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Al-Shaari H, Fulford J, Heales CJ. Diffusion tensor imaging within the healthy cervical spinal cord: Within- participants reliability and measurement error. Magn Reson Imaging 2024; 109:56-66. [PMID: 38458552 DOI: 10.1016/j.mri.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) is a promising technique for the visualization of the cervical spinal cord (CSC) in vivo. It provides information about the tissue structure of axonal white matter, and it is thought to be more sensitive than other MR imaging techniques for the evaluation of damage to tracts in the spinal cord. AIM The purpose of this study was to determine the within-participants reliability and error magnitude of measurements of DTI metrics in healthy human CSC. METHODS A total of twenty healthy controls (10 male, mean age: 33.9 ± 3.5 years, 10 females, mean age: 47.5 ± 14.4 years), with no family history of any neurological disorders or a contraindication to MRI scanning were recruited over a period of two months. Each participant was scanned twice with an MRI 3 T scanner using standard DTI sequences. Spinal Cord Toolbox (SCT) software was used for image post-processing. Data were first corrected for motion artefact, then segmented, registered to a template, and then the DTI metrics were computed. The within-participants coefficients of variation (CV%), the single and average within-participants intraclass correlation coefficients (ICC) and Bland-Altman plots for WM, VC, DC and LC fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were determined for the cervical spinal cord (between the 2nd and 5th cervical vertebrae). RESULTS DTI metrics showed poor to excellent within-participants reliability for both single and average ICC and moderate to high reproducibility for CV%, all variation dependent on the location of the ROI. The BA plots showed good within-participants agreement between the scan-rescan values. CONCLUSION Results from this reliability study demonstrate that clinical trials using the DTI technique are feasible and that DTI, in particular regions of the cord is suitable for use for the monitoring of degenerative WM changes.
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Affiliation(s)
- Hussein Al-Shaari
- Diagnostic Radiology Department, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia; Department of Medical Imaging, Faculty of Health and Life Sciences, The University of Exeter, South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK.
| | - Jon Fulford
- Department of Medical Imaging, Faculty of Health and Life Sciences, The University of Exeter, South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK.
| | - C J Heales
- Department of Medical Imaging, Faculty of Health and Life Sciences, The University of Exeter, South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK.
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Cronin AE, Liebig P, Detombe SA, Duggal N, Bartha R. Reproducibility of 3D pH-weighted chemical exchange saturation transfer contrast in the healthy cervical spinal cord. NMR Biomed 2024; 37:e5103. [PMID: 38243648 DOI: 10.1002/nbm.5103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024]
Abstract
Spinal cord ischemia and hypoxia can be caused by compression, injury, and vascular alterations. Measuring ischemia and hypoxia directly in the spinal cord noninvasively remains challenging. Ischemia and hypoxia alter tissue pH, providing a physiologic parameter that may be more directly related to tissue viability. Chemical exchange saturation transfer (CEST) is an MRI contrast mechanism that can be made sensitive to pH. More specifically, amine/amide concentration independent detection (AACID) is a recently developed endogenous CEST contrast that has demonstrated sensitivity to intracellular pH at 9.4 T. The goal of this study was to evaluate the reproducibility of AACID CEST measurements at different levels of the healthy cervical spinal cord at 3.0 T incorporating B1 correction. Using a 3.0 T MRI scanner, two 3D CEST scans (saturation pulse train followed by a 3D snapshot gradient-echo readout) were performed on 12 healthy subjects approximately 10 days apart, with the CEST volume centered at the C4 level for all subjects. Scan-rescan reproducibility was evaluated by examining between and within-subject coefficients of variation (CVs) and absolute AACID value differences. The C4 level of the spinal cord demonstrated the lowest within-subject CVs (4.1%-4.3%), between-subject CVs (5.6%-6.3%), and absolute AACID percent difference (5.8-6.1%). The B1 correction scheme significantly improved reproducibility (adjusted p-value = 0.002) compared with the noncorrected data, suggesting that implementing B1 corrections in the spinal cord is beneficial. It was concluded that pH-weighted AACID measurements, incorporating B1-inhomogeneity correction, were reproducible within subjects along the healthy cervical spinal cord and that optimal image quality was achieved at the center of the 3D CEST volume.
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Affiliation(s)
- Alicia E Cronin
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Sarah A Detombe
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
| | - Neil Duggal
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Filimonova E, Abdaev M, Vasilenko I, Kubetskij Y, Prokhorov O, Rzaev J. Evaluation of the structural integrity of different spinal cord tracts with magnetization transfer ratio in degenerative cervical myelopathy. Neuroradiology 2024; 66:839-846. [PMID: 38441573 DOI: 10.1007/s00234-024-03327-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/27/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE Degenerative cervical myelopathy (DCM) is a common cause of spinal cord dysfunction. In this study, we explored the potential of magnetization transfer ratio (MTR) for evaluating the structural integrity of spinal cord tracts in patients with clinically significant DCM. METHODS Fifty-three patients with DCM and 41 patients with cervical radiculopathy were evaluated using high-resolution cervical spinal cord magnetic resonance imaging (MRI), which included the magnetization transfer technique. MRI data were analyzed with the Spinal Cord Toolbox (v5.5); MTR values in each spinal tract were calculated and compared between groups after correction for patient age and sex. Correlations between MTR values and patients' clinical disability rate were also evaluated. RESULTS A statistically significant reduction in the average MTR of the spinal cord white matter, as well as the MTR of the ventral columns and lateral funiculi, was revealed in the DCM group (adjusted p < 0.01 for all comparisons). Furthermore, reductions in MTR values in the fasciculus cuneatus, spinocerebellar, rubrospinal, and reticulospinal tracts were found in patients with DCM (adjusted p < 0.01 for all comparisons). Positive correlations between the JOA score and the MTR within the ventral columns of the spinal cord (R = 0.38, adjusted p < 0.05) and the ventral spinocerebellar tract (R = 0.41, adjusted p < 0.05) were revealed. CONCLUSION The findings of our study indicate that demyelination in patients with DCM primarily affects the spinal tracts of the extrapyramidal system, and the extent of these changes is related to the severity of the condition.
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Affiliation(s)
- Elena Filimonova
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia.
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia.
| | - Mars Abdaev
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
| | - Ivan Vasilenko
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
| | | | | | - Jamil Rzaev
- FSBI "Federal Center of Neurosurgery", Novosibirsk, Russia
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
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Liang X, Wang X, Chen Y, He D, Li L, Chen G, Li J, Li J, Liu S, Xu Z. Predictive value of intraoperative contrast-enhanced ultrasound in functional recovery of non-traumatic cervical spinal cord injury. Eur Radiol 2024; 34:2297-2309. [PMID: 37707550 DOI: 10.1007/s00330-023-10221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/05/2023] [Accepted: 07/15/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES To evaluate the ability of intraoperative CEUS to predict neurological recovery in patients with degenerative cervical myelopathy (DCM). METHODS Twenty-six patients with DCM who underwent laminoplasty and intraoperative ultrasound (IOUS) were included in this prospective study. The modified Japanese Orthopaedic Association (mJOA) scores and MRI were assessed before surgery and 12 months postoperatively. The anteroposterior diameter (APD), maximum spinal cord compression (MSCC), and area of signal changes in the cord at the compressed and normal levels were measured and compared using MRI and IOUS. Conventional blood flow and CEUS indices (time to peak, ascending slope, peak intensity (PI), and area under the curve (AUC)) at different levels during IOUS were calculated and analysed. Correlations between all indicators and the neurological recovery rate were evaluated. RESULTS All patients underwent IOUS and intraoperative CEUS, and the total recovery rate was 50.7 ± 33.3%. APD and MSCC improved significantly (p < 0.01). The recovery rate of the hyperechoic lesion group was significantly worse than that of the isoechoic group (p = 0.016). 22 patients were analysed by contrast analysis software. PI was higher in the compressed zone than in the normal zone (24.58 ± 3.19 versus 22.43 ± 2.39, p = 0.019). ΔPI compress-normal and ΔAUC compress-normal of the hyperechoic lesion group were significantly higher than those of the isoechoic group (median 2.19 versus 0.55, p = 0.017; 135.7 versus 21.54, p = 0.014, respectively), and both indices were moderately negatively correlated with the recovery rate (r = - 0.463, p = 0.030; r = - 0.466, p = 0.029). CONCLUSIONS Signal changes and microvascular perfusion evaluated using CEUS during surgery are valuable predictors of cervical myelopathy prognosis. CLINICAL RELEVANCE STATEMENT In the spinal cord compression area of degenerative cervical myelopathy, especially in the hyperechoic lesions, intraoperative CEUS showed more significant contrast agent perfusion than in the normal area, and the degree was negatively correlated with the neurological prognosis. KEY POINTS • Recovery rates in patients with hyperechoic findings were lower than those of patients without lesions detected during intraoperative ultrasound. • The peak intensity of CEUS was higher in compressed zones than in the normal parts of the spinal cord. • Quantitative CEUS comparisons of the peak intensity and area under the curve at the compressed and normal levels of the spinal cord revealed differences that were inversely correlated to the recovery rate.
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Affiliation(s)
- Xuankun Liang
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Xianxiang Wang
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Yanfang Chen
- Outpatient Office, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Danni He
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Lujing Li
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Guoliang Chen
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Jiachun Li
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Jie Li
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Shaoyu Liu
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China.
| | - Zuofeng Xu
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China.
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Lim TRU, Kumaran SP, Suthiphosuwan S, Espiritu AI, Jones A, Lin AW, Oh J, Bharatha A. Limited utility of adding 3T cervical spinal cord MRI to monitor disease activity in multiple sclerosis. Mult Scler 2024; 30:505-515. [PMID: 38419027 DOI: 10.1177/13524585241228426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Performing routine brain magnetic resonance imaging (MRI) is widely accepted as the standard of care for disease monitoring in multiple sclerosis (MS), but the utility of performing routine spinal cord (SC) MRI for this purpose is still debatable. OBJECTIVE This study aimed to measure the frequency of new isolated cervical spinal cord lesions (CSLs) in people with MS (pwMS) undergoing routine brain and cervical SC-MRI for disease monitoring and determine the factors associated with the development of new CSLs and their prognostic value. METHODS We retrospectively identified 1576 pwMS who underwent follow-up 3T brain and cervical SC-MRI over a 9-month period. MRI was reviewed for the presence of new brain lesions (BLs) and CSLs. Clinical records were reviewed for interval relapses between sequential scans and subsequent clinical relapse and disability worsening after the follow-up MRI. RESULTS In 1285 pwMS (median interval: 13-14 months) who were clinically stable with respect to relapses, 73 (5.7%) had new CSLs, of which 49 (3.8%) had concomitant new BLs and 24 (1.9%) had new isolated CSLs only. New asymptomatic CSLs were associated with ⩾ 3 prior relapses (p = 0.04), no disease-modifying therapy (DMT) use (p = 0.048), and ⩾ 3 new BLs (p < 0.001); ⩾ 3 new BLs (OR: 7.11, 95% CI: 4.3-11.7, p < 0.001) remained independently associated with new CSLs on multivariable analysis. Having new asymptomatic CSLs was not independently associated with subsequent relapse or disability worsening after the follow-up MRI (median follow-up time of 26 months). CONCLUSION Routine brain and cervical SC-MRI detected new isolated CSLs in only < 2% of clinically stable pwMS. Developing new asymptomatic CSLs was associated with concomitant new BLs and did not confer an independent increased risk of relapse or disability worsening. Performing SC-MRI may not be warranted for routine monitoring in most pwMS, and performing only brain MRI may be sufficient to capture the vast majority of clinically silent disease activity.
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Affiliation(s)
- Timothy Reynold U Lim
- Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Sunitha P Kumaran
- Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Suradech Suthiphosuwan
- Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Adrian I Espiritu
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada/Department of Neurosciences and Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Ashley Jones
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Amy Wei Lin
- Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada/ Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Aditya Bharatha
- Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada
- Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Meng Y, Wang S, Zhu W, Wang T, Liu D, Wang M, Pi J, Liu Y, Zhuo Z, Pan Y, Wang Y. Association of Mean Upper Cervical Spinal Cord Cross-Sectional Area With Cerebral Small Vessel Disease: A Community-Based Cohort Study. Stroke 2024; 55:687-695. [PMID: 38269540 DOI: 10.1161/strokeaha.123.044666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The purpose of this study was to investigate the association between the mean upper cervical spinal cord cross-sectional area (MUCCA) and the risk and severity of cerebral small vessel disease (CSVD). METHODS Community-dwelling residents in Lishui City, China, from the cross-sectional survey in the PRECISE cohort study (Polyvascular Evaluation for Cognitive Impairment and Vascular Events) conducted from 2017 to 2019. We included 1644 of 3067 community-dwelling adults in the PRECISE study after excluding those with incorrect, incomplete, insufficient, or missing clinical or imaging data. Total and modified total CSVD scores, as well as magnetic resonance imaging features, including white matter hyperintensity, lacunes, cerebral microbleeds, enlarged perivascular spaces, and brain atrophy, were assessed at the baseline. The Spinal Cord Toolbox was used to measure the upper cervical spinal cord cross-sectional area of the C1 to C3 segments of the spinal cord and its average value was taken as MUCCA. Participants were divided into 4 groups according to quartiles of MUCCA. Associations were analyzed using linear regression models adjusted for age, sex, current smoking and drinking, medical history, intracranial volume, and total cortical volume. RESULTS The means±SD age of the participants was 61.4±6.5 years, and 635 of 1644 participants (38.6%) were men. The MUCCA was smaller in patients with CSVD than those without CSVD. Using the total CSVD score as a criterion, the MUCCA was 61.78±6.12 cm2 in 504 of 1644 participants with CSVD and 62.74±5.94 cm2 in 1140 of 1644 participants without CSVD. Using the modified total CSVD score, the MUCCA was 61.81±6.04 cm2 in 699 of 1644 participants with CSVD and 62.91±5.94 cm2 in 945 of 1644 without CSVD. There were statistical differences between the 2 groups after adjusting for covariates in 3 models. The MUCCA was negatively associated with the total and modified total CSVD scores (adjusted β value, -0.009 [95% CI, -0.01 to -0.003] and -0.007 [95% CI, -0.01 to -0.0006]) after adjustment for covariates. Furthermore, the MUCCA was negatively associated with the white matter hyperintensity burden (adjusted β value, -0.01 [95% CI, -0.02 to -0.003]), enlarged perivascular spaces in the basal ganglia (adjusted β value, -0.005 [95% CI, -0.009 to -0.001]), lacunes (adjusted β value, -0.004 [95% CI, -0.007 to -0.0007]), and brain atrophy (adjusted β value, -0.009 [95% CI, -0.01 to -0.004]). CONCLUSIONS The MUCCA and CSVD were correlated. Spinal cord atrophy may serve as an imaging marker for CSVD; thus, small vessel disease may involve the spinal cord in addition to being intracranial.
