOI: 10.1111/j.1552-6569.2011.00589.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the interrelationships between MRI-defined lesion and atrophy measures of spinal cord involvement and brain involvement and their relationships to disability in a small cohort of patients with multiple sclerosis (MS). BACKGROUND Although it is known that cervical spinal cord atrophy correlates with disability in MS, it is unknown whether it is the most important determinant when compared to other regions of the central nervous system (CNS). Furthermore, it is not clear to what extent brain and cord lesions and atrophy are related. DESIGN AND METHODS 3T MRI of the whole brain and whole spinal cord was obtained in 21 patients with MS, including 18 with relapsing-remitting, one with secondary progressive, one with primary progressive, and one with a clinically isolated syndrome. Brain global gray and white matter volumes were segmented with Statistical Parametric Mapping 8. Spinal cord contour volume was segmented in whole by a semi-automated method with bins assigned to either the cervical or thoracic regions. All CNS volumes were normalized by the intracranial volume. Brain and cord T2 hyperintense lesions were segmented using a semi-automated edge finding tool. RESULTS Among all MRI measures, only upper cervical spinal cord volume significantly correlated with Expanded Disability Status Scale score (r =-.515, P = .020). The brain cord relationships between whole or regional spinal cord volume or lesions and gray matter, white matter, or whole brain volume or whole brain lesions were generally weak and all nonsignificant. CONCLUSIONS AND RELEVANCE In this preliminary study of mildly disabled, treated MS patients, cervical spinal cord atrophy most strongly correlates with physical disability in MS when accounting for a wide range of other CNS measures of lesions and atrophy, including thoracic or whole spinal cord volume, and cerebral gray, white or whole brain volume. The weak relationship between spinal cord and brain lesions and atrophy may suggest that they progress rather independently in patients with MS.
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Affiliation(s)
- Adam B Cohen
- Departments of Neurology and Radiology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA
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Abstract
Multiple sclerosis (MS) is primarily an autoimmune disorder of unknown origin. This review focuses iron overload and oxidative stress as surrounding cause that leads to immunomodulation in chronic MS. Iron overload has been demonstrated in MS lesions, as a feature common with other neurodegenerative disorders. However, the recent description of chronic cerebrospinal venous insufficiency (CCSVI) associated to MS, with significant anomalies in cerebral venous outflow hemodynamics, permit to propose a parallel with chronic venous disorders (CVDs) in the mechanism of iron deposition. Abnormal cerebral venous reflux is peculiar to MS, and was not found in a miscellaneous of patients affected by other neurodegenerative disorders characterized by iron stores, such as Parkinson's, Alzheimer's, amyotrophic lateral sclerosis. Several recently published studies support the hypothesis that MS progresses along the venous vasculature. The peculiarity of CCSVI-related cerebral venous blood flow disturbances, together with the histology of the perivenous spaces and recent findings from advanced magnetic resonance imaging techniques, support the hypothesis that iron deposits in MS are a consequence of altered cerebral venous return and chronic insufficient venous drainage.
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Cruz Jr. LCH, Domingues RC, Gasparetto EL. Diffusion tensor imaging of the cervical spinal cord of patients with relapsing-remising multiple sclerosis: a study of 41 cases. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:391-5. [DOI: 10.1590/s0004-282x2009000300004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 03/30/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To evaluate the fractional anisotropy (FA) values of the multiple sclerosis (MS) plaques and normal-appearing cervical spinal cord (NASC) by diffusion tensor MRI imaging (DTI). METHOD: Forty-one patients with relapsing-remising MS and 37 controls were evaluated. All MRI exams were performed using a conventional protocol, as well as diffusion tensor MR imaging. Regions of interest were placed within the spinal cord lesions and in the normal appearing spinal cord adjacent to the plaque. RESULTS: The FA values were statistically reduced in the plaques compared to the surrounding NASC and to equivalent location in controls. A reduction in FA values was also observed in the spinal cord of MS patients without visible lesions on T2WI. CONCLUSION: We observed reduced fractional anisotropy in the demyelinating plaques and in the NASC of MS patients, corroborating the hypothesis that the histological extension of the MS lesions is more severe than the abnormalities seen in the conventional MRI sequences.
