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Valošek J, Cohen-Adad J. Reproducible Spinal Cord Quantitative MRI Analysis with the Spinal Cord Toolbox. Magn Reson Med Sci 2024; 23:307-315. [PMID: 38479843 PMCID: PMC11234946 DOI: 10.2463/mrms.rev.2023-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
The spinal cord plays a pivotal role in the central nervous system, providing communication between the brain and the body and containing critical motor and sensory networks. Recent advancements in spinal cord MRI data acquisition and image analysis have shown a potential to improve the diagnostics, prognosis, and management of a variety of pathological conditions. In this review, we first discuss the significance of standardized spinal cord MRI acquisition protocol in multi-center and multi-manufacturer studies. Then, we cover open-access spinal cord MRI datasets, which are important for reproducible science and validation of new methods. Finally, we elaborate on the recent advances in spinal cord MRI data analysis techniques implemented in the open-source software package Spinal Cord Toolbox (SCT).
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Affiliation(s)
- Jan Valošek
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czechia
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
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2
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Adanyeguh IM, Henry PG, Deelchand DK. Prospective motion correction for cervical spinal cord MRS. Magn Reson Med 2024; 91:19-27. [PMID: 37772616 PMCID: PMC10842172 DOI: 10.1002/mrm.29836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE To develop prospective motion correction for single-voxel MRS in the human cervical spinal cord. METHODS A motion MR navigator was implemented using reduced field-of-view 2D-selective RF excitation together with EPI readout. A short-echo semi-LASER sequence (TE = 30 ms) was updated to incorporate this real-time image-based motion navigator, as well as real-time shim and frequency navigators. Five healthy participants were studied at 3 T with a 64-channel head-neck receive coil. Single-voxel MRS data were measured in a voxel located at the C3-5 vertebrae level. The motion navigator was used to correct for translations in the X-Y plane and was validated by assessing spectral quality with and without prospective correction in the presence of subject motion. RESULTS Without prospective correction, motion resulted in severe lipid contamination in the MR spectra. With prospective correction, the quality of spinal cord MR spectra in the presence of motion was similar to that obtained in the absence of motion, with comparable spectral signal-to-noise ratio and linewidth and no significant lipid contamination. CONCLUSION Prospective motion and B0 correction allow acquisition of good-quality MR spectra in the human cervical spinal cord in the presence of motion. This new technique should facilitate reliable acquisition of spinal cord MR spectra in both research and clinical settings.
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Affiliation(s)
- Isaac M Adanyeguh
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Pierre-Gilles Henry
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dinesh K Deelchand
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
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3
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de Paiva JLR, Sabino JV, Pereira FV, Okuda PA, Villarinho LDL, Queiroz LDS, França MC, Reis F. The Role of MRI in the Diagnosis of Spinal Cord Tumors. Semin Ultrasound CT MR 2023; 44:436-451. [PMID: 37555685 DOI: 10.1053/j.sult.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Spinal cord tumors are uncommon, and its multiple representatives not always have pathognomonic characteristics, which poses a challenge for both patients and caring physicians. The radiologist performs an important role in recognizing these tumors, as well as in differentiating between neoplastic and non-neoplastic processes, supporting clinical and surgical decision-making in patients with spinal cord injury. Magnetic Resonance Imaging (MRI) assessment, paired with a deep understanding of the various patterns of cord involvement allied to detailed clinical data can provide a diagnosis or significantly limit the differential diagnosis in most cases. In this article, we aim to review the most common and noteworthy intramedullary and extramedullary spinal tumors, as well as some other tumoral mimics, with an emphasis on their MRI morphologic characteristics.
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Affiliation(s)
- Jean L R de Paiva
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - João V Sabino
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fernanda V Pereira
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Paulo A Okuda
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | - Marcondes C França
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil.
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Cacciaguerra L, Sechi E, Rocca MA, Filippi M, Pittock SJ, Flanagan EP. Neuroimaging features in inflammatory myelopathies: A review. Front Neurol 2022; 13:993645. [PMID: 36330423 PMCID: PMC9623025 DOI: 10.3389/fneur.2022.993645] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022] Open
Abstract
Spinal cord involvement can be observed in the course of immune-mediated disorders. Although multiple sclerosis (MS) represents the leading cause of inflammatory myelopathy, an increasing number of alternative etiologies must be now considered in the diagnostic work-up of patients presenting with myelitis. These include antibody-mediated disorders and cytotoxic T cell-mediated diseases targeting central nervous system (CNS) antigens, and systemic autoimmune conditions with secondary CNS involvement. Even though clinical features are helpful to orient the diagnostic suspicion (e.g., timing and severity of myelopathy symptoms), the differential diagnosis of inflammatory myelopathies is often challenging due to overlapping features. Moreover, noninflammatory etiologies can sometimes mimic an inflammatory process. In this setting, magnetic resonance imaging (MRI) is becoming a fundamental tool for the characterization of spinal cord damage, revealing a pictorial scenario which is wider than the clinical manifestations. The characterization of spinal cord lesions in terms of longitudinal extension, location on axial plane, involvement of the white matter and/or gray matter, and specific patterns of contrast enhancement, often allows a proper differentiation of these diseases. For instance, besides classical features, such as the presence of longitudinally extensive spinal cord lesions in patients with aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD), novel radiological signs (e.g., H sign, trident sign) have been recently proposed and successfully applied for the differential diagnosis of inflammatory myelopathies. In this review article, we will discuss the radiological features of spinal cord involvement in autoimmune disorders such as MS, AQP4+NMOSD, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and other recently characterized immune-mediated diseases. The identification of imaging pitfalls and mimics that can lead to misdiagnosis will also be examined. Since spinal cord damage is a major cause of irreversible clinical disability, the recognition of these radiological aspects will help clinicians achieve a correct and prompt diagnosis, treat early with disease-specific treatment and improve patient outcomes.