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Affiliation(s)
- Yufei Meng
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China (Y.M.)
| | - Suying Wang
- Department of Neurology and Cerebrovascular Research Laboratory, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical University, Zhejiang, China (S.W.)
| | - Wanlin Zhu
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
| | - Tingting Wang
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases, Beijing (T.W., D.L., M.W., Y.P., Y.W.)
| | - Dandan Liu
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases, Beijing (T.W., D.L., M.W., Y.P., Y.W.)
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases, Beijing (T.W., D.L., M.W., Y.P., Y.W.)
| | - Jingtao Pi
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
| | - Yaou Liu
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
| | - Zhizheng Zhuo
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases, Beijing (T.W., D.L., M.W., Y.P., Y.W.)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- Advanced Innovation Center for Human Brain Protection (Y.W.), Capital Medical University, China
- Beijing Laboratory of Oral Health (Y.W.), Capital Medical University, China
- Chinese Institute for Brain Research, Beijing, China (Y.W.)
- National Center for Neurological Diseases, Beijing, China (Y.W.)
- China National Clinical Research Center for Neurological Diseases, Beijing (T.W., D.L., M.W., Y.P., Y.W.)
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Seifert AC, Xu J, Kong Y, Eippert F, Miller KL, Tracey I, Vannesjo SJ. Thermal stimulus task fMRI in the cervical spinal cord at 7 Tesla. Hum Brain Mapp 2024; 45:e26597. [PMID: 38375948 PMCID: PMC10877664 DOI: 10.1002/hbm.26597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 02/21/2024] Open
Abstract
Although functional magnetic resonance imaging (fMRI) is widely applied in the brain, fMRI of the spinal cord is more technically demanding. Proximity to the vertebral column and lungs results in strong spatial inhomogeneity and temporal fluctuations in B0 . Increasing field strength enables higher spatial resolution and improved sensitivity to blood oxygenation level-dependent (BOLD) signal, but amplifies the effects of B0 inhomogeneity. In this work, we present the first task fMRI in the spinal cord at 7 T. Further, we compare the performance of single-shot and multi-shot 2D echo-planar imaging (EPI) protocols, which differ in sensitivity to spatial and temporal B0 inhomogeneity. The cervical spinal cords of 11 healthy volunteers were scanned at 7 T using single-shot 2D EPI at 0.75 mm in-plane resolution and multi-shot 2D EPI at 0.75 and 0.6 mm in-plane resolutions. All protocols used 3 mm slice thickness. For each protocol, the BOLD response to 13 10-s noxious thermal stimuli applied to the right thumb was acquired in a 10-min fMRI run. Image quality, temporal signal to noise ratio (SNR), and BOLD activation (percent signal change and z-stat) at both individual- and group-level were evaluated between the protocols. Temporal SNR was highest in single-shot and multi-shot 0.75 mm protocols. In group-level analyses, activation clusters appeared in all protocols in the ipsilateral dorsal quadrant at the expected C6 neurological level. In individual-level analyses, activation clusters at the expected level were detected in some, but not all subjects and protocols. Single-shot 0.75 mm generally produced the highest mean z-statistic, while multi-shot 0.60 mm produced the best-localized activation clusters and the least geometric distortion. Larger than expected within-subject segmental variation of BOLD activation along the cord was observed. Group-level sensory task fMRI of the cervical spinal cord is feasible at 7 T with single-shot or multi-shot EPI. The best choice of protocol will likely depend on the relative importance of sensitivity to activation versus spatial localization of activation for a given experiment. PRACTITIONER POINTS: First stimulus task fMRI results in the spinal cord at 7 T. Single-shot 0.75 mm 2D EPI produced the highest mean z-statistic. Multi-shot 0.60 mm 2D EPI provided the best-localized activation and least distortion.
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Affiliation(s)
- Alan C. Seifert
- Biomedical Engineering and Imaging InstituteIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Diagnostic, Molecular, and Interventional RadiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Graduate School of Biomedical SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Junqian Xu
- Department of RadiologyBaylor College of MedicineHoustonTexasUSA
- Department of PsychiatryBaylor College of MedicineHoustonTexasUSA
| | - Yazhuo Kong
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Institute of PsychologyChinese Academy of SciencesBeijingChina
| | - Falk Eippert
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Max Planck Research Group Pain PerceptionMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
| | - Karla L. Miller
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - S. Johanna Vannesjo
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Department of PhysicsNorwegian University of Science and Technology (NTNU)TrondheimNorway
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Kowalczyk OS, Medina S, Tsivaka D, McMahon SB, Williams SCR, Brooks JCW, Lythgoe DJ, Howard MA. Spinal fMRI demonstrates segmental organisation of functionally connected networks in the cervical spinal cord: A test-retest reliability study. Hum Brain Mapp 2024; 45:e26600. [PMID: 38339896 PMCID: PMC10831202 DOI: 10.1002/hbm.26600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
Resting functional magnetic resonance imaging (fMRI) studies have identified intrinsic spinal cord activity, which forms organised motor (ventral) and sensory (dorsal) resting-state networks. However, to facilitate the use of spinal fMRI in, for example, clinical studies, it is crucial to first assess the reliability of the method, particularly given the unique anatomical, physiological, and methodological challenges associated with acquiring the data. Here, we characterise functional connectivity relationships in the cervical cord and assess their between-session test-retest reliability in 23 young healthy volunteers. Resting-state networks were estimated in two ways (1) by estimating seed-to-voxel connectivity maps and (2) by calculating seed-to-seed correlations. Seed regions corresponded to the four grey matter horns (ventral/dorsal and left/right) of C5-C8 segmental levels. Test-retest reliability was assessed using the intraclass correlation coefficient. Spatial overlap of clusters derived from seed-to-voxel analysis between sessions was examined using Dice coefficients. Following seed-to-voxel analysis, we observed distinct unilateral dorsal and ventral organisation of cervical spinal resting-state networks that was largely confined in the rostro-caudal extent to each spinal segmental level, with more sparse connections observed between segments. Additionally, strongest correlations were observed between within-segment ipsilateral dorsal-ventral connections, followed by within-segment dorso-dorsal and ventro-ventral connections. Test-retest reliability of these networks was mixed. Reliability was poor when assessed on a voxelwise level, with more promising indications of reliability when examining the average signal within clusters. Reliability of correlation strength between seeds was highly variable, with the highest reliability achieved in ipsilateral dorsal-ventral and dorso-dorsal/ventro-ventral connectivity. However, the spatial overlap of networks between sessions was excellent. We demonstrate that while test-retest reliability of cervical spinal resting-state networks is mixed, their spatial extent is similar across sessions, suggesting that these networks are characterised by a consistent spatial representation over time.
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Affiliation(s)
- Olivia S. Kowalczyk
- Department of Neuroimaging, Institute of Psychology, Psychiatry & NeuroscienceKing's College LondonLondonUK
- The Wellcome Centre for Human Neuroimaging, Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Sonia Medina
- Department of Neuroimaging, Institute of Psychology, Psychiatry & NeuroscienceKing's College LondonLondonUK
| | - Dimitra Tsivaka
- Department of Neuroimaging, Institute of Psychology, Psychiatry & NeuroscienceKing's College LondonLondonUK
- Medical Physics Department, Medical SchoolUniversity of ThessalyLarisaGreece
| | | | - Steven C. R. Williams
- Department of Neuroimaging, Institute of Psychology, Psychiatry & NeuroscienceKing's College LondonLondonUK
| | | | - David J. Lythgoe
- Department of Neuroimaging, Institute of Psychology, Psychiatry & NeuroscienceKing's College LondonLondonUK
| | - Matthew A. Howard
- Department of Neuroimaging, Institute of Psychology, Psychiatry & NeuroscienceKing's College LondonLondonUK
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9
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Gowda S, Chandra P, Sharma DM, Kamath L, V M. Hypoxic Ischemic Encephalopathy with Cervical Spinal Cord Injury: A Diagnostic Dilemma. Indian J Pediatr 2024; 91:191-192. [PMID: 37782391 DOI: 10.1007/s12098-023-04872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023]
Abstract
Perinatal spinal cord injury is a relatively uncommon, but a frequently misdiagnosed disorder. Improvements in obstetric care have certainly led to a decrease in the incidence of birth related spinal cord trauma but unfortunately the incidence of hypoxic-ischemic encephalopathy is still very high. The exact incidence of spinal cord trauma is difficult to determine because the spinal cord is not routinely examined in far and few neonatal autopsies done in India. Here, authors present a neonate who received treatment for birth asphyxia and then had extubation failure which made the clock tick towards cervical cord injury. This baby had a hemorrhagic contusion of cervical spinal cord.
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Affiliation(s)
- Suresh Gowda
- Department of Pediatrics and Neonatology, Motherhood Hospital, CMH Road, Indiranagar, Bengaluru, 560038, India
| | - Prathap Chandra
- Department of Pediatrics and Neonatology, Motherhood Hospital, CMH Road, Indiranagar, Bengaluru, 560038, India
| | - Deepa Mohan Sharma
- Department of Pediatrics and Neonatology, Motherhood Hospital, CMH Road, Indiranagar, Bengaluru, 560038, India
| | - Laxmi Kamath
- Department of Pediatrics and Neonatology, Motherhood Hospital, CMH Road, Indiranagar, Bengaluru, 560038, India.
| | - Mamatha V
- Department of Pediatrics and Neonatology, Motherhood Hospital, CMH Road, Indiranagar, Bengaluru, 560038, India
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10
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Charco-Roca LM, Simón-Polo E, Cuesta-Montero PC. Ultrasound evaluation of diaphragm function in patients with cervical spinal cord injury: case report. Braz J Anesthesiol 2024; 74:744348. [PMID: 34963619 PMCID: PMC10877324 DOI: 10.1016/j.bjane.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/04/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022]
Abstract
Ultrasound evaluation of diaphragm function allows the detection of diaphragm dysfunction and the adaptation of ventilatory support in patients admitted to intensive care units. The studied patient had a C3 spinal cord injury. Ultrasound evaluation of diaphragm mobility showed that the patient suffered diaphragm dysfunction. A tracheotomy was indicated, and early ventilatory support was initiated. Ultrasound evaluation of diaphragm function in patients with cervical spinal cord injury is a useful and simple technique. It provides fast and reliable data for the diagnosis of respiratory insufficiency of neuromuscular origin.
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Affiliation(s)
- Luisa María Charco-Roca
- General University Hospital of Albacete, Anaesthesiology and Resuscitation Service, Albacete, Spain
| | - Elena Simón-Polo
- General Hospital of Albacete, Anaesthesaia, Reanimation and Pain Treatment, Albacete, Spain.
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Nayak MK, Nerbadyswari DB, Biswajit S. Isolated Tumefactive Demyelination in the Cervical Spinal Cord with Open-Ring Enhancement. Neurol India 2024; 72:223-224. [PMID: 38443052 DOI: 10.4103/neurol-india.neurol-india-d-23-00695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Manoj Kumar Nayak
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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13
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Filimonova E, Letyagin V, Zaitsev B, Kubetsky Y, Rzaev J. Application of the T1w/T2w mapping technique for spinal cord assessment in patients with degenerative cervical myelopathy. Spinal Cord 2024; 62:6-11. [PMID: 37919382 DOI: 10.1038/s41393-023-00941-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES To investigate signal changes on T1w/T2w signal intensity ratio maps within cervical cord in patients with degenerative cervical myelopathy (DCM). SETTING Novosibirsk Neurosurgery Center, Russia. METHODS A total of 261 patients with DCM and 42 age- and sex-matched healthy controls were evaluated using the T1w/T2w mapping method and spinal cord automatic morphometry. The T1w/T2w signal intensity ratio, which reflects white matter integrity, and the spinal cord cross-sectional area (CSA) were calculated and compared between the patients and the controls. In patients with DCM, the correlations between these parameters and neurological scores were also evaluated. RESULTS The regional T1w/T2w ratio values from the cervical spinal cord at the level of maximal compression in patients with DCM were significantly lower than those in healthy controls (p < 0.001), as were the regional CSA values (p < 0.001). There was a positive correlation between the regional values of the T1w/T2w ratio and the values of the CSA at the level of maximal spinal cord compression. CONCLUSIONS T1w/T2w mapping revealed that spinal cord tissue damage exists at the level of maximal compression in patients with DCM in association with spinal cord atrophy according to automatic morphometry. These changes were correlated with each other.
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Affiliation(s)
- Elena Filimonova
- Federal Center of Neurosurgery Novosibirsk, Novosibirsk, Russia.
