Are midsagittal tissue bridges predictive of outcome after cervical spinal cord injury?

Huber, Eveline; Lachappelle, Patrice; Sutter, Reto; Curt, Armin; Freund, Patrick

doi:10.1002/ana.24932

Cited by 54 publications

(98 citation statements)

References 23 publications

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“…In tetraplegic participants, lesion severity was assessed on the midsagittal section of the T2-weighted images by using Jim 6.0 as previously described (2). At the level of injury, the midsagittal anteroposterior lesion width, the midsagittal rostrocaudal lesion length, the total midsagittal lesion area, and the thickness of the midsagittal ventral and dorsal tissue bridges (total amount of tissue bridges) were quantified ( Fig E2 [online]).…”

Section: Demographicsmentioning

confidence: 99%

“…S pinal cord injury (SCI) results in permanent sensorimotor deficits and remote neurodegeneration and reorganization along the neuroaxis, all of which have strong relationships with clinical outcomes (1,2). These relationships are of high clinical relevance because in vivo neuroimaging assessing volumetric and microstructural changes of the central nervous system might help to improve prediction of outcome and stratification of patients in future interventional trials (3).…”

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confidence: 99%

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MR Spectroscopy of the Cervical Spinal Cord in Chronic Spinal Cord Injury

Wyss¹,

Huber²,

Curt³

et al. 2019

Radiology

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Purpose To investigate metabolic changes in chronic spinal cord injury (SCI) by applying MR spectroscopy in the cervical spinal cord. Materials and Methods Single-voxel short-echo spectroscopic data in study participants with chronic SCI and healthy control subjects were prospectively acquired in the cervical spinal cord at C2 above the level of injury between March 2016 and January 2017 and were compared between groups. Concentrations of total N-acetylaspartate (tNAA), myo-inositol (mI), total choline-containing compounds (tCho), creatine, and glutamine and glutamate complex were estimated from the acquired spectra. Participants were assessed with a comprehensive clinical evaluation investigating sensory and motor deficits. Correlation analysis was applied to investigate relationships between observed metabolic differences, lesion severity, and clinical outcome. Results There were 18 male study participants with chronic SCI (median age, 51 years; range, 30-68 years) and 11 male healthy control subjects (median age, 45 years; range, 30-67 years). At cervical level C2, tNAA/mI and tCho/mI ratios were lower in participants with SCI (tNAA/mI: -26%, P = .003; tCho/mI: -18%; P = .04) than in healthy control subjects. The magnitude of difference was greater with the severity of cord atrophy (tNAA/mI: R = 0.44, P = .003; tCho/mI: R = 0.166, P = .09). Smaller tissue bridges at the lesion site correlated with lower ratios of tNAA/mI (R = 0.69, P = .006) and tCho/mI (R = 0.51, P = .03) at the C2 level. Lower tNAA/mI and tCho/mI ratios were associated with worse sensory and motor outcomes (P < .05). Conclusion Supralesional metabolic alterations are observed in chronic spinal cord injury, likely reflecting neurodegeneration, demyelination, and astrocytic gliosis in the injured cervical cord. Lesion severity and greater clinical impairment are both linked to the biochemical changes in the atrophied cervical cord after spinal cord injury. • Content codes:Purpose: To investigate metabolic changes in chronic spinal cord injury (SCI) by applying MR spectroscopy in the cervical spinal cord. Materials and Methods:Single-voxel short-echo spectroscopic data in study participants with chronic SCI and healthy control subjects were prospectively acquired in the cervical spinal cord at C2 above the level of injury between March 2016 and January 2017 and were compared between groups. Concentrations of total N-acetylaspartate (tNAA), myo-inositol (mI), total choline-containing compounds (tCho), creatine, and glutamine and glutamate complex were estimated from the acquired spectra. Participants were assessed with a comprehensive clinical evaluation investigating sensory and motor deficits. Correlation analysis was applied to investigate relationships between observed metabolic differences, lesion severity, and clinical outcome.Results: There were 18 male study participants with chronic SCI (median age, 51 years; range, 30-68 years) and 11 male healthy control subjects (median age, 45 years; range, 30-67 years). At cervical level C2, tNAA/m...