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Affiliation(s)
- Laura Cacciaguerra
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elia Sechi
- Neurology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maria A. Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sean J. Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Eoin P. Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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5
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Kossowski B, Kong Y, Klimiec-Moskal E, Emir U, Palace J, Juryńczyk M. Relapsing antibody-negative patients with features of neuromyelitis optica spectrum disorders: Differences in N-acetylaspartate level in the cervical spinal cord indicate distinct underlying processes. Mult Scler 2022; 28:2221-2230. [PMID: 35971567 DOI: 10.1177/13524585221115304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Due to lack of biomarkers, antibody-negative patients with features of neuromyelitis optica spectrum disorders (NMOSD) are among the most challenging to diagnose and treat. Using unsupervised clustering, we recently identified 'MS-like', 'spinal MS-like', 'classic NMOSD-like' and 'NMOSD-like with brain involvement' subgroups in this cohort. OBJECTIVE We used magnetic resonance spectroscopy (MRS) to examine differences in the level of key metabolites in the spinal cord between the four identified subgroups. METHODS Twenty-five relapsing antibody-negative patients with NMOSD features classified by the unsupervised algorithm to one of the subgroups underwent a prospective cervical spinal cord MRS. Spectra from 16 patients fulfilled quality criteria and were included in the analysis. RESULTS Total N-acetylaspartate (tNAA), but not total choline (tCho) or myo-inositol (Ins), was significantly different between the four subgroups (p = 0.03). In particular, tNAA was 47.8% lower in the 'MS-like' subgroup as compared with the 'classic NMOSD-like' subgroup (p = 0.02). While we found a negative overall correlation between tNAA and disability score (r = -0.514, p = 0.04) in the whole cohort, the disability score did not differ significantly between the subgroups to explain subgroup differences in tNAA level. CONCLUSIONS Significant differences in the cervical spinal cord tNAA measurements confirm that the previously identified clinico-radiologic subgroups contain patients with distinct underlying disease processes.
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Affiliation(s)
- Bartosz Kossowski
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Yazhuo Kong
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Uzay Emir
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Headley Way, OX3 9DU Oxford, UK.,Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Maciej Juryńczyk
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Pasteura 3 Street, 02-098 Warsaw, Poland.,Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland; Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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6
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Roussel T, Le Fur Y, Guye M, Viout P, Ranjeva JP, Callot V. Respiratory-triggered quantitative MR spectroscopy of the human cervical spinal cord at 7 T. Magn Reson Med 2022; 87:2600-2612. [PMID: 35181915 DOI: 10.1002/mrm.29182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Ultra-high field 1 H MR spectroscopy (MRS) is of great interest to help characterizing human spinal cord pathologies. However, very few studies have been reported so far in this small size structure at these fields due to challenging experimental difficulties caused by static and radiofrequency field heterogeneities, as well as physiological motion. In this work, in line with the recent developments proposed to strengthen spinal cord MRS feasibility at 7 T, a respiratory-triggered acquisition approach was optimized to compensate for dynamic B 0 field heterogeneities and to provide robust cervical spinal cord MRS data. METHODS A semi-LASER sequence was purposely used, and a dedicated raw data processing algorithm was developed to enhance MR spectral quality by discarding corrupted scans. To legitimate the choices done during the optimization stage, additional tests were carried out to determine the impact of breathing, voluntary motion, body mass index, and fitting algorithm. An in-house quantification tool was concomitantly designed for accurate estimation of the metabolite concentration ratios for choline, N-acetyl-aspartate (NAA), myo-inositol and glutathione. The method was tested on a cohort of 14 healthy volunteers. RESULTS Average water linewidth and NAA signal-to-noise ratio reached 0.04 ppm and 11.01, respectively. The group-average metabolic ratios were in good agreement with previous studies and showed intersession reproducibility variations below 30%. CONCLUSION The developed approach allows a rise of the acquired MRS signal quality and of the quantification robustness as compared to previous studies hence offering strengthened possibilities to probe the metabolism of degenerative and traumatic spinal cord pathologies.