- Novosibirsk State Medical University, Novosibirsk, Russia.
| | | | - Boris Zaitsev
- Federal Center of Neurosurgery Novosibirsk, Novosibirsk, Russia
| | - Yulij Kubetsky
- Federal Center of Neurosurgery Novosibirsk, Novosibirsk, Russia
| | - Jamil Rzaev
- Federal Center of Neurosurgery Novosibirsk, Novosibirsk, Russia
- Novosibirsk State Medical University, Novosibirsk, Russia
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
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14
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Lebret A, Lévy S, Pfender N, Farshad M, Altorfer FCS, Callot V, Curt A, Freund P, Seif M. Investigation of perfusion impairment in degenerative cervical myelopathy beyond the site of cord compression. Sci Rep 2023; 13:22660. [PMID: 38114733 PMCID: PMC10730822 DOI: 10.1038/s41598-023-49896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
The aim of this study was to determine tissue-specific blood perfusion impairment of the cervical cord above the compression site in patients with degenerative cervical myelopathy (DCM) using intravoxel incoherent motion (IVIM) imaging. A quantitative MRI protocol, including structural and IVIM imaging, was conducted in healthy controls and patients. In patients, T2-weighted scans were acquired to quantify intramedullary signal changes, the maximal canal compromise, and the maximal cord compression. T2*-weighted MRI and IVIM were applied in all participants in the cervical cord (covering C1-C3 levels) to determine white matter (WM) and grey matter (GM) cross-sectional areas (as a marker of atrophy), and tissue-specific perfusion indices, respectively. IVIM imaging resulted in microvascular volume fraction ([Formula: see text]), blood velocity ([Formula: see text]), and blood flow ([Formula: see text]) indices. DCM patients additionally underwent a standard neurological clinical assessment. Regression analysis assessed associations between perfusion parameters, clinical outcome measures, and remote spinal cord atrophy. Twenty-nine DCM patients and 30 healthy controls were enrolled in the study. At the level of stenosis, 11 patients showed focal radiological evidence of cervical myelopathy. Above the stenosis level, cord atrophy was observed in the WM (- 9.3%; p = 0.005) and GM (- 6.3%; p = 0.008) in patients compared to healthy controls. Blood velocity (BV) and blood flow (BF) indices were decreased in the ventral horns of the GM (BV: - 20.1%, p = 0.0009; BF: - 28.2%, p = 0.0008), in the ventral funiculi (BV: - 18.2%, p = 0.01; BF: - 21.5%, p = 0.04) and lateral funiculi (BV: - 8.5%, p = 0.03; BF: - 16.5%, p = 0.03) of the WM, across C1-C3 levels. A decrease in microvascular volume fraction was associated with GM atrophy (R = 0.46, p = 0.02). This study demonstrates tissue-specific cervical perfusion impairment rostral to the compression site in DCM patients. IVIM indices are sensitive to remote perfusion changes in the cervical cord in DCM and may serve as neuroimaging biomarkers of hemodynamic impairment in future studies. The association between perfusion impairment and cervical cord atrophy indicates that changes in hemodynamics caused by compression may contribute to the neurodegenerative processes in DCM.
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Affiliation(s)
- Anna Lebret
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| | - Simon Lévy
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- APHM, CEMEREM, Hôpital Universitaire Timone, Marseille, France
- MR Research Collaborations, Siemens Healthcare Pty Ltd, Melbourne, Australia
| | - Nikolai Pfender
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| | - Mazda Farshad
- Department of Orthopedic Surgery, Balgrist University Hospital, Zürich, Switzerland
| | | | - Virginie Callot
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- APHM, CEMEREM, Hôpital Universitaire Timone, Marseille, France
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
- Department of Brain Repair and Rehabilitation, Wellcome Trust Center for Neuroimaging, Institute of Neurology, University College London, London, UK
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Maryam Seif
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland.
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
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15
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Clarke MA, Witt AA, Robison RK, Fleishman S, Combes AJE, Houston D, Prock LE, Sweeney G, O'Grady KP, McKnight CD, Smith SA. Cervical spinal cord susceptibility-weighted MRI at 7T: Application to multiple sclerosis. Neuroimage 2023; 284:120460. [PMID: 37979894 DOI: 10.1016/j.neuroimage.2023.120460] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Susceptibility-weighted imaging (SWI) has been extensively studied in the brain and in diseases of the central nervous system such as multiple sclerosis (MS) providing unique opportunities to visualize cerebral vasculature and disease-related pathology, including the central vein sign (CVS) and paramagnetic rim lesions (PRLs). However, similar studies evaluating SWI in the spinal cord of patients with MS remain severely limited. PURPOSE Based on our previous findings of enlarged spinal vessels in MS compared to healthy controls (HCs), we developed high-field SWI acquisition and processing methods for the cervical spinal cord with application in people with MS (pwMS) and HCs. Here, we demonstrate the vascular variability between the two cohorts and unique MS lesion features in the cervical cord. METHODS In this retrospective, exploratory pilot study conducted between March 2021 and March 2022, we scanned 12 HCs and 9 pwMS using an optimized non-contrast 2D T2*-weighted gradient echo sequence at 7 tesla. The overall appearance of the white and gray matter as well as tissue vasculature were compared between the two cohorts and areas of MS pathology in the patient group were assessed using both the magnitude and processed SWI images. RESULTS We show improved visibility of vessels and more pronounced gray and white matter contrast in the MS group compared to HCs, hypointensities surrounding the cord in the MS cohort, and identify signal changes indicative of the CVS and paramagnetic rims in 66 % of pwMS with cervical spinal lesions. CONCLUSION In this first study of SWI at 7T in the human spinal cord, SWI holds promise in advancing our understanding of disease processes in the cervical cord in MS.
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Affiliation(s)
- Margareta A Clarke
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Atlee A Witt
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA; School of Medicine, Vanderbilt University, Nashville, TN 37232 USA
| | - Ryan K Robison
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA; Philips Healthcare, Nashville TN 37232 USA
| | - Sawyer Fleishman
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Anna J E Combes
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Delaney Houston
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Logan E Prock
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Grace Sweeney
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Kristin P O'Grady
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232 USA; Department of Biomedical Engineering, Vanderbilt University, Nashville TN 37232 USA
| | - Colin D McKnight
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Seth A Smith
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232 USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232 USA; Department of Biomedical Engineering, Vanderbilt University, Nashville TN 37232 USA.
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16
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Karamzadeh M, Al Samman MM, Vargas AI, Bhadelia RA, Oshinski J, Barrow DL, Amini R, Loth F. The Effect of Posterior Fossa Decompression Surgery on Brainstem and Cervical Spinal Cord Dimensions in Adults with Chiari Malformation Type 1. World Neurosurg 2023; 180:149-154.e2. [PMID: 37783305 PMCID: PMC10841825 DOI: 10.1016/j.wneu.2023.09.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Posterior fossa decompression (PFD) surgery creates more space at the skull base, reduces the resistance to the cerebrospinal fluid motion, and alters craniocervical biomechanics. In this paper, we retrospectively examined the changes in neural tissue dimensions following PFD surgery on Chiari malformation type 1 adults. METHODS Measurements were performed on T2-weighted brain magnetic resonance images acquired before and 4 months after surgery. Measurements were conducted for neural tissue volume and spinal cord/brainstem width at 4 different locations; 2 width measurements were made on the brainstem and 2 on the spinal cord in the midsagittal plane. Cerebellar tonsillar position (CTP) was also measured before and after surgery. RESULTS Twenty-five adult patients, with a mean age of 38.9 ± 8.8 years, were included in the study. The cervical cord volume increased by an average of 2.3 ± 3.3% (P = 0.002). The width at the pontomedullary junction increased by 2.2 ± 3.5% (P < 0.01), while the width 10 mm caudal to this junction increased by 4.2 ± 3.9% (P < 0.0001). The spinal cord width at the base of second cervical vertebra and third cervical vertebra did not significantly change after surgery. The CTP decreased by 60 ± 37% (P < 0.0001) after surgery, but no correlation was found between CTP change and dimension change. CONCLUSIONS The brainstem width and cervical cord volume showed a modest increase after PFD surgery, although standard deviations were large. A reduction in compression after PFD surgery may allow for an increase in neural tissue dimension. However, clinical relevance is unclear and should be assessed in future studies with high-resolution imaging.
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Affiliation(s)
- Mahsa Karamzadeh
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA.
| | | | - Ana I Vargas
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Rafeeque A Bhadelia
- Department of Radiology, Beth Israel Deaconess Medical Center & Harvard University School of Medicine, Boston, Massachusetts, USA
| | - John Oshinski
- Departments of Radiology & Imaging Sciences and Biomedical Engineering, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel L Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rouzbeh Amini
- Departments of Mechanical and Industrial Engineering and Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Francis Loth
- Departments of Mechanical and Industrial Engineering and Bioengineering, Northeastern University, Boston, Massachusetts, USA
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17
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Celik NG, Karabulut AK, Fazliogullari Z, Gumus H, Cebeci H, Dogan NU. Relationship between cervical spinal cord morphometry and clinical disability in patients with multiple sclerosis. Rev Assoc Med Bras (1992) 2023; 69:e20230949. [PMID: 37971136 PMCID: PMC10645167 DOI: 10.1590/1806-9282.20230949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Multiple sclerosis is an autoimmune disease that commonly affects the cervical part of the spinal cord. The aim of this study was to evaluate the relationship between cervical spinal cord atrophy and clinical disability in multiple sclerosis patients. METHODS We examined the cervical spinal cord area measurements of 64 multiple sclerosis patients and 64 healthy control groups over the images obtained by a T2-weighted magnetic resonance imaging device. RESULTS The C2-3, C3-4, C4-5, and C6-7 axial cross-sectional surface area values of the patient group were statistically lower than those of the control group (p<0.05). A negative correlation was found between patients' Expanded Disability Status Scale scores and C4-5, C5-6, and C6-7 axial area (axial area p<0.05; r1=-0.472, r2=-0.513, and r3=-0.415). CONCLUSION When all parameters were evaluated, the data of our control group were found to be higher than the multiple sclerosis groups. There appears to be a significant relationship between patients with cervical spinal cord atrophy and an increase in Expanded Disability Status Scale scores.
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Affiliation(s)
- Nihal Gurlek Celik
- Amasya University, Faculty of Medicine, Department of Anatomy – Amasya, Turkey
| | | | | | - Haluk Gumus
- Selçuk University, School of Medicine, Department of Neurology – Konya, Turkey
| | - Hakan Cebeci
- Selçuk University, Department of Radiology – Konya, Turkey
| | - Nadire Unver Dogan
- Selçuk University, School of Medicine, Department of Anatomy – Konya, Turkey
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18
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Middleton DM, Li Y, Chen A, Shinohara R, Fisher J, Krisa L, Elliot M, Faro SH, Woo JH, Flanders AE, Mohamed FB. Harmonization of multi-site diffusion tensor imaging data for cervical and thoracic spinal cord at 1.5 T and 3 T using longitudinal ComBat. Sci Rep 2023; 13:19809. [PMID: 37957164 PMCID: PMC10643628 DOI: 10.1038/s41598-023-46465-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
MRI scanner hardware, field strengths, and sequence parameters are major variables in diffusion studies of the spinal cord. Reliability between scanners is not well known, particularly for the thoracic cord. DTI data was collected for the entire cervical and thoracic spinal cord in thirty healthy adult subjects with different MR vendors and field strengths. DTI metrics were extracted and averaged for all slices within each vertebral level. Metrics were examined for variability and then harmonized using longitudinal ComBat (longComBat). Four scanners were used: Siemens 3 T Prisma, Siemens 1.5 T Avanto, Philips 3 T Ingenia, Philips 1.5 T Achieva. Average full cord diffusion values/standard deviation for all subjects and scanners were FA: 0.63, σ = 0.10, MD: 1.11, σ = 0.12 × 10-3 mm2/s, AD: 1.98, σ = 0.55 × 10-3 mm2/s, RD: 0.67, σ = 0.31 × 10-3 mm2/s. FA metrics averaged for all subjects by level were relatively consistent across scanners, but large variability was found in diffusivity measures. Coefficients of variation were lowest in the cervical region, and relatively lower for FA than diffusivity measures. Harmonized metrics showed greatly improved agreement between scanners. Variability in DTI of the spinal cord arises from scanner hardware differences, pulse sequence differences, physiological motion, and subject compliance. The use of longComBat resulted in large improvement in agreement of all DTI metrics between scanners. This study shows the importance of harmonization of diffusion data in the spinal cord and potential for longitudinal and multisite clinical research and clinical trials.
