Assessing structure and function of myelin in cervical spondylotic myelopathy

Liu, Hanwen; MacMillian, Erin L.; Jutzeler, Catherine R.; Ljungberg, Emil; MacKay, Alex L.; Kolind, Shannon; Mädler, Burkhard; Li, David K.B.; Dvorak, Marcel F.; Curt, Armin; Laule, Cornelia; Kramer, John L.K.

doi:10.1212/wnl.0000000000004197

Cited by 50 publications

(37 citation statements)

References 39 publications

(31 reference statements)

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“…This differs from current literature suggesting pathophysiologic processes contributing to CSM symptoms are hypothesized to be most heavily driven by descending corticospinal tract damage. 7,30 It is unclear to the authors why the current study is not consistent with such findings. These findings, while possibly a result of sampling bias, could also suggest a more prominent role played by the reticulospinal tracts than previously understood.…”

Section: Discussioncontrasting

confidence: 90%

Tract-Specific Volume Loss on 3T MRI in Patients With Cervical Spondylotic Myelopathy

Hopkins

Weber

Cloney

et al. 2018

Spine

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Section: Discussioncontrasting

confidence: 90%

Tract-Specific Volume Loss on 3T MRI in Patients With Cervical Spondylotic Myelopathy

Hopkins

Weber

Cloney

et al. 2018

Spine

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“…Patients with CSM with pathologic SEPs had also reduction in myelin water fraction (MWF) in 3 T magnetic resonance (MR) [43]. MWF was also correlated with SEP latencies.…”

Section: Diagnostic Tests For Csmmentioning

confidence: 99%

Cervical Spondylotic Myelopathy: Natural Course and the Value of Diagnostic Techniques –WFNS Spine Committee Recommendations

et al. 2019

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ObjectiveThis study presents the results of a systematic literature review conducted to determine most up-to-date information on the natural outcome of cervical spondylotic myelopathy (CSM) and the most reliable diagnostic techniques. MethodsA literature search was performed for articles published during the last 10 years. ResultsThe natural course of patients with cervical stenosis and signs of myelopathy is quite variable. In patients with no symptoms, but significant stenosis, the risk of developing myelopathy with cervical stenosis is approximately 3% per year. Myelopathic signs are useful for the clinical diagnosis of CSM. However, they are not highly sensitive and may be absent in approximately one-fifth of patients with myelopathy. The electrophysiological tests to be used in CSM patients are motor evoked potential (MEP), spinal cord evoked potential, somatosensory evoked potential, and electromyography (EMG). The differential diagnosis of CSM from other neurological conditions can be accomplished by those tests. MEP and EMG monitoring are useful to reduce C5 root palsy during CSM surgery. Notable spinal cord T2 hyperintensity on cervical magnetic resonance imaging (MRI) is correlated with a worse outcome, whereas lighter signal changes may predict better outcomes. T1 hypointensity should be considered a sign of more advanced disease. ConclusionThe natural course of CSM is quite variable. Signal changes on MRI and some electrophysiological tests are valuable adjuncts to diagnosis.

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“…While the majority of MWI work has been conducted in brain, some studies have also explored MWI in the spinal cord, where measurement of myelin can further improve the understanding and treatment of neurological diseases (Laule and MacKay, 2014; Wu et al, 2006; Kearney et al, 2015; Liu et al, 2017; Laule et al, 2010; Kolind et al, 2015; Combes et al, 2017; Martin et al, 2016). However, spinal cord imaging has several technical challenges which have hindered the wide-spread implementation of MWI, including motion, flow of cerebrospinal fluid, susceptibility artifacts, and the spinal cord's small cross-sectional area (Stroman et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Rapid myelin water imaging for the assessment of cervical spinal cord myelin damage

Dvorak

Ljungberg

Vavasour

et al. 2019

NeuroImage: Clinical

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Background Rapid myelin water imaging (MWI) using a combined gradient and spin echo (GRASE) sequence can produce myelin specific metrics for the human brain. Spinal cord MWI could be similarly useful, but technical challenges have hindered routine application. GRASE rapid MWI was recently successfully implemented for imaging of healthy cervical spinal cord and may complement other advanced imaging methods, such as diffusion tensor imaging (DTI) and quantitative T 1 (qT 1 ). Objective To demonstrate the feasibility of cervical cord GRASE rapid MWI in multiple sclerosis (MS), primary lateral sclerosis (PLS) and neuromyelitis optica spectrum disorder (NMO), with comparison to DTI and qT 1 metrics. Methods GRASE MWI, DTI and qT 1 data were acquired in 2 PLS, 1 relapsing-remitting MS (RRMS), 1 primary-progressive MS (PPMS) and 2 NMO subjects, as well as 6 age (±3 yrs) and sex matched healthy controls (HC). Internal cord structure guided template registrations, used for region of interest (ROI) analysis. Z score maps were calculated for the difference between disease subject and mean HC metric values. Results PLS subjects had low myelin water fraction (MWF) in the lateral funiculi compared to HC. RRMS subject MWF was heterogeneous within the cord. The PPMS subject showed no trends in ROI results but had a region of low MWF Z score corresponding to a focal lesion. The NMO subject with a longitudinally extensive transverse myelitis lesion had low values for whole cord mean MWF of 12.8% compared to 24.3% (standard deviation 2.2%) for HC. The NMO subject without lesions also had low MWF compared to HC. DTI and qT 1 metrics showed similar trends, corroborating the MWF results and providing complementary information. Conclusion GRASE is sufficiently sensitive to detect decreased myelin within MS spinal cord plaques, NMO lesions, and PLS diffuse spinal cord injury. Decreased MWF in PLS is consistent with demyelination secondary to motor neuron degeneration. GRASE MWI is a feasible method for rapid assessment of myelin content in the cervical spinal cord and provides complementary information to that of DTI and qT 1 measures.

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Assessing structure and function of myelin in cervical spondylotic myelopathy

Cited by 50 publications

References 39 publications

Tract-Specific Volume Loss on 3T MRI in Patients With Cervical Spondylotic Myelopathy

Tract-Specific Volume Loss on 3T MRI in Patients With Cervical Spondylotic Myelopathy

Cervical Spondylotic Myelopathy: Natural Course and the Value of Diagnostic Techniques –WFNS Spine Committee Recommendations

Rapid myelin water imaging for the assessment of cervical spinal cord myelin damage

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