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Affiliation(s)
- Tangi Roussel
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Yann Le Fur
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Patrick Viout
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Jean-Philippe Ranjeva
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Virginie Callot
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
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7
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Horak T, Horakova M, Svatkova A, Kadanka Z, Kudlicka P, Valosek J, Rohan T, Kerkovsky M, Vlckova E, Kadanka Z, Deelchand DK, Henry PG, Bednarik J, Bednarik P. In vivo Molecular Signatures of Cervical Spinal Cord Pathology in Degenerative Compression. J Neurotrauma 2021; 38:2999-3010. [PMID: 34428934 PMCID: PMC8917902 DOI: 10.1089/neu.2021.0151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a severe consequence of degenerative cervical spinal cord (CSC) compression. The non-myelopathic stage of compression (NMDC) is highly prevalent and often progresses to disabling DCM. This study aims to disclose markers of progressive neurochemical alterations in NMDC and DCM by utilizing an approach based on state-of-the-art proton magnetic resonance spectroscopy (1H-MRS). Proton-MRS data were prospectively acquired from 73 participants with CSC compression and 47 healthy controls (HCs). The MRS voxel was centered at the C2 level. Compression-affected participants were clinically categorized as NMDC and DCM, radiologically as mild (MC) or severe (SC) compression. CSC volumes and neurochemical concentrations were compared between cohorts (HC vs. NMDC vs. DCM and HC vs. MC vs. SC) with general linear models adjusted for age and height (pFWE < 0.05) and correlated to stenosis severity, electrophysiology, and myelopathy symptoms (p < 0.05). Whereas the ratio of total creatine (tCr) to total N-acetylaspartate (tNAA) increased in NMDC (+11%) and in DCM (+26%) and SC (+21%), myo-inositol/tNAA, glutamate + glutamine/tNAA, and volumes changed only in DCM (+20%, +73%, and −14%) and SC (+12%, +46%, and −8%, respectively) relative to HCs. Both tCr/tNAA and myo-inositol/tNAA correlated with compression severity and volume (−0.376 < r < −0.259). Myo-inositol/tNAA correlated with myelopathy symptoms (r = −0.670), whereas CSC volume did not. Short-echo 1H-MRS provided neurochemical signatures of CSC impairment that reflected compression severity and clinical significance. Whereas volumetry only reflected clinically manifest myelopathy (DCM), MRS detected neurochemical changes already before the onset of myelopathy symptoms.
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Affiliation(s)
- Tomas Horak
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Magda Horakova
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Alena Svatkova
- Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria.,Department of Imaging Methods, Faculty of Medicine, University of Ostrava, Czechia
| | - Zdenek Kadanka
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia
| | - Petr Kudlicka
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Jan Valosek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czechia.,Department of Biomedical Engineering, University Hospital, Olomouc, Czechia
| | - Tomas Rohan
- Department of Radiology, University Hospital Brno, Brno, Czechia
| | - Milos Kerkovsky
- Department of Radiology, University Hospital Brno, Brno, Czechia
| | - Eva Vlckova
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Zdenek Kadanka
- Department of Neurology, University Hospital Brno, Brno, Czechia
| | - Dinesh K Deelchand
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Pierre-Gilles Henry
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Josef Bednarik
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Petr Bednarik
- Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia.,Department of Biomedical Imaging and Image-guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
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Intradural Pediatric Spinal Tumors: An Overview from Imaging to Novel Molecular Findings. Diagnostics (Basel) 2021; 11:diagnostics11091710. [PMID: 34574050 PMCID: PMC8469574 DOI: 10.3390/diagnostics11091710] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 12/20/2022] Open
Abstract
Pediatric spinal tumors are rare and account for 10% of all central nervous system tumors in children. Onset usually occurs with chronic nonspecific symptoms and may depend on the intra- or extradural neoplastic location. Meningiomas, schwannomas, and neurofibromas are the most common intradural-extramedullary lesions, while astrocytomas and ependymomas represent the majority of intramedullary tumors. The new molecular discoveries regarding pediatric spinal cancer currently contribute to the diagnostic and therapeutic processes. Moreover, some familial genetic syndromes can be associated with the development of spinal tumors. Currently, magnetic resonance imaging (MRI) is the standard reference for the evaluation of pediatric spinal tumors. Our aim in this review was to describe the imaging of the most frequent intradural intra/extramedullary pediatric spinal tumors and to investigate the latest molecular findings and genetic syndromes.
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Abstract
Multiple diverse pathologies result in the clinical presentation of myelopathy. The preferred way to image the spinal cord depends on clinical history, anatomic site of interest, and patient issues limiting certain imaging modalities. This radiology-focused article discusses pertinent physiological considerations, reviews basic and newer imaging techniques, and examines several distinct disease entities in order to highlight the key role of imaging in the work-up of myelopathy.
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Affiliation(s)
- Alice C Shea
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Anderson H Kuo
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Liangge Hsu
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
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Pfyffer D, Wyss PO, Huber E, Curt A, Henning A, Freund P. Metabolites of neuroinflammation relate to neuropathic pain after spinal cord injury. Neurology 2020; 95:e805-e814. [PMID: 32591473 PMCID: PMC7605501 DOI: 10.1212/wnl.0000000000010003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine whether cervical cord levels of metabolites are associated with pain sensation after spinal cord injury (SCI) by performing magnetic resonance spectroscopy in patients with SCI with and without neuropathic pain (NP). METHODS Cervical cord single-voxel spectroscopic data of 24 patients with SCI (14 with NP, 10 pain-free) and 21 healthy controls were acquired at C2/3 to investigate metabolite ratios associated with neuroinflammation (choline-containing compounds to myoinositol [tCho/mI]) and neurodegeneration (total N-acetylaspartate to myo-inositol [tNAA/mI]). NP levels were measured, and Spearman correlation tests assessed associations between metabolite levels, cord atrophy, and pinprick score. RESULTS In patients with NP, tCho/mI levels were increased (p = 0.024) compared to pain-free patients and negatively related to cord atrophy (p = 0.006, r = 0.714). Better pinprick score was associated with higher tCho/mI levels (p = 0.032, r = 0.574). In pain-free patients, tCho/mI levels were not related to cord atrophy (p = 0.881, r = 0.055) or pinprick score (p = 0.676, r = 0.152). tNAA/mI levels were similar in both patient groups (p = 0.396) and were not associated with pinprick score in patients with NP (p = 0.405, r = 0.242) and pain-free patients (p = 0.117, r = 0.527). CONCLUSIONS Neuroinflammatory metabolite levels (i.e., tCho/mI) were elevated in patients with NP, its magnitude being associated with less cord atrophy and greater pain sensation (e.g., pinprick score). This suggests that patients with NP have more residual spinal tissue and greater metabolite turnover than pain-free patients. Neurodegenerative metabolite levels (i.e., tNAA/mI) were associated with greater cord atrophy but unrelated to NP. Identifying the metabolic NP signature provides new NP treatment targets and could improve patient stratification in interventional trials. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that levels of magnetic resonance spectroscopy-identified metabolites of neuroinflammation were elevated in patients with SCI with NP compared to those without NP.