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Affiliation(s)
- Devon M Middleton
- Department of Radiology, Thomas Jefferson University, 909 Walnut Street, First Floor COB, Philadelphia, PA, 19107, USA.
| | - Yutong Li
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew Chen
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
| | - Russell Shinohara
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
| | | | - Laura Krisa
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Elliot
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott H Faro
- Department of Radiology, Thomas Jefferson University, 909 Walnut Street, First Floor COB, Philadelphia, PA, 19107, USA
| | - John H Woo
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam E Flanders
- Department of Radiology, Thomas Jefferson University, 909 Walnut Street, First Floor COB, Philadelphia, PA, 19107, USA
| | - Feroze B Mohamed
- Department of Radiology, Thomas Jefferson University, 909 Walnut Street, First Floor COB, Philadelphia, PA, 19107, USA
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Davies BM, Banerjee A, Mowforth OD, Kotter MRN, Newcombe VFJ. Is the type and/or co-existence of degenerative spinal pathology associated with the occurrence of degenerative cervical myelopathy? A single centre retrospective analysis of individuals with MRI defined cervical cord compression. J Clin Neurosci 2023; 117:84-90. [PMID: 37783068 DOI: 10.1016/j.jocn.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) arises from spinal degenerative changes injuring the cervical spinal cord. Most cord compression is incidental, referred to as asymptomatic spinal cord compression (ASCC). How and why ASCC differs from DCM is poorly understood. In this paper, we study a local cohort to identify specific types and groups of degenerative pathology more likely associated with DCM than ASCC. METHODS This study was a retrospective cohort analysis (IRB Approval ID: PRN10455). The frequency of degenerative findings between those with ASCC and DCM patients were compared using network analysis, hierarchical clustering, and comparison to existing literature to identify potential subgroups in a local cohort (N = 155) with MRI-defined cervical spinal cord compression. Quantitative measures of spinal cord compression (MSCC and MCC) were used to confirm their relevance. RESULTS ELF (8.7 %, 95 % CI 3.8-13.6 % vs 35.7 %, 95 % CI 27.4-44.0 %) Congenital Stenosis (3.9 %, 95 % CI 0.6-7.3 % vs 25.0 %, 95 % CI 17.5-32.5 %), and OPLL (0.0 %, 95 % CI 0.0-0.0 % vs 3.6 %, 95 % CI 0.3-6.8 %) were more likely in patients with DCM. Comparative network analysis indicated loss of lordosis was associated with ASCC, whilst ELF with DCM. Hierarchical Cluster Analysis indicated four sub-groups: multi-level disc disease with ELF, single-level disc disease without loss of lordosis and OPLL with DCM, and single-level disc disease with loss of lordosis with ASCC. Quantitative measures of cord compression were higher in groups associated with DCM, but similar in patients with single-level disc disease and loss of lordosis. CONCLUSIONS This study identified four subgroups based on degenerative pathology requiring further investigation.
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Affiliation(s)
- Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK.
| | - Arka Banerjee
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Oliver D Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Mark R N Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
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Rios NL, Gilbert KM, Papp D, Cereza G, Foias A, Rangaprakash D, May MW, Guerin B, Wald LL, Keil B, Stockmann JP, Barry RL, Cohen-Adad J. An 8-channel Tx dipole and 20-channel Rx loop coil array for MRI of the cervical spinal cord at 7 Tesla. NMR Biomed 2023; 36:e5002. [PMID: 37439129 PMCID: PMC10733907 DOI: 10.1002/nbm.5002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/10/2023] [Accepted: 06/15/2023] [Indexed: 07/14/2023]
Abstract
The quality of cervical spinal cord images can be improved by the use of tailored radiofrequency (RF) coil solutions for ultrahigh field imaging; however, very few commercial and research 7-T RF coils currently exist for the spinal cord, and in particular, those with parallel transmission (pTx) capabilities. This work presents the design, testing, and validation of a pTx/Rx coil for the human neck and cervical/upper thoracic spinal cord. The pTx portion is composed of eight dipoles to ensure high homogeneity over this large region of the spinal cord. The Rx portion is made up of twenty semiadaptable overlapping loops to produce high signal-to-noise ratio (SNR) across the patient population. The coil housing is designed to facilitate patient positioning and comfort, while also being tight fitting to ensure high sensitivity. We demonstrate RF shimming capabilities to optimize B1 + uniformity, power efficiency, and/or specific absorption rate efficiency. B1 + homogeneity, SNR, and g-factor were evaluated in adult volunteers and demonstrated excellent performance from the occipital lobe down to the T4-T5 level. We compared the proposed coil with two state-of-the-art head and head/neck coils, confirming its superiority in the cervical and upper thoracic regions of the spinal cord. This coil solution therefore provides a convincing platform for producing the high image quality necessary for clinical and research scanning of the upper spinal cord.
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Affiliation(s)
- Nibardo Lopez Rios
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Kyle M. Gilbert
- Centre for Functional and Metabolic Mapping, The University of Western Ontario, London, ON, Canada
| | - Daniel Papp
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Gaspard Cereza
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Alexandru Foias
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - D. Rangaprakash
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Markus W. May
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
- High Field and Hybrid MR Imaging, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastien Guerin
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lawrence L. Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA
| | - Boris Keil
- Institute of Medical Physics and Radiation Protection, University of Applied Sciences Mittelhessen, Giessen, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Jason P. Stockmann
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Robert L. Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
- Mila – Quebec AI Institute, Montreal, QC, Canada
- Centre de recherche du CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
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Zhou Y, Zhu L, Tu P. Embryonal Tumor with Multilayered Rosettes, NOS of Cervical Spinal Cord. Neurol India 2023; 71:1266-1267. [PMID: 38174474 DOI: 10.4103/0028-3886.391338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Yuan Zhou
- Department of Neurosurgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - Lin Zhu
- Department of Neurosurgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - Pin Tu
- Department of Neurosurgery, Jinling Hospital, Nanjing, Jiangsu, China
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Snoussi H, Cohen‐Adad J, Combès B, Bannier É, Tounekti S, Kerbrat A, Barillot C, Caruyer E. Effectiveness of regional diffusion MRI measures in distinguishing multiple sclerosis abnormalities within the cervical spinal cord. Brain Behav 2023; 13:e3159. [PMID: 37775975 PMCID: PMC10636413 DOI: 10.1002/brb3.3159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is an inflammatory disorder of the central nervous system. Although conventional magnetic resonance imaging (MRI) is widely used for MS diagnosis and clinical follow-up, quantitative MRI has the potential to provide valuable intrinsic values of tissue properties that can enhance accuracy. In this study, we investigate the efficacy of diffusion MRI in distinguishing MS lesions within the cervical spinal cord, using a combination of metrics extracted from diffusion tensor imaging and Ball-and-Stick models. METHODS We analyzed spinal cord data acquired from multiple hospitals and extracted average diffusion MRI metrics per vertebral level using a collection of image processing methods and an atlas-based approach. We then performed a statistical analysis to evaluate the feasibility of these metrics for detecting lesions, exploring the usefulness of combining different metrics to improve accuracy. RESULTS Our study demonstrates the sensitivity of each metric to underlying microstructure changes in MS patients. We show that selecting a specific subset of metrics, which provide complementary information, significantly improves the prediction score of lesion presence in the cervical spinal cord. Furthermore, the Ball-and-Stick model has the potential to provide novel information about the microstructure of damaged tissue. CONCLUSION Our results suggest that diffusion measures, particularly combined measures, are sensitive in discriminating abnormal from healthy cervical vertebral levels in patients. This information could aid in improving MS diagnosis and clinical follow-up. Our study highlights the potential of the Ball-and-Stick model in providing additional insights into the microstructure of the damaged tissue.
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Affiliation(s)
- Haykel Snoussi
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, Empenn ERL U 1228, Rennes, FranceUniversité de Rennes, CNRS, Inria, Inserm, IRISA UMR 6074RennesFrance
- Department of RadiologyBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Julien Cohen‐Adad
- NeuroPoly LabInstitute of Biomedical Engineering, Polytechnique MontrealMontrealQuebecCanada
- Functional Neuroimaging UnitCRIUGM, Université de MontréalMontréalQuebecCanada
- Mila – Quebec AI InstituteMontréalQuebecCanada
| | - Benoît Combès
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, Empenn ERL U 1228, Rennes, FranceUniversité de Rennes, CNRS, Inria, Inserm, IRISA UMR 6074RennesFrance
| | - Élise Bannier
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, Empenn ERL U 1228, Rennes, FranceUniversité de Rennes, CNRS, Inria, Inserm, IRISA UMR 6074RennesFrance
- Department of RadiologyRennes University HospitalRennesFrance
| | - Slimane Tounekti
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Anne Kerbrat
- Departement of NeurologyRennes University HospitalRennesFrance
| | - Christian Barillot
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, Empenn ERL U 1228, Rennes, FranceUniversité de Rennes, CNRS, Inria, Inserm, IRISA UMR 6074RennesFrance
| | - Emmanuel Caruyer
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, Empenn ERL U 1228, Rennes, FranceUniversité de Rennes, CNRS, Inria, Inserm, IRISA UMR 6074RennesFrance
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Al-shaari H, J F, R M, CJ H. A systematic review of repeatability and reproducibility studies of diffusion tensor imaging of cervical spinal cord. Br J Radiol 2023; 96:20221019. [PMID: 37751162 PMCID: PMC10607424 DOI: 10.1259/bjr.20221019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/12/2023] [Accepted: 08/10/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES Diffusion tensor imaging (DTI) techniques are being studied as a possible diagnostic and predictive tool for the evaluation of cervical spinal cord disease. This systematic review aims to evaluate the previous DTI studies that specifically investigated the repeatability and reproducibility of DTI in the cervical spinal cord. METHODS AND MATERIALS A search in the PubMed, Scopus, Web of Science and Ovid electronic databases was conducted for articles published between January 1990 and February 2022 that related to the repeatability and reproducibility of DTI in evaluating the cervical spinal cord using one of the following measurements: the intraclass correlation coefficient (ICC) and/or the coefficient of variation (CV), and/or Bland-Altman (BA) differences analysis methods. DTI studies that presented full statistical analysis of repeatability and/or reproducibility tests of the cervical spinal cord in peer-reviewed full-text publications published in journals were included. Articles that included at least one of the keywords within the titles or abstracts were identified. Additional full-text papers were found by searching the citations and reference lists of related articles. This review has followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Risk of bias was evaluated with 13 criteria weighted toward methodological quality of reported studies using the QuADS assessment criteria. This assessment only included full-text articles written in English. RESULTS A total of 11 studies were included and assessed for different characteristics, including sample size,(3-34) re-test time interval (<1 h to >3 months), test-retest reproducibility scores and acquisition method. Six studies used ICC which ranged from poor (ICC<0.37) to excellent reproducibility (ICC 0.91-0.99). Four studies reported an overall CV lower than 40% for all DTI metrics. Three studies reported the Bland-Altman (BA) differences and reported a minimum percentage showing no strong differences between repeated measurements. Quantitative analysis was not undertaken due to heterogeneity of methods. Repeatability and reproducibility measures were generally found to be good. CONCLUSION This study revealed that the application of DTI and its related measures in a clinical setting in the assessment of cervical spinal cord changes is feasible and reproducible. However, cervical spinal cord DTI suffers from some existing limitations that prevent it from being routinely used in research and clinical settings. ADVANCES IN KNOWLEDGE DTI with its parametric maps provide broad evaluation of the tissue structure of axonal white matter and are being studied as a possible diagnostic and predictive tool for the assessment of cervical spinal cord (CSC) disease.
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Affiliation(s)
| | - Fulford J
- Medical Imaging Department, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Meertens R
- Medical Imaging Department, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Heales CJ
- Medical Imaging Department, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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Filimonova E, Vasilenko I, Kubetsky Y, Prokhorov O, Abdaev M, Rzaev J. Brainstem and subcortical regions volume loss in patients with degenerative cervical myelopathy and its association with spinal cord compression severity. Clin Neurol Neurosurg 2023; 233:107943. [PMID: 37634395 DOI: 10.1016/j.clineuro.2023.107943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND In recent years, structural and functional reorganization of the brain and changes in brainstem structural connectivity have been shown in patients with degenerative cervical myelopathy (DCM). We hypothesized that volume loss in the basal ganglia, thalami, and brainstem structures exists and is associated with spinal cord compression severity in patients with DCM. METHODS Forty-seven patients with DCM and 25 patients with cervical radiculopathy were evaluated using cervical spinal cord and brain magnetic resonance imaging (MRI). Brainstem structures, basal ganglia, and thalami volumes were evaluated with FreeSurfer and compared between groups with correction for individual intracranial volume, as well as patient age and sex. Additionally, spinal cord MRI data were analysed with the Spinal Cord Toolbox, and cross-sectional area (CSA) and fractional anisotropy (FA) values were calculated. Correlations between MR-morphometry data and spinal cord structural changes, as well as disease duration, were also evaluated in patients with DCM. RESULTS A statistically significant reduction in the volume of the whole brainstem was revealed in the DCM group compared to the radiculopathy group (p < 0.01, FDR-corrected). Additionally, reductions in medulla oblongata, pons and midbrain volumes were found in patients with DCM (p < 0.01, p < 0.01 and p < 0.05, respectively, FDR-corrected). Additionally, a trend in the loss of volume of the left putamen was found (p = 0.087, FDR-corrected). Furthermore, medulla oblongata volume was correlated with spinal cord compression severity (R = 0.54, adjusted p < 0.001) and white matter damage (R = 0.46, adjusted p < 0.05) in patients with DCM. Negative correlations between the duration of the disease and the severity of spinal cord compression (R = -0.42, adjusted p < 0.05) and white matter damage (R = -0.49, adjusted p < 0.05) were also revealed, as well as a trend toward a negative association between the duration of the disease and the volume of the medulla oblongata (R = -0.35; adjusted p < 0.1). CONCLUSIONS We revealed a reduction in the volume of brainstem structures in patients with DCM compared to patients with radiculopathy. Moreover, we found that these changes are associated with cord compression severity.