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Affiliation(s)
| | - Romeu C. Domingues
- Universidade Federal do Rio de Janeiro, Brazil; Clínicas Multi-Imagem, Brazil
| | - Emerson L. Gasparetto
- Universidade Federal do Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro, Brazil
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Zackowski KM, Smith SA, Reich DS, Gordon-Lipkin E, Chodkowski BA, Sambandan DR, Shteyman M, Bastian AJ, van Zijl PC, Calabresi PA. Sensorimotor dysfunction in multiple sclerosis and column-specific magnetization transfer-imaging abnormalities in the spinal cord. Brain 2009; 132:1200-9. [PMID: 19297508 DOI: 10.1093/brain/awp032] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The human spinal cord contains segregated sensory and motor pathways that have been difficult to quantify using conventional magnetic resonance imaging (MRI) techniques. Multiple sclerosis is characterized by both focal and spatially diffuse spinal cord lesions with heterogeneous pathologies that have limited attempts at linking MRI and behaviour. We used a novel magnetization-transfer-weighted imaging approach to quantify damage to spinal white matter columns and tested its association with sensorimotor impairment. We studied 42 participants with multiple sclerosis who each underwent MRI at 3 Tesla and quantitative tests of sensorimotor function. We measured cerebrospinal-fluid-normalized magnetization-transfer signals in the dorsal and lateral columns and grey matter of the cervical cord. We also measured brain lesion volume, cervical spinal cord lesion number and cross-sectional area, vibration sensation, strength, walking velocity and standing balance. We used linear regression to assess the relationship between sensorimotor impairment and MRI abnormalities. We found that the dorsal column cerebrospinal-fluid-normalized magnetization-transfer signal specifically correlated with vibration sensation (R = 0.58, P < 0.001) and the lateral column signal with strength (R = -0.45, P = 0.003). Spinal cord signal measures also correlated with walking and balance dysfunction. A stepwise multiple regression showed that the dorsal column signal and diagnosis subtype alone explained a significant portion of the variance in sensation (R(2) = 0.54, P < 0.001), whereas the lateral column signal and diagnosis subtype explained a significant portion of the variance in strength (R(2) = 0.30, P < 0.001). These results help to understand the anatomic basis of sensorimotor disability in multiple sclerosis and have implications for testing the effects of neuroprotective and reparative interventions.
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Affiliation(s)
- Kathleen M Zackowski
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287, USA.
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Gray matter atrophy correlates with MS disability progression measured with MSFC but not EDSS. J Neurol Sci 2008; 282:106-11. [PMID: 19100997 DOI: 10.1016/j.jns.2008.11.018] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 11/17/2008] [Accepted: 11/18/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gray matter (GM) pathology is an important component of the multiple sclerosis (MS) disease process. Accelerated gray matter atrophy has been observed in MS patients, but its relationship to neurological disability is not defined. This study was done to determine the relationship between whole brain, GM, and white matter (WM) atrophy and MS disability progression. METHODS Patients with MS and Clinically Isolated Syndromes (CIS), and age- and gender-matched healthy controls were entered into an observational protocol. Baseline brain parenchymal fraction (BPF), GM fraction, and WM fraction, and change over 4 years were correlated with sustained disability progression over the entire study duration. Disability progression was measured using the Multiple Sclerosis Functional Composite (MSFC) and the Expanded Disability Status Scale (EDSS). RESULTS Seventy MS and CIS patients and 17 HCs were studied for an average of 6.6 years (range, 3.6-7.8 years). At the final visit, 7 patients were classified as CIS, 36 as relapsing-remitting MS (RRMS), and 27 as secondary progressive MS (SPMS). Baseline whole brain, GM, and WM atrophy predicted EDSS >6.0 at the last study visit. Twenty-one (33%) patients worsened using the EDSS to define disability progression; 29 (46%) worsened using MSFC to define disability progression. Patients with MSFC progression had significantly higher GM atrophy rates compared with patients who were stable on MSFC. White matter atrophy was similar in patients with and without disability progression. Atrophy rates were not different in patients with or without disability progression defined using EDSS. CONCLUSIONS Whole brain, GM, and WM atrophy predicted MS disability progression observed over the next 6.6 years. Gray matter atrophy rates over 4 years correlated with disability progression measured with the MSFC, but not EDSS. This indicates that MSFC defined disability progression is more closely linked to brain atrophy than EDSS defined disability progression, and provides important new insight into the poor correlation between MRI and clinical disability in MS. The findings confirm the clinical relevance of gray matter atrophy in MS.
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