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Affiliation(s)
- Dario Pfyffer
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Patrik O Wyss
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Eveline Huber
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Armin Curt
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Anke Henning
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Patrick Freund
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
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11
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Moccia M, Ruggieri S, Ianniello A, Toosy A, Pozzilli C, Ciccarelli O. Advances in spinal cord imaging in multiple sclerosis. Ther Adv Neurol Disord 2019; 12:1756286419840593. [PMID: 31040881 PMCID: PMC6477770 DOI: 10.1177/1756286419840593] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/03/2019] [Indexed: 11/18/2022] Open
Abstract
The spinal cord is frequently affected in multiple sclerosis (MS), causing motor, sensory and autonomic dysfunction. A number of pathological abnormalities, including demyelination and neuroaxonal loss, occur in the MS spinal cord and are studied in vivo with magnetic resonance imaging (MRI). The aim of this review is to summarise and discuss recent advances in spinal cord MRI. Advances in conventional spinal cord MRI include improved identification of MS lesions, recommended spinal cord MRI protocols, enhanced recognition of MRI lesion characteristics that allow MS to be distinguished from other myelopathies, evidence for the role of spinal cord lesions in predicting prognosis and monitoring disease course, and novel post-processing methods to obtain lesion probability maps. The rate of spinal cord atrophy is greater than that of brain atrophy (-1.78% versus -0.5% per year), and reflects neuroaxonal loss in an eloquent site of the central nervous system, suggesting that it can become an important outcome measure in clinical trials, especially in progressive MS. Recent developments allow the calculation of spinal cord atrophy from brain volumetric scans and evaluation of its progression over time with registration-based techniques. Fully automated analysis methods, including segmentation of grey matter and intramedullary lesions, will facilitate the use of spinal cord atrophy in trial designs and observational studies. Advances in quantitative imaging techniques to evaluate neuroaxonal integrity, myelin content, metabolic changes, and functional connectivity, have provided new insights into the mechanisms of damage in MS. Future directions of research and the possible impact of 7T scanners on spinal cord imaging will be discussed.
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Affiliation(s)
- Marcello Moccia
- Queen Square MS Centre, NMR Research Unit, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Federico II University of Naples, via Sergio Pansini, 5, Edificio 17 - piano terra, Napoli, 80131 Naples, Italy
| | - Serena Ruggieri
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Antonio Ianniello
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Ahmed Toosy
- Queen Square MS Centre, NMR Research Unit, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Carlo Pozzilli
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Olga Ciccarelli
- Queen Square MS Centre, NMR Research Unit, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
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12
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El Mendili MM, Querin G, Bede P, Pradat PF. Spinal Cord Imaging in Amyotrophic Lateral Sclerosis: Historical Concepts-Novel Techniques. Front Neurol 2019; 10:350. [PMID: 31031688 PMCID: PMC6474186 DOI: 10.3389/fneur.2019.00350] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/21/2019] [Indexed: 01/13/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common adult onset motor neuron disease with no effective disease modifying therapies at present. Spinal cord degeneration is a hallmark feature of ALS, highlighted in the earliest descriptions of the disease by Lockhart Clarke and Jean-Martin Charcot. The anterior horns and corticospinal tracts are invariably affected in ALS, but up to recently it has been notoriously challenging to detect and characterize spinal pathology in vivo. With recent technological advances, spinal imaging now offers unique opportunities to appraise lower motor neuron degeneration, sensory involvement, metabolic alterations, and interneuron pathology in ALS. Quantitative spinal imaging in ALS has now been used in cross-sectional and longitudinal study designs, applied to presymptomatic mutation carriers, and utilized in machine learning applications. Despite its enormous clinical and academic potential, a number of physiological, technological, and methodological challenges limit the routine use of computational spinal imaging in ALS. In this review, we provide a comprehensive overview of emerging spinal cord imaging methods and discuss their advantages, drawbacks, and biomarker potential in clinical applications, clinical trial settings, monitoring, and prognostic roles.