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Affiliation(s)
- Elena Filimonova
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia; Novosibirsk State Medical University, Krasny Prospect St. 52, Novosibirsk 630091, Russia.
| | - Ivan Vasilenko
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia
| | - Yulij Kubetsky
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia
| | - Oleg Prokhorov
- Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Pirogov Str. 1, Novosibirsk 630090, Russia
| | - Mars Abdaev
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia
| | - Jamil Rzaev
- Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk 630087, Russia; Novosibirsk State Medical University, Krasny Prospect St. 52, Novosibirsk 630091, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Pirogov Str. 1, Novosibirsk 630090, Russia
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El Mendili MM, Verschueren A, Ranjeva JP, Guye M, Attarian S, Zaaraoui W, Grapperon AM. Association between brain and upper cervical spinal cord atrophy assessed by MRI and disease aggressiveness in amyotrophic lateral sclerosis. Neuroradiology 2023; 65:1395-1403. [PMID: 37458788 DOI: 10.1007/s00234-023-03191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/29/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To study the relative contributions of brain and upper cervical spinal cord compartmental atrophy to disease aggressiveness in amyotrophic lateral sclerosis (ALS). METHODS Twenty-nine ALS patients and 24 age- and gender-matched healthy controls (HC) were recruited. Disease duration and the Revised-ALS Functional Rating Scale (ALSFRS-R) at baseline, 3- and 6-months follow-up were assessed. Patients were clinically differentiated into fast (n=13) and slow (n=16) progressors according to their ALSFRS-R progression rate. Brain grey (GM) and white matter, brainstem sub-structures volumes and spinal cord cross-sectional area (SC-CSA) at C1-C2 vertebral levels were measured from a 3D-T1-weighted MRI. RESULTS Fast progressors showed significant GM, medulla oblongata and SC atrophy compared to HC (p<0.001, p=0.013 and p=0.008) and significant GM atrophy compared to slow progressors (p=0.008). GM volume correlated with the ALSFRS-R progression rate (Rho/p=-0.487/0.007), the ALSFRS-R at 3-months (Rho/p=0.622/0.002), and ALSFRS-R at 6-months (Rho/p=0.407/0.039). Medulla oblongata volume and SC-CSA correlated with the ALSFRS-R at 3-months (Rho/p=0.510/0.015 and Rho/p=0.479/0.024). MRI measures showed high performance to discriminate between fast and slow progressors. CONCLUSION Our study suggests an association between compartmental atrophy and disease aggressiveness. This result is consistent with the combination of upper and lower motor neuron degeneration as the main driver of disease worsening and severity in ALS. Our study highlights the potential of brain and spinal cord atrophy measured by MRI as biomarker of disease aggressiveness signature.
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Affiliation(s)
- Mohamed Mounir El Mendili
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.
- APHM, Hopital de la Timone, CEMEREM, Marseille, France.
- Centre de Résonance Magnétique Biologique et Médicale, CRMBM-CEMEREM, UMR 7339 CNRS - Aix-Marseille Université, 27 Bd Jean Moulin, 13005, Marseille, France.
| | - Annie Verschueren
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- APHM, Hôpital de la Timone, Referral Centre for Neuromuscular Diseases and ALS, Marseille, France
| | - Jean-Philippe Ranjeva
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
| | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
| | - Shahram Attarian
- APHM, Hôpital de la Timone, Referral Centre for Neuromuscular Diseases and ALS, Marseille, France
- Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Wafaa Zaaraoui
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
| | - Aude-Marie Grapperon
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- APHM, Hôpital de la Timone, Referral Centre for Neuromuscular Diseases and ALS, Marseille, France
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Sadeghi-Naini M, Yousefifard M, Ghodsi Z, Azarhomayoun A, Kermanian F, Golpayegani M, Alizadeh SD, Hosseini M, Shokraneh F, Komlakh K, Vaccaro AR, Jiang F, Fehlings MG, Rahimi-Movaghar V. In-hospital mortality rate in subaxial cervical spinal cord injury patients: a systematic review and meta-analysis. Acta Neurochir (Wien) 2023; 165:2675-2688. [PMID: 37480505 DOI: 10.1007/s00701-023-05720-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades. METHODS We searched MEDLINE and EMBASE to assess the role of the following factors on in-hospital mortality over the last four decades: neurological deficit, age, surgical decompression, use of computed tomography (CT) and magnetic resonance imaging (MRI), use of methylprednisolone in the acute post-injury period, and study location (developing versus developed countries). RESULTS Among 3333 papers after deduplication, 21 studies met the eligibility criteria. The mortality rate was 17.88% [95% confidence interval (CI): 12.9-22.87%]. No significant trend in mortality rate was observed over the 42-year period (meta-regression coefficient = 0.317; p = 0.372). Subgroup analysis revealed no significant association between acute subaxial cervical SCI-related mortality when stratified by use of surgery, administration of methylprednisolone, use of MRI and CT imaging, study design (prospective versus retrospective study), and study location. The mortality rate was significantly higher in complete SCI (20.66%, p = 0.002) and American Spinal Injury Association impairment scale (AIS) A (20.57%) and B (9.28%) (p = 0.028). CONCLUSION A very low level of evidence showed that in-hospital mortality in patients with traumatic subaxial cervical SCI did not decrease over the last four decades despite diagnostic and therapeutic advancements. The overall acute mortality rate following subaxial cervical SCI is 17.88%. We recommend reporting a stratified mortality rate according to key factors such as treatment paradigms, age, and severity of injury in future studies.
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Affiliation(s)
- Mohsen Sadeghi-Naini
- Department of Neurosurgery, Lorestan University of Medical Sciences, Khoram-Abad, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Amir Azarhomayoun
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kermanian
- Department of Anatomy, Alborz University of Medical Sciences, Karaj, Iran
| | - Mehdi Golpayegani
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Seyed Danial Alizadeh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran
- Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shokraneh
- King's Technology Evaluation Centre (KiTEC), School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, London Institute of Healthcare Engineering, King's College London, London, UK
| | - Khalil Komlakh
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alexander R Vaccaro
- Department of Orthopedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA, USA
| | - Fan Jiang
- Department of Surgery and Spine Program, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Michael G Fehlings
- Department of Surgery, University of Toronto, Toronto, Canada
- Krembil Brain Institute and McEwen Centre for Regenerative Medicine, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran.
- Visiting Professor, Spine Program, University of Toronto, Toronto, Canada.
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, Tehran, 11365-3876, Iran.
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Testud B, Fabiani N, Demortière S, Mchinda S, Medina NL, Pelletier J, Guye M, Audoin B, Stellmann JP, Callot V. Contribution of the MP2RAGE 7T Sequence in MS Lesions of the Cervical Spinal Cord. AJNR Am J Neuroradiol 2023; 44:1101-1107. [PMID: 37562829 PMCID: PMC10494945 DOI: 10.3174/ajnr.a7964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND PURPOSE The detection of spinal cord lesions in patients with MS is challenging. Recently, the 3D MP2RAGE sequence demonstrated its usefulness at 3T. Benefiting from the high spatial resolution provided by ultra-high-field MR imaging systems, we aimed to evaluate the contribution of the 3D MP2RAGE sequence acquired at 7T for the detection of MS lesions in the cervical spine. MATERIALS AND METHODS Seventeen patients with MS participated in this study. They were examined at both 3T and 7T. The MR imaging examination included a Magnetic Imaging in MS (MAGNIMS) protocol with an axial T2*-WI gradient recalled-echo sequence ("optimized MAGNIMS protocol") and a 0.9-mm isotropic 3D MP2RAGE sequence at 3T, as well as a 0.7-mm isotropic and 0.3-mm in-plane-resolution anisotropic 3D MP2RAGE sequences at 7T. Each data set was read by a consensus of radiologists, neurologists, and neuroscientists. The number of lesions and their topography, as well as the visibility of the lesions from one set to another, were carefully analyzed. RESULTS A total of 55 lesions were detected. The absolute number of visible lesions differed among the 4 sequences (linear mixed effect ANOVA, P = .020). The highest detection was observed for the two 7T sequences with 51 lesions each (92.7% of the total). The optimized 3T MAGNIMS protocol and the 3T MP2RAGE isotropic sequence detected 41 (74.5%) and 35 lesions (63.6%), respectively. CONCLUSIONS The 7T MP2RAGE sequences detected more lesions than the 3T sets. Isotropic and anisotropic acquisitions performed comparably. Ultra-high-resolution sequences obtained at 7T improve the identification and delineation of lesions of the cervical spinal cord in MS.
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Affiliation(s)
- B Testud
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - N Fabiani
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - S Demortière
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
- Department of Neurology (S.D., J.P., B.A.), Assistance Publique-Hopitaux de Marseille, Hôpital Universitaire Timone, Marseille, France
| | - S Mchinda
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - N L Medina
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - J Pelletier
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
- Department of Neurology (S.D., J.P., B.A.), Assistance Publique-Hopitaux de Marseille, Hôpital Universitaire Timone, Marseille, France
| | - M Guye
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - B Audoin
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
- Department of Neurology (S.D., J.P., B.A.), Assistance Publique-Hopitaux de Marseille, Hôpital Universitaire Timone, Marseille, France
| | - J P Stellmann
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - V Callot
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
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28
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Bian B, Zhou B, Shao Z, Zhu X, Jie Y, Li D. Feasibility of diffusion kurtosis imaging in evaluating cervical spinal cord injury in multiple sclerosis. Medicine (Baltimore) 2023; 102:e34205. [PMID: 37478237 PMCID: PMC10662919 DOI: 10.1097/md.0000000000034205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/14/2023] [Indexed: 07/23/2023] Open
Abstract
This research aimed to assess gray matter (GM), white matter (WM), lesions of multiple sclerosis (MS) and the therapeutic effect using diffusion kurtosis imaging (DKI). From January 2018 to October 2019, 78 subjects (48 of MS and 30 of health) perform routine MR scan and DKI of cervical spinal cord. The MS patients were divided into 2 groups according to the presence or absence of T2 hyperintensity. DKI-metrics were measured in the lesions, normal-appearing GM and WM. Significant differences were detected in DKI metrics between MS and healthy (P < .05) and between patients with cervical spinal cord T2-hyperintense and without T2-hyperintense (P < .001). Compared to healthy, GM-mean kurtosis (MK), GM-radial kurtosis, and WM-fractional anisotropy, WM-axial diffusion were statistically reduced in patients without T2-hyperintense (P < .05). Significant differences were observed in DKI metrics between patients with T2-hyperintense after therapy (P < .05), as well as GM-MK and WM-fractional anisotropy, WM-axial diffusion in patients without T2-hyperintense (P < .05); Expanded Disability Status Scale was correlated with MK values, as well as Expanded Disability Status Scale scores and MK values after therapy. Our results indicate that DKI-metrics can detect and quantitatively evaluate the changes in cervical spinal cord micropathological structure.
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Affiliation(s)
- BingYang Bian
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - BoXu Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - ZhiQing Shao
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - XiaoNa Zhu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - YiGe Jie
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Dan Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
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29
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Yang Y, Wang Q, Zhang S, Li J, Tang Y. Unilateral upper cervical cord infarction in Opalski's syndrome caused by spontaneous vertebral artery dissection. Clin Med (Lond) 2023; 23:425-426. [PMID: 38614662 PMCID: PMC10541047 DOI: 10.7861/clinmed.2023-0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
We report a case of a man with concurrent unilateral upper cervical cord infarction in Opalski's syndrome due to spontaneous vertebral artery dissection.
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Affiliation(s)
- Yi Yang
- Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | | | - Shanshan Zhang
- Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Jinmei Li
- West China Hospital, Sichuan University, Chengdu, China
| | - Yufeng Tang
- Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China.
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30
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Feldman KW, Wright JN, Menashe SJ, Otjen JP, Pidaparti V. Symptomatic Cervical Spinal Cord Injury Without Accompanying Intracranial Injury Because of Child Abuse. Pediatr Emerg Care 2023; 39:371-373. [PMID: 35413043 DOI: 10.1097/pec.0000000000002696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although spinal ligamentous injuries and extra-axial hemorrhages are known to commonly accompany abusive head trauma (AHT), symptomatic and radiological apparent cervical spinal cord injuries are rare. Of the 16 previously reported cases, 3 such cord injuries lacked the accompanying intracranial injuries of AHT. We report an additional child who developed symptomatic central cervical cord syndrome, with accompanying cervical imaging findings, but no intracranial AHT injuries. The mechanism of trauma for this child and the other children without intracranial injury remains unclear. However, 1 additional reported child sustained similar injuries when she was held by her head and shaken. It is likely that as cervical magnetic resonance imaging becomes more common in AHT, more cases will be recognized.
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31
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Trolle C, Goldberg E, Linnman C. Spinal cord atrophy after spinal cord injury - A systematic review and meta-analysis. Neuroimage Clin 2023; 38:103372. [PMID: 36931004 PMCID: PMC10026037 DOI: 10.1016/j.nicl.2023.103372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/12/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023]
Abstract
Cervical spinal cord atrophy occurs after spinal cord injury. The atrophy and how level of injury affects atrophy differs between studies. A systematic review and metaanalysis were done after systematic searches of PubMed, CINAHL, APA PsycInfo and Web of Science. English language original studies analyzing MRI cervical spinal cord cross-sectional area in adults with spinal cord injury were included. Atrophy and correlation between injury level and atrophy were estimated with random-effects models, standardized mean differences, and 95% confidence intervals. 24 studies were identified. 13/24 studies had low risk of bias. Cord atrophy meta-analysis of 18 articles corresponded to a standardized mean difference of -1.48 (95% CI -1.78 to -1.19) with moderate to large interstudy heterogeneity. Logarithmic time since injury influenced heterogeneity. Longitudinal atrophy was best described by a logarithmic model, indicating that rate of spinal atrophy decreases over time. Meta-correlation of eight studies indicated more severe atrophy in more rostral injuries (0.41, 95% CI 0.20-0.59). Larger and preferably longitudinal studies, data sharing, and standardized protocols are warranted.