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Section: Demographicsmentioning

confidence: 99%

mentioning

confidence: 99%

MR Spectroscopy of the Cervical Spinal Cord in Chronic Spinal Cord Injury

Wyss¹,

Huber²,

Curt³

et al. 2019

Radiology

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“…MRI performed immediately after surgery may thus be more informative for estimating ISP and SCPP opt than preoperative MRIs. Earlier studies support the notion preoperative MRI features only weakly correlate with outcome, and in general, postoperative MRIs are more informative [31–33]. The take-home message is that preoperative MRIs cannot be relied upon to estimate the degree of cord compression or the optimal MAP to target after surgery.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Intraspinal Pressure and Optimal Cord Perfusion Pressure After Traumatic Spinal Cord Injury

et al. 2018

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Background/ObjectivesWe recently developed techniques to monitor intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP) from the injury site to compute the optimum SCPP (SCPPopt) in patients with acute traumatic spinal cord injury (TSCI). We hypothesized that ISP and SCPPopt can be predicted using clinical factors instead of ISP monitoring.MethodsSixty-four TSCI patients, grades A–C (American spinal injuries association Impairment Scale, AIS), were analyzed. For 24 h after surgery, we monitored ISP and SCPP and computed SCPPopt (SCPP that optimizes pressure reactivity). We studied how well 28 factors correlate with mean ISP or SCPPopt including 7 patient-related, 3 injury-related, 6 management-related, and 12 preoperative MRI-related factors.ResultsAll patients underwent surgery to restore normal spinal alignment within 72 h of injury. Fifty-one percentage had U-shaped sPRx versus SCPP curves, thus allowing SCPPopt to be computed. Thirteen percentage, all AIS grade A or B, had no U-shaped sPRx versus SCPP curves. Thirty-six percentage (22/64) had U-shaped sPRx versus SCPP curves, but the SCPP did not reach the minimum of the curve, and thus, an exact SCPPopt could not be calculated. In total 5/28 factors were associated with lower ISP: older age, excess alcohol consumption, nonconus medullaris injury, expansion duroplasty, and less intraoperative bleeding. In a multivariate logistic regression model, these 5 factors predicted ISP as normal or high with 73% accuracy. Only 2/28 factors correlated with lower SCPPopt: higher mean ISP and conus medullaris injury. In an ordinal multivariate logistic regression model, these 2 factors predicted SCPPopt as low, medium–low, medium–high, or high with only 42% accuracy. No MRI factors correlated with ISP or SCPPopt.ConclusionsElevated ISP can be predicted by clinical factors. Modifiable factors that may lower ISP are: reducing surgical bleeding and performing expansion duroplasty. No factors accurately predict SCPPopt; thus, invasive monitoring remains the only way to estimate SCPPopt.Electronic supplementary materialThe online version of this article (10.1007/s12028-018-0616-7) contains supplementary material, which is available to authorized users.

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“…Edema is commonly observed on T 2 -weighted MRI as an irregularly shaped characterization of hyperintensity to indicate areas of the damaged cord [5]. While a variety of measures for quantifying the extent of edema have been reported [5,[7][8][9][10][11][12][13][14][15][16] and associated with functional recovery [5,7,8], more evidence is needed to establish the psychometric properties of these measurements.…”

Section: Introductionmentioning

confidence: 99%

“…Edema length (EL) has been commonly measured and reported as the extent of edema along the cranial-caudal axis [7, 9-11, 13-15, 18]. Midsagittal tissue bridge (MTB) measures have emerged as a promising approach for functional prognosis [12,19]. The axial damage ratio (ADR) is a novel measure used to capture the two-dimensional extent of edema within the cord [5].…”

Section: Introductionmentioning

confidence: 99%

Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging

Cummins

Connor

Heller

et al. 2019

Spinal Cord Ser Cases

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Study design Retrospective study. Objectives To establish the inter-rater reliability in the quantitative evaluation of spinal cord damage following cervical incomplete spinal cord injury (SCI) utilizing magnetic resonance imaging (MRI). MRI was used to perform manual measurements of the cranial and caudal boundaries of edema, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume in 10 participants with cervical incomplete SCI. Setting Academic university setting. Methods Structural MRIs of 10 participants with SCI were collected from Northwestern University's Neuromuscular Imaging and Research Lab. All manual measures were performed using OsiriX (Pixmeo Sarl, Geneva, Switzerland). Intraclass correlation coefficients (ICC) were used to determine inter-rater reliability across seven raters of varying experience.Results High-to-excellent inter-rater reliability was found for all measures. ICC values for cranial/caudal levels of involvement, edema length, midsagittal tissue bridge ratio, axial damage ratio, and edema volume were 0.99, 0.98, 0.90, 0.84, and 0.93, respectively. Conclusions Manual MRI measures of spinal cord damage are reliable between raters. Researchers and clinicians may confidently utilize manual MRI measures to quantify cord damage. Future research to predict functional recovery following SCI and better inform clinical management is warranted.

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Are midsagittal tissue bridges predictive of outcome after cervical spinal cord injury?

Cited by 54 publications

References 23 publications

MR Spectroscopy of the Cervical Spinal Cord in Chronic Spinal Cord Injury

MR Spectroscopy of the Cervical Spinal Cord in Chronic Spinal Cord Injury

Predictors of Intraspinal Pressure and Optimal Cord Perfusion Pressure After Traumatic Spinal Cord Injury

Establishing the inter-rater reliability of spinal cord damage manual measurement using magnetic resonance imaging

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