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Affiliation(s)
- Mohamed Mounir El Mendili
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France
| | - Giorgia Querin
- Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France.,Department of Neurology, Pitié-Salpêtrière University Hospital (APHP), Paris, France
| | - Peter Bede
- Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France.,Department of Neurology, Pitié-Salpêtrière University Hospital (APHP), Paris, France.,Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Pierre-François Pradat
- Biomedical Imaging Laboratory (LIB), Sorbonne University, CNRS, INSERM, Paris, France.,Department of Neurology, Pitié-Salpêtrière University Hospital (APHP), Paris, France
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13
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Agarwal A. Role of proton MR spectroscopy in spinal cord lesions: A guarded espousal. Indian J Radiol Imaging 2019; 28:481. [PMID: 30662216 PMCID: PMC6319095 DOI: 10.4103/ijri.ijri_401_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arjit Agarwal
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Center, Teerthanker Mahaveer University, Moradabad, UP, India. E-mail:
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14
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Sathyanathan BP, Raju BP, Natarajan K, Ranganathan R. 3T proton MR Spectroscopy evaluation of spinal cord lesions. Indian J Radiol Imaging 2018; 28:285-295. [PMID: 30319204 PMCID: PMC6176681 DOI: 10.4103/ijri.ijri_122_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: The objective of this study was to evaluate intramedullary spinal cord lesions using magnetic resonance spectroscopy and correlate the results with histo-pathological examination (HPE). Materials and Methods: Approval for this study was obtained from our institute ethical committee. Overall, 50 patients were recruited (29 male and 21 female), with a maximum age of 53 years and minimum age of 7 years. The mean age group of the study was 33 years. Standard magnetic resonance imaging (MRI) spine was done on a Siemens Skyra 3Tesla MRI scanner. MR Spectroscopy (MRS) was performed for all patients with intramedullary spinal lesions after getting written consent. It was performed using single-voxel method. The change in the metabolite peak was observed in each case and the results were compared with HPE. These collected data were analyzed using SPSS 16.0 version. Descriptive statistics, frequency analysis, and percentage analysis were used for categorical variables; and for continuous variables, mean and standard deviation were analyzed. McNemar's test was used to find the significance between conventional MRI MRS. In the above statistical tool, the probability value 0.05 is considered as significant level. Results: From our study, we observed that by applying routine MRI sequences alone, we could only detect around 58% of the cases correctly. However, when MRS was done along with the conventional MR imaging, the number of cases detected significantly increased to 84%. By applying McNemar's test and comparing the conventional MRI and MRS with HPE, it was found that statistically significant difference exists with P value of 0.007. Conclusion: MRS of the spinal cord is a promising tool for research and diagnosis because it can provide additional information complementary to other non-invasive imaging methods. It is an emerging tool and adds new biomarker information for characterization of spinal cord tumors, to differentiate benign from malignant lesions and to prevent unnecessary biopsies and surgeries.
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Affiliation(s)
| | - Bharathi Priya Raju
- Barnard Institute of Radiology, Madras Medical College, Chennai, Tamil Nadu, India
| | | | - Ravi Ranganathan
- Barnard Institute of Radiology, Madras Medical College, Chennai, Tamil Nadu, India
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15
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Sathyanathan BP, Ranganathan R, Raju BP, Natarajan K. Author’s Reply. Indian J Radiol Imaging 2018; 28:482. [PMID: 30662218 PMCID: PMC6319110 DOI: 10.4103/ijri.ijri_417_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Ravi Ranganathan
- Barnard Institute of Radiology, Madras Medical College, Chennai, Tamil Nadu, India
| | - Bharathi Priya Raju
- Barnard Institute of Radiology, Madras Medical College, Chennai, Tamil Nadu, India
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16
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Vargas MI, Delattre BMA, Boto J, Gariani J, Dhouib A, Fitsiori A, Dietemann JL. Advanced magnetic resonance imaging (MRI) techniques of the spine and spinal cord in children and adults. Insights Imaging 2018; 9:549-557. [PMID: 29858818 PMCID: PMC6108966 DOI: 10.1007/s13244-018-0626-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/19/2018] [Accepted: 04/05/2018] [Indexed: 12/14/2022] Open
Abstract
Abstract In this article, we illustrate the main advanced magnetic resonance imaging (MRI) techniques used for imaging of the spine and spinal cord in children and adults. This work focuses on daily clinical practice and aims to address the most common questions and needs of radiologists. We will also provide tips to solve common problems with which we were confronted. The main clinical indications for each MR technique, possible pitfalls and the challenges faced in spine imaging because of anatomical and physical constraints will be discussed. The major advanced MRI techniques dealt with in this article are CSF, (cerebrosopinal fluid) flow, diffusion, diffusion tensor imaging (DTI), MRA, dynamic contrast-enhanced T1-weighted perfusion, MR angiography, susceptibility-weighted imaging (SWI), functional imaging (fMRI) and spectroscopy. Teaching Points • DWI is essential to diagnose cord ischaemia in the acute stage. • MRA is useful to guide surgical planning or endovascular embolisation of AVMs. • Three Tesla is superior to 1.5 T for spine MR angiography and spectroscopy. • Advanced sequences should only be used together with conventional morphological sequences.