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Affiliation(s)
- Carl Trolle
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Department of Medical Sciences, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden.
| | - Estee Goldberg
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Clas Linnman
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
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32
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Schilling KG, Fadnavis S, Batson J, Visagie M, Combes AJE, By S, McKnight CD, Bagnato F, Garyfallidis E, Landman BA, Smith SA, O'Grady KP. Denoising of diffusion MRI in the cervical spinal cord - effects of denoising strategy and acquisition on intra-cord contrast, signal modeling, and feature conspicuity. Neuroimage 2023; 266:119826. [PMID: 36543265 PMCID: PMC9843739 DOI: 10.1016/j.neuroimage.2022.119826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/02/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Quantitative diffusion MRI (dMRI) is a promising technique for evaluating the spinal cord in health and disease. However, low signal-to-noise ratio (SNR) can impede interpretation and quantification of these images. The purpose of this study is to evaluate several dMRI denoising approaches on their ability to improve the quality, reliability, and accuracy of quantitative diffusion MRI of the spinal cord. We evaluate three denoising approaches (Non-Local Means, Marchenko-Pastur PCA, and a newly proposed Patch2Self algorithm) and conduct five experiments to validate the denoising performance on clinical-quality and commonly-acquired dMRI acquisitions: 1) a phantom experiment to assess denoising error and bias; 2) a multi-vendor, multi-acquisition open experiment for both qualitative and quantitative evaluation of noise residuals; 3) a bootstrapping experiment to estimate uncertainty of parametric maps; 4) an assessment of spinal cord lesion conspicuity in a multiple sclerosis group; and 5) an evaluation of denoising for advanced parametric multi-compartment modeling. We find that all methods improve signal-to-noise ratio and conspicuity of MS lesions in individual diffusion weighted images (DWIs), but MPPCA and Patch2Self excel at improving the quality and intra-cord contrast of diffusion weighted images - removing signal fluctuations due to thermal noise while improving precision of estimation of diffusion parameters even with very few DWIs (i.e., 16-32) typical of clinical acquisitions. These denoising approaches hold promise for facilitating reliable diffusion observations and measurements in the spinal cord to investigate biological and pathological processes.
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Affiliation(s)
- Kurt G Schilling
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Shreyas Fadnavis
- Department of Intelligent Systems Engineering, Indiana University Bloomington, Bloomington, IN, United States
| | - Joshua Batson
- The Public Health Company, California, United States
| | - Mereze Visagie
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anna J E Combes
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Samantha By
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States
| | - Colin D McKnight
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Francesca Bagnato
- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Neurology, VA Hospital, TN Valley Healthcare System, Nashville, TN, United States
| | - Eleftherios Garyfallidis
- Department of Intelligent Systems Engineering, Indiana University Bloomington, Bloomington, IN, United States
| | - Bennett A Landman
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States; Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, United States
| | - Seth A Smith
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States
| | - Kristin P O'Grady
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States.
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Seifert AC, Xu J. Impact of autocalibration method on accelerated EPI of the cervical spinal cord at 7 T. Magn Reson Med 2022; 88:2583-2591. [PMID: 36000559 PMCID: PMC9529816 DOI: 10.1002/mrm.29415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/14/2022] [Accepted: 07/27/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The spinal cord contains sensorimotor neural circuits of scientific and clinical interest. However, spinal cord functional MRI (fMRI) is significantly more technically demanding than brain fMRI, due primarily to its proximity to the lungs. Accelerated echo-planar imaging (EPI) at 7 T is particularly vulnerable to k-space phase inconsistencies induced by motion or B0 fluctuation, during either autocalibration signal (ACS) or time-series acquisition. For 7 T brain fMRI, sensitivity to motion and B0 fluctuation can be reduced using a re-ordered segmented EPI ACS based on the fast low-angle excitation echo-planar technique (FLEET). However, respiration-induced B0 fluctuations (exceeding 100 Hz at C7) are greater, and fewer k-space lines per slice are required for cervical spinal cord fMRI at 7 T, necessitating a separate evaluation of ACS methods. METHODS We compared 24-line single-shot EPI with 48-line two-shot segmented EPI, two-shot FLEET, and gradient echo (GRE)-based ACS acquisition methods, performed under various physiological conditions, in terms of temporal signal-to-noise ratio and prevalence of artifacts in generalized autocalibrating partially parallel acquisition (GRAPPA)-accelerated EPI of the cervical spinal cord at 7 T. RESULTS Segmented EPI and FLEET ACS produce images with nearly identical patterns of severe image artifacts. GRE and single-shot EPI ACS consistently produce images free from significant artifacts, and temporal signal-to-noise ratio is significantly greater for GRE ACS, particularly in lower slices where through-slice dephasing is most severe. CONCLUSIONS GRE and single-shot EPI-ACS acquisition methods, which are robust to respiration-induced phase errors between k-space segments, produce images with fewer and less severe artifacts than either FLEET or conventionally segmented EPI for accelerated EPI of the cervical spinal cord at 7 T.
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Affiliation(s)
- Alan C. Seifert
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Junqian Xu
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY USA
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Bueno A, Bosch I, Rodríguez A, Jiménez A, Carreres J, Fernández M, Marti-Bonmati L, Alberich-Bayarri A. Automated Cervical Spinal Cord Segmentation in Real-World MRI of Multiple Sclerosis Patients by Optimized Hybrid Residual Attention-Aware Convolutional Neural Networks. J Digit Imaging 2022; 35:1131-1142. [PMID: 35789447 PMCID: PMC9582086 DOI: 10.1007/s10278-022-00637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 03/22/2022] [Accepted: 04/09/2022] [Indexed: 10/17/2022] Open
Abstract
Magnetic resonance (MR) imaging is the most sensitive clinical tool in the diagnosis and monitoring of multiple sclerosis (MS) alterations. Spinal cord evaluation has gained interest in this clinical scenario in recent years, but, unlike the brain, there is a more limited choice of algorithms to assist spinal cord segmentation. Our goal was to investigate and develop an automatic MR cervical cord segmentation method, enabling automated and seamless spinal cord atrophy assessment and setting the stage for the development of an aggregated algorithm for the extraction of lesion-related imaging biomarkers. The algorithm was developed using a real-world MR imaging dataset of 121 MS patients (96 cases used as a training dataset and 25 cases as a validation dataset). Transversal, 3D T1-weighted gradient echo MR images (TE/TR/FA = 1.7-2.7 ms/5.6-8.2 ms/12°) were acquired in a 3 T system (Signa HD, GEHC) as standard of care in our clinical practice. Experienced radiologists supervised the manual labelling, which was considered the ground-truth. The 2D convolutional neural network consisted of a hybrid residual attention-aware segmentation method trained to delineate the cervical spinal cord. The training was conducted using a focal loss function, based on the Tversky index to address label imbalance, and an automatic optimal learning rate finder. Our automated model provided an accurate segmentation, achieving a validation DICE coefficient of 0.904 ± 0.101 compared with the manual delineation. An automatic method for cervical spinal cord segmentation on T1-weighted MR images was successfully implemented. It will have direct implications serving as the first step for accelerating the process for MS staging and follow-up through imaging biomarkers.
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Affiliation(s)
- América Bueno
- Instituto de Tecnologías y Aplicaciones Multimedia, Universitat Politècnica de Valencia, Valencia, Spain.
| | - Ignacio Bosch
- Instituto de Tecnologías y Aplicaciones Multimedia, Universitat Politècnica de Valencia, Valencia, Spain
| | - Alejandro Rodríguez
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Ana Jiménez
- Quantitative Imaging Biomarkers in Medicine, QUIBIM S.L, Valencia, Spain
| | - Joan Carreres
- Radiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Matías Fernández
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Luis Marti-Bonmati
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Imaging La Fe node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), Valencia, Spain
| | - Angel Alberich-Bayarri
- Biomedical Imaging Research Group (GIBI230), Hospital Universitario y Politécnico e Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Quantitative Imaging Biomarkers in Medicine, QUIBIM S.L, Valencia, Spain
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35
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Franz S, Eck U, Schuld C, Heutehaus L, Wolf M, Wilder-Smith E, Schulte-Mattler W, Weber MA, Rupp R, Weidner N. Lower motoneuron dysfunction impacts spontaneous motor recovery in acute cervical spinal cord injury. J Neurotrauma 2022; 40:862-875. [PMID: 36006372 PMCID: PMC10162119 DOI: 10.1089/neu.2022.0181] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Paresis after spinal cord injury is caused by damage to upper and lower motoneurons and may differentially impact neurological recovery. This prospective monocentric longitudinal observational study investigated the extent and severity of lower motoneuron dysfunction and its impact on upper extremity motor recovery after acute cervical spinal cord injury. Pathological spontaneous activity at rest and/or increased discharge rates of motor unit action potentials recorded by needle electromyography (EMG) were taken as parameters for lower motoneuron dysfunction and its relation to the extent of myelopathy in the first available spine MRI was determined. Motor recovery was assessed by standardized neurological examination within the first 4 weeks (acute stage) and up to 1 year (chronic stage) after injury. Eighty-five muscles of 17 individuals with cervical spinal cord injury (neurological level of injury from C1 to C7) and a median age of 54 (28-59) were examined. The results showed that muscles with signs of lower motoneuron dysfunction peaked at the lesion center (Χ²[2,n=85]=6.6, p=0.04) and that the severity of lower motoneuron dysfunction correlated with T2-weighted hyperintense MRI signal changes in routine spine MRI at the lesion site (spearman ρ=0.31, p=0.01). Muscles exhibiting signs of lower motoneuron dysfunction, as indicated by pathological spontaneous activity at rest and/or increased discharge rates of motor unit action potentials, were associated with more severe paresis in both the acute and chronic stages after spinal cord injury (spearman ρ acute=-0.22, p=0.04 and chronic=-0.31, p=0.004). Moreover, the severity of lower motoneuron dysfunction in the acute stage was also associated with a greater degree of paresis (spearman ρ acute=-0.24, p=0.03 and chronic=-0.35, p=0.001). While both muscles with and without signs of lower motoneuron dysfunction were capable of regaining strength over time, those without lower motoneuron dysfunctions had a higher potential to reach full strength. Muscles with signs of lower motoneuron dysfunction in the acute stage displayed increased amplitudes of motor unit action potentials with chronic-stage needle EMG, indicating reinnervation through peripheral collateral sprouting as compensatory mechanism (Χ²[1,n=72]=4.3, p=0.04). Thus, lower motoneuron dysfunction represents a relevant factor contributing to motor impairment and recovery in acute cervical spinal cord injury. Defined recovery mechanisms (peripheral reinnervation) may at least partially underlie spontaneous recovery in respective muscles. Therefore, assessment of lower motoneuron dysfunction could help refine prediction of motor recovery following spinal cord injury.
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Affiliation(s)
- Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
- Address correspondence to: Steffen Franz, MD, Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Ute Eck
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Laura Heutehaus
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcel Wolf
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Einar Wilder-Smith
- Department of Neurology, Kantonsspital Lucerne, Lucerne, Switzerland
- Department of Neurology, Inselspital Bern, University of Bern, Bern, Switzerland
| | | | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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36
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Liang S, Yang F, Zhang Y, Zhao H, Wang X. Changes and clinical correlation of diffusion tensor imaging parameters of compressed spinal cord and nerve root in patients with cervical spondylosis. BMC Med Imaging 2022; 22:107. [PMID: 35659198 PMCID: PMC9166510 DOI: 10.1186/s12880-022-00835-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) was used to quantitatively study the characteristics of the related spinal cord and nerve root compression parameters in patients with cervical spondylosis (CS), and diffusion tensor tractography (DTT) was used to visualize the spinal cord and nerve root and analyze their relevance to clinical evaluation. METHODS A total of 67 patients with CS and 30 healthy volunteers received 3.0 T magnetic resonance imaging. Cervical DTI and DTT were performed in all the participants, where the b value of DTI was set at 800 s/mm2. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the spinal cord and cervical nerve roots were measured by using DTI. Patients with CS were scored according to the modified Japanese Orthopedic Association (mJOA) score. RESULTS In all the participants, the spinal cord and cervical nerve roots were clearly visible by DTT. Compared to the healthy volunteers, the FA values were significantly decreased and ADC values were significantly increased in patients with CS. mJOA score was significantly correlated with the DTI index (ADC and FA) values. Receiver operator characteristic curve analysis revealed that FA and ADC could identify mild, moderate, and severe CS. CONCLUSIONS DTI parameters of cervical spinal cord and nerve root compression are associated with the clinical evaluation of patients with CS and may be helpful in assessing the severity of CS.
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Affiliation(s)
- Shuo Liang
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Feng Yang
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China.
| | - Yang Zhang
- Department of Spine Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China.
| | - Huiyu Zhao
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Xinyue Wang
- Department of Radiology, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
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37
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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38
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Joshi K, Kirby A, Niu J, VanderHorst V. Stereotaxic Surgical Approach to Microinject the Caudal Brainstem and Upper Cervical Spinal Cord via the Cisterna Magna in Mice. J Vis Exp 2022:10.3791/63344. [PMID: 35129178 PMCID: PMC9092805 DOI: 10.3791/63344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Stereotaxic surgery to target brain sites in mice is commonly guided by skull landmarks. Access is then obtained via burr holes drilled through the skull. This standard approach can be challenging for targets in the caudal brainstem and upper cervical cord due to specific anatomical challenges as these sites are remote from skull landmarks, leading to imprecision. Here we outline an alternative stereotaxic approach via the cisterna magna that has been used to target discrete regions of interest in the caudal brainstem and upper cervical cord. The cisterna magna extends from the occipital bone to the atlas (i.e., the second vertebral bone), is filled with cerebrospinal fluid, and is covered by dura mater. This approach provides a reproducible route of access to select central nervous system (CNS) structures that are otherwise hard to reach due to anatomical barriers. Furthermore, it allows for direct visualization of brainstem landmarks in close proximity to the target sites, increasing accuracy when delivering small injection volumes to restricted regions of interest in the caudal brainstem and upper cervical cord. Finally, this approach provides an opportunity to avoid the cerebellum, which can be important for motor and sensorimotor studies.
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Affiliation(s)
- Krutika Joshi
- Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Alana Kirby
- Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Jianguo Niu
- Beth Israel Deaconess Medical Center, Harvard Medical School
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39
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Collins R, Lafford G, Parry L. Paralysis from an ear infection: a severe case of otitis externa leading to acute complete cervical cord syndrome. BMJ Case Rep 2021; 14:e245594. [PMID: 34853046 PMCID: PMC8638130 DOI: 10.1136/bcr-2021-245594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
We report a case of a generally fit and well 54-year-old man who presented with a 2-day history of worsening left-sided otorrhea, headache, neck stiffness, vomiting and fever on the background of a 7-week history of otitis externa (OE). His condition progressed dramatically as he developed symptoms consistent with acute complete cervical cord syndrome with radiological evidence of skull base osteomyelitis, parapharyngeal, retropharyngeal and paravertebral abscesses and sigmoid sinus thrombus. Ultimately, he made a significant, although not complete, recovery. This case is unique in demonstrating how OE can develop into a potentially life threatening condition. It emphasises the importance of early diagnosis and treatment of OE, the recognition of 'red flag' symptoms and highlights the importance of a multidisciplinary team approach when managing complex complications of OE.
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Affiliation(s)
- Rachael Collins
- Norwich Medical School, University of East Anglia Norwich Medical School, Norwich, UK
- Department of Otolaryngology, Norfolk and Norwich University Hospital, Norwich, UK
| | - George Lafford
- Department of Plastic Surgery, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Laura Parry
- Department of Ear, Nose and Throat, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
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40
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Murphy SA, Furger R, Kurpad SN, Arpinar VE, Nencka A, Koch K, Budde MD. Filtered Diffusion-Weighted MRI of the Human Cervical Spinal Cord: Feasibility and Application to Traumatic Spinal Cord Injury. AJNR Am J Neuroradiol 2021; 42:2101-2106. [PMID: 34620590 DOI: 10.3174/ajnr.a7295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/07/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In traumatic spinal cord injury, DTI is sensitive to injury but is unable to differentiate multiple pathologies. Axonal damage is a central feature of the underlying cord injury, but prominent edema confounds its detection. The purpose of this study was to examine a filtered DWI technique in patients with acute spinal cord injury. MATERIALS AND METHODS The MR imaging protocol was first evaluated in a cohort of healthy subjects at 3T (n = 3). Subsequently, patients with acute cervical spinal cord injury (n = 8) underwent filtered DWI concurrent with their acute clinical MR imaging examination <24 hours postinjury at 1.5T. DTI was obtained with 25 directions at a b-value of 800 s/mm2. Filtered DWI used spinal cord-optimized diffusion-weighting along 26 directions with a "filter" b-value of 2000 s/mm2 and a "probe" maximum b-value of 1000 s/mm2. Parallel diffusivity metrics obtained from DTI and filtered DWI were compared. RESULTS The high-strength diffusion-weighting perpendicular to the cord suppressed signals from tissues outside of the spinal cord, including muscle and CSF. The parallel ADC acquired from filtered DWI at the level of injury relative to the most cranial region showed a greater decrease (38.71%) compared with the decrease in axial diffusivity acquired by DTI (17.68%). CONCLUSIONS The results demonstrated that filtered DWI is feasible in the acute setting of spinal cord injury and reveals spinal cord diffusion characteristics not evident with conventional DTI.
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Affiliation(s)
- S A Murphy
- From the Department of Neurosurgery (S.A.M., R.F., S.N.K., M.D.B.)
| | - R Furger
- From the Department of Neurosurgery (S.A.M., R.F., S.N.K., M.D.B.)
- Center for Neurotrauma Research (R.F., S.N.K., M.D.B.)
| | - S N Kurpad
- From the Department of Neurosurgery (S.A.M., R.F., S.N.K., M.D.B.)
- Center for Neurotrauma Research (R.F., S.N.K., M.D.B.)
| | - V E Arpinar
- Center for Imaging Research (V.E.A., A.N., K.K.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - A Nencka
- Center for Imaging Research (V.E.A., A.N., K.K.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - K Koch
- Center for Imaging Research (V.E.A., A.N., K.K.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - M D Budde
- From the Department of Neurosurgery (S.A.M., R.F., S.N.K., M.D.B.)
- Center for Neurotrauma Research (R.F., S.N.K., M.D.B.)
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41
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Weber CE, Krämer J, Wittayer M, Gregori J, Randoll S, Weiler F, Heldmann S, Roßmanith C, Platten M, Gass A, Eisele P. Association of iron rim lesions with brain and cervical cord volume in relapsing multiple sclerosis. Eur Radiol 2021; 32:2012-2022. [PMID: 34549326 PMCID: PMC8831268 DOI: 10.1007/s00330-021-08233-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/22/2021] [Accepted: 07/22/2021] [Indexed: 10/28/2022]
Abstract
OBJECTIVES In multiple sclerosis (MS), iron rim lesions (IRLs) are indicators of chronic low-grade inflammation and ongoing tissue destruction. The aim of this study was to assess the relationship of IRLs with clinical measures and magnetic resonance imaging (MRI) markers, in particular brain and cervical cord volume. METHODS Clinical and MRI parameters from 102 relapsing MS patients (no relapses for at least 6 months, no contrast-enhancing lesions) were included; follow-up data obtained after 12 months was available in 49 patients. IRLs were identified on susceptibility-weighted images (SWIs). In addition to standard brain and spinal cord MRI parameters, normalised cross-sectional area (nCSA) of the upper cervical cord was calculated. RESULTS Thirty-eight patients had at least one IRL on SWI MRI. At baseline, patients with IRLs had higher EDSS scores, higher lesion loads (brain and spinal cord), and lower cortical grey matter volumes and a lower nCSA. At follow-up, brain atrophy rates were higher in patients with IRLs. IRLs correlated spatially with T1-hypointense lesions. CONCLUSIONS Relapsing MS patients with IRLs showed more aggressive MRI disease characteristics in both the cross-sectional and longitudinal analyses. KEY POINTS • Multiple sclerosis patients with iron rim lesions had higher EDSS scores, higher brain and spinal cord lesion loads, lower cortical grey matter volumes, and a lower normalised cross-sectional area of the upper cervical spinal cord. • Iron rim lesions are a new lesion descriptor obtained from susceptibility-weighted MRI. Our data suggests that further exploration of this lesion characteristic in regard to a poorer prognosis in multiple sclerosis patients is warranted.
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Affiliation(s)
- Claudia E Weber
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | - Julia Krämer
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1; Gebäude A1, Westturm, Ebene 5, 48149, Münster, Germany
| | - Matthias Wittayer
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | | | - Sigurd Randoll
- Mediri GmbH, Eppelheimer Straße 113, 69115, Heidelberg, Germany
| | | | | | - Christina Roßmanith
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany.
| | - Philipp Eisele
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
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Hirai T, Otani K, Sekiguchi M, Kikuchi SI, Konno SI. Epidemiological study of cervical cord compression and its clinical symptoms in community-dwelling residents. PLoS One 2021; 16:e0256732. [PMID: 34449818 PMCID: PMC8396744 DOI: 10.1371/journal.pone.0256732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 08/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Degenerative compressive myelopathy (DCM) is caused by cervical cord compression. The relationship between the magnitude and clinical findings of cervical cord compression has been described in the literature, but the details remain unclear. This study aimed to clarify the relationship between the magnitude and clinical symptoms of cervical cord compression in community-dwelling residents. METHODS The present study included 532 subjects. The subjective symptoms and the objective findings of one board-certified spine surgeon were assessed. The subjective symptoms were upper extremity pain and numbness, clumsy hand, fall in the past 1 year, and subjective gait disturbance. The objective findings were: Hoffmann, Trömner, and Wartenberg signs; Babinski's and Chaddock's signs; hyperreflexia of the patellar tendon and Achilles tendon reflexes; ankle clonus; Romberg and modified Romberg tests; grip and release test; finger escape sign; and grip strength. Using midsagittal T2-weighted magnetic resonance imaging, the anterior-posterior (AP) diameters (mm) of the spinal cord at the C2 midvertebral body level (DC2) and at each intervertebral disc level from C2/3 to C7/T1 (DC2/3-C7/T1) were measured. The spinal cord compression ratio (R) for each intervertebral disc level was defined and calculated as DC2/3-C7/T1 divided by DC2. The lowest R (LR) along C2/3 to C7/T1 of each individual was divided into 3 grades by the tertile method. The relationship between LR and clinical symptoms was investigated by trend analysis. RESULTS The prevalence of subjective gait disturbance increased significantly with the severity of spinal cord compression (p = 0.002812), whereas the other clinical symptoms were not significantly related with the severity of spinal cord compression. CONCLUSIONS The magnitude of cervical cord compression had no relationship with any of the neurologic findings. However, subjective gait disturbance might be a better indicator of the possibility of early stage cervical cord compression.
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Affiliation(s)
- Toru Hirai
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shin-ichi Kikuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shin-ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Watanabe Y, Tamura T, Imai R, Maruyama K, Iizuka M, Ohashi S, Yamaguchi S, Watanabe T. High-flow nasal cannula oxygen therapy was effective for dysphagia associated with respiratory muscle paralysis due to cervical spinal cord injury: A case report. Medicine (Baltimore) 2021; 100:e26907. [PMID: 34397924 PMCID: PMC8360423 DOI: 10.1097/md.0000000000026907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Respiratory muscle paralysis due to low cervical spinal cord injury (CSCI) can lead to dysphagia. Noninvasive positive airway pressure (PAP) therapy can effectively treat this type of dysphagia. High-flow nasal cannula (HFNC) oxygen therapy can generate a low level of positive airway pressure resembling PAP therapy, it may improve the dysphagia. PATIENT CONCERNS The patient was an 87-year-old man without preexisting dysphagia. He suffered a CSCI due to a dislocated C5/6 fracture, without brain injury, and underwent emergency surgery. Postoperatively (day 2), he complained of dysphagia, and the intervention was initiated. DIAGNOSIS Based on clinical findings, dysphagia in this case, may have arisen due to impaired coordination between breathing and swallowing, which typically occurs in patients with CSCI who have reduced forced vital capacity. INTERVENTIONS HFNC oxygen therapy was started immediately after the surgery, and swallowing rehabilitation was started on Day 2. Indirect therapy (without food) and direct therapy (with food) were applied in stages. HFNC oxygen therapy appeared to be effective because swallowing function temporarily decreased when the HFNC oxygen therapy was changed to nasal canula oxygen therapy. OUTCOMES Swallowing function of the patient improved and he did not develop aspiration pneumonia. LESSONS HFNC oxygen therapy improved swallowing function in a patient with dysphagia associated with respiratory-muscle paralysis following a CSCI. It may have prolonged the apnea tolerance time during swallowing and may have improved the timing of swallowing. HFNC oxygen therapy can facilitate both indirect and direct early swallowing therapy to restore both swallowing and respiratory function.
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Affiliation(s)
- Yoshihiro Watanabe
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Toshiaki Tamura
- Department of Speech, Language, and Hearing Sciences, Niigata University of Health and Welfare, Niigata Prefecture, Japan
| | - Ryota Imai
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Koki Maruyama
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Mayumi Iizuka
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Satomi Ohashi
- Department of Emergency and Critical Care, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Seigo Yamaguchi
- Department of Emergency and Critical Care, Uonuma Kikan Hospital, Niigata Prefecture, Japan
| | - Tatsunori Watanabe
- Department of Anesthesiology, Uonuma Kikan Hospital, Niigata Prefecture, Japan
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Diaz A, Burks SS, Fisher R, Levi AD. Posterior Surgical Approach for Ventral Cervical Spinal Cord Herniation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E215-E216. [PMID: 33372993 DOI: 10.1093/ons/opaa340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
Spinal cord herniation (SCH) is a rare condition that is typically of idiopathic origin. Although SCH is mostly found in the thoracic region because of a dural defect, there are some reports of cervical SCH following surgery or trauma.1-3 Spinal cord tethering can be a result of SCH or as a standalone issue.4,5 These conditions can lead to progressive neurological deficits, including numbness, gait disturbances, and decreased muscle strength, requiring surgical correction. There are limited reports of surgical procedures for ventral SCHs. Several reports exist using a ventral approach for intradural tumors, but it is not commonly employed because of the inability to obtain adequate dural closure.6 Much of the literature on SCH comes from idiopathic and congenital cases in the thoracic spine.7,8 Posterior and posterolateral approaches for a ventral thoracic SCH have been described, as well as an anterior approach for a ventral cervical SCH.9-12 In this video, we describe a posterior approach for a ventral cervical SCH. A 38-yr-old male presented with progressive cervical myelopathy 9 yr after a C2-C3 schwannoma resection requiring an anterior approach and corpectomy of C3 with partial corpectomies of C2 and C4. A preoperative magnetic resonance imaging showed a ventrally herniated spinal cord at the top of the C3 vertebral body and below the C4 vertebral body. Informed consent was obtained. The posterior surgical approach involved a C1-C5 laminectomy, sectioning the dentate ligament, ventral cord untethering, removal of residual tumor, and placement of a ventral sling. A significant improvement in sensory and motor function was observed postoperatively.