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Affiliation(s)
- M I Vargas
- Division of Neuroradiology, DISIM, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
| | - B M A Delattre
- Division of Radiology, DISIM, Geneva University Hospitals, Geneva, Switzerland
| | - J Boto
- Division of Neuroradiology, DISIM, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - J Gariani
- Division of Radiology, DISIM, Geneva University Hospitals, Geneva, Switzerland
| | - A Dhouib
- Division of Radiology, DISIM, Geneva University Hospitals, Geneva, Switzerland
| | - A Fitsiori
- Division of Neuroradiology, DISIM, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - J L Dietemann
- Division of Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
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17
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de Matos NM, Hock A, Wyss M, Ettlin DA, Brügger M. Neurochemical dynamics of acute orofacial pain in the human trigeminal brainstem nuclear complex. Neuroimage 2017; 162:162-172. [DOI: 10.1016/j.neuroimage.2017.08.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 01/25/2023] Open
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18
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Giapitzakis I, Shao T, Avdievich N, Mekle R, Kreis R, Henning A. Metabolite‐cycled STEAM and semi‐LASER localization for MR spectroscopy of the human brain at 9.4T. Magn Reson Med 2017; 79:1841-1850. [DOI: 10.1002/mrm.26873] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Ioannis‐Angelos Giapitzakis
- High‐Field Magnetic Resonance, Max Planck Institute for Biological CyberneticsTübingen Germany
- IMPRS for Cognitive & Systems NeuroscienceTübingen Germany
| | - Tingting Shao
- High‐Field Magnetic Resonance, Max Planck Institute for Biological CyberneticsTübingen Germany
| | - Nikolai Avdievich
- High‐Field Magnetic Resonance, Max Planck Institute for Biological CyberneticsTübingen Germany
| | - Ralf Mekle
- Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin BerlinBerlin Germany
| | - Roland Kreis
- Departments of Radiology and Clinical ResearchUniversity BernBern Switzerland
| | - Anke Henning
- High‐Field Magnetic Resonance, Max Planck Institute for Biological CyberneticsTübingen Germany
- Institute of PhysicsUniversity of GreifswaldGreifswald Germany
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19
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Wyss PO, Hock A, Kollias S. The Application of Human Spinal Cord Magnetic Resonance Spectroscopy to Clinical Studies: A Review. Semin Ultrasound CT MR 2017; 38:153-162. [DOI: 10.1053/j.sult.2016.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Cuvinciuc V, Viallon M, Barnaure I, Vargas MI, Lovblad KO, Haller S. Dynamic Contrast-Enhanced MR Perfusion of Intradural Spinal Lesions. AJNR Am J Neuroradiol 2017; 38:192-194. [PMID: 27856434 DOI: 10.3174/ajnr.a4995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/03/2016] [Indexed: 11/07/2022]
Abstract
Fifteen patients with intradural spinal lesions were examined with an optimized dynamic contrast-enhanced MR perfusion sequence at 1.5T and 3T. SNR and mean contrast-to-noise ratio were better on 3T compared with 1.5T (P ≤ .05). The goodness of fit of the Tofts and Tofts extended pharmacokinetic models was similar between 1.5T and 3T. Thus, dynamic contrast-enhanced MR perfusion of intradural spinal canal lesions is technically feasible at 1.5T and 3T, with better image quality at 3T.
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Affiliation(s)
- V Cuvinciuc
- From the Departments of Neuroradiology (V.C., I.B., M.I.V., K.-O.L., S.H.)
- Centre d'Imagerie Rive Droite (V.C.), Geneva, Switzerland
| | - M Viallon
- Radiology (M.V.), Geneva University Hospitals, Geneva, Switzerland
- Université de Lyon, INSA de Lyon, Université Jean-Monnet, CHU de Saint-Etienne, CREATIS CNRS 5220, INSERM 1206, F-42055, Saint-Etienne, France (M.V.)
| | - I Barnaure
- From the Departments of Neuroradiology (V.C., I.B., M.I.V., K.-O.L., S.H.)
| | - M I Vargas
- From the Departments of Neuroradiology (V.C., I.B., M.I.V., K.-O.L., S.H.)
| | - K-O Lovblad
- From the Departments of Neuroradiology (V.C., I.B., M.I.V., K.-O.L., S.H.)
| | - S Haller
- From the Departments of Neuroradiology (V.C., I.B., M.I.V., K.-O.L., S.H.)
- Affidea Centre de Diagnostique Radiologique de Carouge (S.H.), Geneva, Switzerland
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21
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Hock A, Wilm B, Zandomeneghi G, Ampanozi G, Franckenberg S, Zoelch N, Wyss PO, De Zanche N, Nordmeyer-Maßner J, Kraemer T, Thali M, Ernst M, Kollias S, Henning A. Neurochemical profile of the human cervical spinal cord determined by MRS. NMR IN BIOMEDICINE 2016; 29:1464-1476. [PMID: 27580498 DOI: 10.1002/nbm.3589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/14/2016] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
Abstract
MRS enables insight into the chemical composition of central nervous system tissue. However, technical challenges degrade the data quality when applied to the human spinal cord. Therefore, to date detection of only the most prominent metabolite resonances has been reported in the healthy human spinal cord. The aim of this investigation is to provide an extended metabolic profile including neurotransmitters and antioxidants in addition to metabolites involved in the energy and membrane metabolism of the human cervical spinal cord in vivo. To achieve this, data quality was improved by using a custom-made, cervical detector array together with constructive averaging of a high number of echo signals, which is enabled by the metabolite cycling technique at 3T. In addition, the improved spinal cord spectra were extensively cross-validated, in vivo, post-mortem in situ and ex vivo. Reliable identification of up to nine metabolites was achieved in group analyses for the first time. Distinct features of the spinal cord neurochemical profile, in comparison with the brain neurotransmission system, include decreased concentrations of the sum of glutamate and glutamate and increased concentrations of aspartate, γ-amino-butyric acid, scyllo-inositol and the sum of myo-inositol and glycine.