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Jeong K, Shah LM, Lee YJ, Thapa B, Sapkota N, Bisson E, Carlson NG, Jeong EK, Rose JW. High-b diffusivity of MS lesions in cervical spinal cord using ultrahigh-b DWI (UHb-DWI). Neuroimage Clin 2021; 30:102610. [PMID: 33752076 PMCID: PMC7985401 DOI: 10.1016/j.nicl.2021.102610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study was to investigate UHb-rDWI signal in white matter tracts of the cervical spinal cord (CSC) and compare quantitative values between healthy control WM with both MS NAWM and MS WM lesions. METHODS UHb-rDWI experiments were performed on (a) 7 MS patients with recently active or chronic lesions in CSC and on (b) 7 healthy control of similar age range and gender distribution to MS subjects. All MRI data were acquired using clinical 3T MRI system. Axial high-b diffusion images were acquired using 2D single-shot DW stimulated EPI with reduced FOV and a CSC-dedicated 8 channel array coil. High-b diffusion coefficient DH was estimated by fitting the signal-b curve to a double or single-exponential function. RESULTS The high-b diffusivity DH values were measured as (0.767 ± 0.297) × 10-3 mm2/s in the posterior column lesions, averaged over 6 MS patients, and 0.587 × 10-3 mm2/s in the corticospinal tract for another patient. The averaged DH values of the 7 healthy volunteers from the posterior and lateral column were (0.0312 ± 0.0306) × 10-3 and (0.0505 ± 0.0205) × 10-3 mm2/s, respectively. UHb-rDWI signal-b curves of the MS patients revealed to noticeably behave differently to that of the healthy controls. The patient signal-b curves decayed with greater high-b decay constants to reach lower signal intensities relative to signal-b curves of the healthy controls. CONCLUSION UHb-DWI of the CSC reveals a marked difference in signal-b-curves and DH values in MS lesions compared to NAWM and healthy control WM. Based on physical principles, we interpret these altered observations of quantitative diffusion values to be indicative of demyelination. Further studies in animal models will be required to fully interpret UHb-DWI quantitative diffusion values during demyelination and remyelination.
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Affiliation(s)
- Kyle Jeong
- Utah Center for Advanced Imaging Research, University of Utah, Utah, USA
| | - Lubdha M Shah
- Department of Radiology and Imaging Sciences, University of Utah, Utah, USA
| | - You-Jung Lee
- Utah Center for Advanced Imaging Research, University of Utah, Utah, USA
| | - Bijaya Thapa
- Utah Center for Advanced Imaging Research, University of Utah, Utah, USA
| | - Nabraj Sapkota
- Utah Center for Advanced Imaging Research, University of Utah, Utah, USA
| | - Erica Bisson
- Department of Neurosurgery, University of Utah, Utah, USA
| | - Noel G Carlson
- Neuroimmunology and Neurovirology Division, Department of Neurology, University of Utah, Utah, USA; GRECC, VA Salt Lake City Health Care System, Utah, USA; Department of Neurobiology, University of Utah, Utah, USA
| | - E K Jeong
- Utah Center for Advanced Imaging Research, University of Utah, Utah, USA; Department of Radiology and Imaging Sciences, University of Utah, Utah, USA
| | - John W Rose
- Neuroimmunology and Neurovirology Division, Department of Neurology, University of Utah, Utah, USA; Neurology Service, VA Salt Lake City Health Care System, Utah, USA.
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Kahan J, Gibson CJ, Strauss SB, Bronstein M, Winchell RJ, Barie PS, Segal AZ. Cervical spinal cord infarction associated with coronavirus infectious disease (COVID)-19. J Clin Neurosci 2021; 87:89-91. [PMID: 33863542 PMCID: PMC7938747 DOI: 10.1016/j.jocn.2021.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/07/2021] [Accepted: 02/25/2021] [Indexed: 02/07/2023]
Abstract
Coronavirus disease (COVID-19) has a number of emerging neurological manifestations in addition to pneumonia and respiratory distress. In what follows, we describe a case of a previously healthy young man with severe COVID-19 who subsequently developed an acute flaccid paralysis. Work up revealed a lesion in his cervical spinal cord concerning for spinal infarction or transverse myelitis. He received empiric pulsed steroids without improvement. Taken together, we felt his presentation was most consistent with spinal cord infarction in the setting of critical illness with COVID-19. We believe this is a rare case of spinal cord stroke associated with COVID-19.
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Affiliation(s)
- Joshua Kahan
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Cameron J Gibson
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Sara B Strauss
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Philip S Barie
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA; Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alan Z Segal
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
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Asiri A, Dimpudus F, Atcheson N, Al‐Najjar A, McMahon K, Kurniawan ND. Comparison between 2D and 3D MEDIC for human cervical spinal cord MRI at 3T. J Med Radiat Sci 2021; 68:4-12. [PMID: 32931647 PMCID: PMC7890925 DOI: 10.1002/jmrs.433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 08/06/2020] [Accepted: 08/27/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION High-resolution magnetic resonance imaging (MRI) of the cervical spinal cord is important to provide accurate diagnosis and pathological assessment of injuries. MEDIC (Multiple Echo Data Image Combination) sequences have been used in clinical MRI; however, a comparison of the performance of 2D and 3D MEDIC for cervical spinal cord imaging has not been reported. The aim of this study is to compare axial 2D and 3D MEDIC for the visualisation of the grey matter (GM) and white matter (WM) of the human cervical spinal cord. METHODS Eight healthy participants were scanned using Siemens Prismafit 3T MRI. T2*-weighted gradient spoiled 2D and 3D MEDIC sequences were acquired at 0.4 × 0.4 × 3.0 and 0.3 × 0.3 × 3.0 mm resolutions, with the acquisition times of 6 and 7 min, respectively. Quantitative analyses of the images were made based on the image signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and non-uniformity (NU). Two independent radiologists (CS and FN), each provided Likert scoring assessments of anatomical visibility of the GM and WM structures and image clarity for all samples. RESULTS Quantitative evaluation showed that 3D MEDIC provided higher SNR, higher CNR and lower NU than 2D MEDIC. However, 2D MEDIC provided better anatomical visibility for the GM, WM and CSF, and higher image clarity (lower artefacts) compared to 3D MEDIC. CONCLUSIONS 2D MEDIC provides better information for depicting the internal structures of the cervical spinal cord compared to 3D MEDIC.
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Affiliation(s)
- Abdullah Asiri
- Centre for Advanced ImagingUniversity of QueenslandBrisbaneAustralia
- Radiological Sciences DepartmentCollege of Applied Medical SciencesNajran UniversityNajranSaudi Arabia
| | - Franky Dimpudus
- Centre for Advanced ImagingUniversity of QueenslandBrisbaneAustralia
- Rumah Sakit Premier Surabaya ‐ Ramsay Sime Darby HealthcareSurabayaIndonesia
| | - Nicole Atcheson
- Centre for Advanced ImagingUniversity of QueenslandBrisbaneAustralia
| | - Aiman Al‐Najjar
- Centre for Advanced ImagingUniversity of QueenslandBrisbaneAustralia
| | - Katie McMahon
- Centre for Advanced ImagingUniversity of QueenslandBrisbaneAustralia
- Herston Imaging Research FacilitySchool of Clinical SciencesInstitute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
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Wolf K, Reisert M, Beltrán SF, Klingler JH, Hubbe U, Krafft AJ, Egger K, Hohenhaus M. Focal cervical spinal stenosis causes mechanical strain on the entire cervical spinal cord tissue - A prospective controlled, matched-pair analysis based on phase-contrast MRI. Neuroimage Clin 2021; 30:102580. [PMID: 33578322 PMCID: PMC7875814 DOI: 10.1016/j.nicl.2021.102580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Focally increased spinal cord motion at the level of cervical spinal stenosis has been revealed by phase-contrast MRI (PC-MRI). OBJECTIVE To investigate spinal cord motion among patients suffering of degenerative cervical myelopathy (DCM) across the entire cervical spine applying automated segmentation and standardized PC-MRI post-processing protocols. METHODS Prospective, matched-pair controlled trial on 29 patients with stenosis at C5/C6. MRI-protocol covering all cervical segments: 3D T2-SPACE, prospectively ECG-triggered sagittal PC-MRI. Segmentation by trained 3D hierarchical deep convolutional neural network and data processing were conducted via in-house software pipeline. Parameters per segment: maximum velocity, peak-to-peak (PTP)-amplitude, total displacement, PTP-amplitudeHB (PTP-amplitude per duration of heartbeat), and, for characterization of intraindividual alterations, the PTP-amplitude index between the cervical segments C3/C4-C7/T1 and C2/C3. RESULTS Spinal cord motion was increased at C4/C5, C5/C6 and C6/C7 among patients (all parameters, p < 0.001-0.025). The PTP-amplitude index revealed an increase from C3/C4 to C4/C5 (p = 0.002), C4/C5 to C5/C6 (p = 0.037) and a decrease from C5/C6 to C6/C7 and C6/C7 to C7/T1 (p < 0.001, each). This implied an up-building stretch on spinal cord tissue cranial and a mechanical compression caudal of the stenotic level. Furthermore, significant far range effects across the entire cervical spinal cord were observed (e.g. PTP-amplitude C2/C3 vs. C6/C7, p = 0.026) in contrast to controls (p = 1.00). CONCLUSION This study revealed the nature and extends of mechanical stress on the entire cervical spinal cord tissue due to focal stenosis. These pathophysiological alterations of spinal cord motion can be expected to be clinically relevant.
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Affiliation(s)
- Katharina Wolf
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Marco Reisert
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Saúl Felipe Beltrán
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jan-Helge Klingler
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Ulrich Hubbe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Axel J Krafft
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Karl Egger
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Department of Radiology, Tauernklinikum Zell am See/Mittersill, Salzburg, Austria
| | - Marc Hohenhaus
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Buchanan FR, Wang VY, Amadio JP, Ortega-Barnett JR, Brown LH, Teixeira PG, Aydelotte JD, Leede E, Ali S, Brown CVR. Does preoperative magnetic resonance imaging alter the surgical plan in patients with acute traumatic cervical spinal cord injury? J Trauma Acute Care Surg 2021; 90:157-162. [PMID: 33009342 DOI: 10.1097/ta.0000000000002962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whether magnetic resonance imaging (MRI) adds value to surgical planning for patients with acute traumatic cervical spinal cord injury (ATCSCI) remains controversial. In this study, we compared surgeons' operative planning decisions with and without preoperative MRI. We had two hypotheses: (1) the surgical plan for ATCSCI would not change substantially after the MRI and (2) intersurgeon agreement on the surgical plan would also not change substantially after the MRI. METHODS We performed a vignette-based survey study that included a retrospective review of all adult trauma patients who presented to our American College of Surgeons-verified level 1 trauma center from 2010 to 2019 with signs of acute quadriplegia and underwent computed tomography (CT), MRI, and subsequent cervical spine surgery within 48 hours of admission. We abstracted patient demographics, admission physiology, and injury details. Patient clinical scenarios were presented to three spine surgeons, first with only the CT and then, a minimum of 2 weeks later, with both the CT and MRI. At each presentation, the surgeons identified their surgical plan, which included timing (none, <8, <24, >24 hours), approach (anterior, posterior, circumferential), and targeted vertebral levels. The outcomes were change in surgical plan and intersurgeon agreement. We used Fleiss' kappa (κ) to measure intersurgeon agreement. RESULTS Twenty-nine patients met the criteria and were included. Ninety-three percent of the surgical plans were changed after the MRI. Intersurgeon agreement was "slight" to "fair" both before the MRI (timing, κ = 0.22; approach, κ = 0.35; levels, κ = 0.13) and after the MRI (timing, κ = 0.06; approach, κ = 0.27; levels, κ = 0.10). CONCLUSION Surgical plans for ATCSCI changed substantially when the MRI was presented in addition to the CT; however, intersurgeon agreement regarding the surgical plan was low and not improved by the addition of the MRI. LEVEL OF EVIDENCE Diagnostic, level II.
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Affiliation(s)
- Frank R Buchanan
- From the Department of Surgery and Perioperative Care (F.R.B., V.Y.W., J.P.A., J.R.O.-B., L.H.B., P.G.T., J.D.A., E.L., S.A.), Dell Medical School, and Trauma Services, Dell Seton Medical Center (C.V.R.B.), University of Texas at Austin, Austin, Texas
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Collorone S, Cawley N, Grussu F, Prados F, Tona F, Calvi A, Kanber B, Schneider T, Kipp L, Zhang H, Alexander DC, Thompson AJ, Toosy A, Wheeler-Kingshott CAG, Ciccarelli O. Reduced neurite density in the brain and cervical spinal cord in relapsing-remitting multiple sclerosis: A NODDI study. Mult Scler 2020; 26:1647-1657. [PMID: 31682198 DOI: 10.1177/1352458519885107] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) affects both brain and spinal cord. However, studies of the neuraxis with advanced magnetic resonance imaging (MRI) are rare because of long acquisition times. We investigated neurodegeneration in MS brain and cervical spinal cord using neurite orientation dispersion and density imaging (NODDI). OBJECTIVE The aim of this study was to investigate possible alterations, and their clinical relevance, in neurite morphology along the brain and cervical spinal cord of relapsing-remitting MS (RRMS) patients. METHODS In total, 28 RRMS patients and 20 healthy controls (HCs) underwent brain and spinal cord NODDI at 3T. Physical and cognitive disability was assessed. Individual maps of orientation dispersion index (ODI) and neurite density index (NDI) in brain and spinal cord were obtained. We examined differences in NODDI measures between groups and the relationships between NODDI metrics and clinical scores using linear regression models adjusted for age, sex and brain tissue volumes or cord cross-sectional area (CSA). RESULTS Patients showed lower NDI in the brain normal-appearing white matter (WM) and spinal cord WM than HCs. In patients, a lower NDI in the spinal cord WM was associated with higher disability. CONCLUSION Reduced neurite density occurs in the neuraxis but, especially when affecting the spinal cord, it may represent a mechanism of disability in MS.
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Affiliation(s)
- Sara Collorone
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Niamh Cawley
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Francesco Grussu
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Ferran Prados
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Francesca Tona
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Alberto Calvi
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Department of Pathophysiology and Transplantation, Neurodegenerative Disease Unit, La Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Baris Kanber
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Torben Schneider
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Philips UK, Guildford, UK
| | - Lucas Kipp
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Stanford MS Center, Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Hui Zhang
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Alan J Thompson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Ahmed Toosy
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Claudia Am Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy/Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
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