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Affiliation(s)
- Andreas Hock
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
- Hospital of Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.
| | - Bertram Wilm
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | | | - Garyfalia Ampanozi
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | | | - Niklaus Zoelch
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Patrik Oliver Wyss
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- Institute of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Nicola De Zanche
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Thomas Kraemer
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Michael Thali
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | | | - Spyros Kollias
- Institute of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Anke Henning
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- Max Plank Institute for Biological Cybernetics, Tuebingen, Baden-Württemberg, Germany
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22
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Henning A, Koning W, Fuchs A, Raaijmakers A, Bluemink JJ, van den Berg CAT, Boer VO, Klomp DWJ. (1) H MRS in the human spinal cord at 7 T using a dielectric waveguide transmitter, RF shimming and a high density receive array. NMR IN BIOMEDICINE 2016; 29:1231-1239. [PMID: 27191947 DOI: 10.1002/nbm.3541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 06/05/2023]
Abstract
Multimodal MRI is the state of the art method for clinical diagnostics and therapy monitoring of the spinal cord, with MRS being an emerging modality that has the potential to detect relevant changes of the spinal cord tissue at an earlier stage and to enhance specificity. Methodological challenges related to the small dimensions and deep location of the human spinal cord inside the human body, field fluctuations due to respiratory motion, susceptibility differences to adjacent tissue such as vertebras and pulsatile flow of the cerebrospinal fluid hinder the clinical application of (1) H MRS to the human spinal cord. Complementary to previous studies that partly addressed these problems, this work aims at enhancing the signal-to-noise ratio (SNR) of (1) H MRS in the human spinal cord. To this end a flexible tight fit high density receiver array and ultra-high field strength (7 T) were combined. A dielectric waveguide and dipole antenna transmission coil allowed for dual channel RF shimming, focusing the RF field in the spinal cord, and an inner-volume saturated semi-LASER sequence was used for robust localization in the presence of B1 (+) inhomogeneity. Herein we report the first 7 T spinal cord (1) H MR spectra, which were obtained in seven independent measurements of 128 averages each in three healthy volunteers. The spectra exhibit high quality (full width at half maximum 0.09 ppm, SNR 7.6) and absence of artifacts and allow for reliable quantification of N-acetyl aspartate (NAA) (NAA/Cr (creatine) 1.31 ± 0.20; Cramér-Rao lower bound (CRLB) 5), total choline containing compounds (Cho) (Cho/Cr 0.32 ± 0.07; CRLB 7), Cr (CRLB 5) and myo-inositol (mI) (mI/Cr 1.08 ± 0.22; CRLB 6) in 7.5 min in the human cervical spinal cord. Thus metabolic information from the spinal cord can be obtained in clinically feasible scan times at 7 T, and its benefit for clinical decision making in spinal cord disorders will be investigated in the future using the presented methodology. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- A Henning
- Max Plank Institute for Biological Cybernetics, Tübingen, Germany
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - W Koning
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Fuchs
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - A Raaijmakers
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J Bluemink
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - V O Boer
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - D W J Klomp
- University Medical Center Utrecht, Utrecht, The Netherlands
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23
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Hock A, Henning A. Motion correction and frequency stabilization for MRS of the human spinal cord. NMR IN BIOMEDICINE 2016; 29:490-498. [PMID: 26867133 DOI: 10.1002/nbm.3487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/15/2015] [Accepted: 12/20/2015] [Indexed: 06/05/2023]
Abstract
Subject motion is challenging for MRS, because it can falsify results. For spinal cord MRS in particular, subject movement is critical, since even a small movement > 1 mm) can lead to a voxel shift out of the desired measurement region. Therefore, the identification of motion corrupted MRS scans is essential. In this investigation, MR navigators acquired simultaneously with the MRS data are used to identify a displacement of the spinal cord due to subject motion. It is shown that navigators are able to recognize substantial subject motion (>1 mm) without impairing the MRS measurement. In addition, navigators are easy to apply to the measurement, because no additional hardware and just a minor additional user effort are needed. Moreover, no additional scan time is required, because navigators can be applied in the deadtime of the MRS sequence. Furthermore, in this work, retrospective motion correction combined with frequency stabilization is presented by combining navigators with non-water-suppressed (1)H-MRS, resulting in an improved spectral quality of the spinal cord measurements.
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Affiliation(s)
- Andreas Hock
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Anke Henning
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- Max Plank Institute for Biological Cybernetics, Tuebingen, Germany
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24
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Gass A, Rocca MA, Agosta F, Ciccarelli O, Chard D, Valsasina P, Brooks JCW, Bischof A, Eisele P, Kappos L, Barkhof F, Filippi M. MRI monitoring of pathological changes in the spinal cord in patients with multiple sclerosis. Lancet Neurol 2015; 14:443-54. [PMID: 25748099 DOI: 10.1016/s1474-4422(14)70294-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The spinal cord is a clinically important site that is affected by pathological changes in most patients with multiple sclerosis; however, imaging of the spinal cord with conventional MRI can be difficult. Improvements in MRI provide a major advantage for spinal cord imaging, with better signal-to-noise ratio and improved spatial resolution. Through the use of multiplanar MRI, identification of diffuse and focal changes in the whole spinal cord is now routinely possible. Corroborated by related histopathological analyses, several new techniques, such as magnetisation transfer, diffusion tension imaging, functional MRI, and proton magnetic resonance spectroscopy, can detect non-focal, spinal cord pathological changes in patients with multiple sclerosis. Additionally, functional MRI can reveal changes in the response pattern to sensory stimulation in patients with multiple sclerosis. Through use of these techniques, findings of cord atrophy, intrinsic cord damage, and adaptation are shown to occur largely independently of focal spinal cord lesion load, which emphasises their relevance in depiction of the true burden of disease. Combinations of magnetisation transfer ratio or diffusion tension imaging indices with cord atrophy markers seem to be the most robust and meaningful biomarkers to monitor disease evolution in early multiple sclerosis.
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Affiliation(s)
- Achim Gass
- Department of Neurology, Universitätsmedizin Mannheim UMM, University of Heidelberg, Germany.
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Olga Ciccarelli
- Department of Brain Repair and Rehabilitation, University College London, Institute of Neurology National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Declan Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London, Institute of Neurology National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Antje Bischof
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Philipp Eisele
- Department of Neurology, Universitätsmedizin Mannheim UMM, University of Heidelberg, Germany
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Öz G, Alger JR, Barker PB, Bartha R, Bizzi A, Boesch C, Bolan PJ, Brindle KM, Cudalbu C, Dinçer A, Dydak U, Emir UE, Frahm J, González RG, Gruber S, Gruetter R, Gupta RK, Heerschap A, Henning A, Hetherington HP, Howe FA, Hüppi PS, Hurd RE, Kantarci K, Klomp DWJ, Kreis R, Kruiskamp MJ, Leach MO, Lin AP, Luijten PR, Marjańska M, Maudsley AA, Meyerhoff DJ, Mountford CE, Nelson SJ, Pamir MN, Pan JW, Peet AC, Poptani H, Posse S, Pouwels PJW, Ratai EM, Ross BD, Scheenen TWJ, Schuster C, Smith ICP, Soher BJ, Tkáč I, Vigneron DB, Kauppinen RA. Clinical proton MR spectroscopy in central nervous system disorders. Radiology 2014; 270:658-79. [PMID: 24568703 PMCID: PMC4263653 DOI: 10.1148/radiol.13130531] [Citation(s) in RCA: 419] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A large body of published work shows that proton (hydrogen 1 [(1)H]) magnetic resonance (MR) spectroscopy has evolved from a research tool into a clinical neuroimaging modality. Herein, the authors present a summary of brain disorders in which MR spectroscopy has an impact on patient management, together with a critical consideration of common data acquisition and processing procedures. The article documents the impact of (1)H MR spectroscopy in the clinical evaluation of disorders of the central nervous system. The clinical usefulness of (1)H MR spectroscopy has been established for brain neoplasms, neonatal and pediatric disorders (hypoxia-ischemia, inherited metabolic diseases, and traumatic brain injury), demyelinating disorders, and infectious brain lesions. The growing list of disorders for which (1)H MR spectroscopy may contribute to patient management extends to neurodegenerative diseases, epilepsy, and stroke. To facilitate expanded clinical acceptance and standardization of MR spectroscopy methodology, guidelines are provided for data acquisition and analysis, quality assessment, and interpretation. Finally, the authors offer recommendations to expedite the use of robust MR spectroscopy methodology in the clinical setting, including incorporation of technical advances on clinical units.
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Affiliation(s)
- Gülin Öz
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Jeffry R. Alger
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Peter B. Barker
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Robert Bartha
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Alberto Bizzi
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Chris Boesch
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Patrick J. Bolan
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Kevin M. Brindle
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Cristina Cudalbu
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Alp Dinçer
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ulrike Dydak
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Uzay E. Emir
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Jens Frahm
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ramón Gilberto González
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Stephan Gruber
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Rolf Gruetter
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Rakesh K. Gupta
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Arend Heerschap
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Anke Henning
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Hoby P. Hetherington
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Franklyn A. Howe
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Petra S. Hüppi
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ralph E. Hurd
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Kejal Kantarci
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Dennis W. J. Klomp
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Roland Kreis
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Marijn J. Kruiskamp
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Martin O. Leach
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Alexander P. Lin
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Peter R. Luijten
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Małgorzata Marjańska
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Andrew A. Maudsley
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Dieter J. Meyerhoff
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Carolyn E. Mountford
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Sarah J. Nelson
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - M. Necmettin Pamir
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Jullie W. Pan
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Andrew C. Peet
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Harish Poptani
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Stefan Posse
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Petra J. W. Pouwels
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Eva-Maria Ratai
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Brian D. Ross
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Tom W. J. Scheenen
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Christian Schuster
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ian C. P. Smith
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Brian J. Soher
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ivan Tkáč
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Daniel B. Vigneron
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
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26
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Hock A, Henning A, Kollias SS. Reply: To PMID 23237857. AJNR Am J Neuroradiol 2014; 34:E130. [PMID: 24479160 DOI: 10.3174/ajnr.a3810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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27
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da Cruz LCH. Can we perform spinal 1H-MR spectroscopy in daily clinical practice? AJNR Am J Neuroradiol 2013; 34:E128-9. [PMID: 24287095 DOI: 10.3174/ajnr.a3809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- L C Hygino da Cruz
- Clinicas CDPI and IRMFederal University of Rio de JaneiroRio de Janeiro, Brazil
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