Disability, atrophy and cortical reorganization following spinal cord injury

Freund, Patrick; Weiskopf, Nikolaus; Ward, Nick; Hutton, Chloe; Gall, Angela; Ciccarelli, Olga; Craggs, Michael; Friston, Karl J.; Thompson, Alan J.

doi:10.1093/brain/awr093

Cited by 248 publications

(303 citation statements)

References 51 publications

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“…23,24 We did not find any significant differences in the DTI metrics between SCI patients and controls in these structures. Freund et al 14 and Guleria et al 15 showed reduced FA values but unchanged MDs in the PLIC after SCI compared with healthy subjects. Guleria et al 15 reported a progressive increase in the FA values in the PLIC and corona radiata up to 12 months after injury.…”

Section: Discussionmentioning

confidence: 96%

“…Freund et al 14 and Guleria et al 15 showed reduced FA values but unchanged MDs in the PLIC after SCI compared with healthy subjects. Guleria et al 15 reported a progressive increase in the FA values in the PLIC and corona radiata up to 12 months after injury. FA values in the corona radiata were eventually higher in subjects with SCI compared with the controls.…”

Section: Discussionmentioning

confidence: 96%

“…In a study by Guleria et al, 14 alterations in DTI metrics suggesting retrograde degeneration after SCI were shown along the corticospinal tract in the medulla, pons, midbrain and PLIC. Freund et al 15 observed a reduction in the FA in patients with SCI in the pyramids and the PLIC. Although there were no significant differences in FA values at the level of the cerebral peduncles, axonal degeneration and demyelination -related alterations in directional diffusivities were noted.…”

Section: Discussionmentioning

confidence: 97%

“…This finding is in agreement with previous studies. 5,15 There was a moderate association between macroscopic posttraumatic changes in the spinal cord and microstructural changes in the centrum semiovale. An increase in ADC in the posterior part of the centrum semiovale was positively correlated with the craniocaudal length of the spinal cord lesion.…”

Section: Discussionmentioning

confidence: 97%

“…However, these studies consisted of relatively small samples and primarily included subjects with complete SCI. 5,14,15 The purpose of this study was to quantitatively assess the state of the cerebral white matter tracts in chronic traumatic SCI using DTI in a generalizable sample of patients with both clinically complete and incomplete SCI. We also investigated the association of DTI values with clinical neurological deficit.…”

Section: Introductionmentioning

confidence: 99%

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Clinical correlates of cerebral diffusion tensor imaging findings in chronic traumatic spinal cord injury

et al. 2014

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Study design: Prospective clinical case-control study. Objectives: The aim of this study was to use diffusion tensor imaging (DTI) to assess the state of cerebral white matter tracts after spinal cord injury (SCI). The DTI metrics were evaluated in relation to neurological deficits and to the size and level of the spinal cord lesions. Setting: Tampere University Hospital, Tampere, Finland. Methods: Thirty-four patients (n ¼ 34) with clinically complete and incomplete SCI were evaluated using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). DTI metrics (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) were calculated for multiple levels along the course of the corticospinal tract. The state of the spinal cord after injury was assessed using conventional magnetic resonance imaging (MRI). DTI parameters were compared with 40 orthopedically injured control subjects. Results: Statistically significant differences in the DTI values between patients and controls were detected in the posterior area of the centrum semiovale. In this area, the FA values were lower in the patients compared with controls (P ¼ 0.008). For patients with clinically complete injury, the difference was even more significant (P ¼ 0.0005). Motor and sensory scores of the ISNCSCI correlated positively with FA and negatively with ADC values of the centrum semiovale. A moderate association was observed between the macroscopic changes in the spinal cord and the DTI abnormalities in the centrum semiovale. Conclusion: In patients with chronic SCI, DTI changes can be observed in the cerebral white matter. These alterations are associated with the clinical state of the patients.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Clinical correlates of cerebral diffusion tensor imaging findings in chronic traumatic spinal cord injury

et al. 2014

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Tracking sensory system atrophy and outcome prediction in spinal cord injury

Grabher

Callaghan

Ashburner

et al. 2015

Annals of Neurology

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117

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ObjectiveIn patients with subacute spinal cord injury (SCI), the motor system undergoes progressive structural changes rostral to the lesion, which are associated with motor outcome. The extent to which the sensory system is affected and how this relates to sensory outcome are uncertain.MethodsChanges in the sensory system were prospectively followed by applying a comprehensive magnetic resonance imaging (MRI) protocol to 14 patients with subacute traumatic SCI at baseline, 2 months, 6 months, and 12 months after injury, combined with a full neurological examination and comprehensive pain assessment. Eighteen controls underwent the same MRI protocol. T1‐weighted volumes, myelin‐sensitive magnetization transfer saturation (MT), and longitudinal relaxation rate (R1) mapping provided data on spinal cord and brain morphometry and microstructure. Regression analysis assessed the relationship between MRI readouts and sensory outcomes.ResultsAt 12 months from baseline, sensory scores were unchanged and below‐level neuropathic pain became prominent. Compared with controls, patients showed progressive degenerative changes in cervical cord and brain morphometry across the sensory system. At 12 months, MT and R1 were reduced in areas of structural decline. Sensory scores at 12 months correlated with rate of change in cord area and brain volume and decreased MT in the spinal cord at 12 months.InterpretationThis study has demonstrated progressive atrophic and microstructural changes across the sensory system with a close relation to sensory outcome. Structural MRI protocols remote from the site of lesion provide new insights into neuronal degeneration underpinning sensory disturbance and have potential as responsive biomarkers of rehabilitation and treatment interventions. Ann Neurol 2015;78:Ann Neurol 2015;78:679–696

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Cortical morphometric changes associated with completeness, level, and duration of spinal cord injury in humans: A case–control study

et al. 2021

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Objective This study investigated how the injury completeness, level, and duration of spinal cord injury (SCI) affect cortical morphometric changes in humans. Methods T1‐weighted images were acquired from 59 SCI patients and 37 healthy controls. Voxel‐based morphometry analyses of the gray matter volume (GMV) were performed between SCI patients and healthy controls, complete SCI and incomplete SCI, and tetraplegia and paraplegia. Correlation analyses were performed to explore the associations between GMV and clinical variables in SCI patients. Results Compared to healthy controls, SCI patients showed decreased GMV in bilateral middle frontal gyrus, left superior frontal gyrus (SFG), left medial frontal gyrus in the whole‐brain analysis, while increased GMV in right supplementary motor area and right pallidum in ROI analysis. The complete SCI had lower GMV in left primary somatosensory cortex (S1) and higher GMV in left primary motor cortex compared with incomplete SCI. Lower GMV was identified in left thalamus and SFG in tetraplegia than that in paraplegia. Moreover, time since injury was positive with the GMV in right pallidum, positive correlations were observed between the GMV in bilateral S1 and total motor and sensory scores, whereas the GMV in left cuneus was negatively correlated with total motor and sensory scores in SCI patients. Conclusions The study provided imaging evidence for identifying cerebral structural abnormalities in SCI patients and significant differences in complete/incomplete and paraplegia/tetraplegia subgroups. These results suggested brain structural changes occur after SCI and these changes may depend on the injury completeness, level, and duration.

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Disability, atrophy and cortical reorganization following spinal cord injury

Cited by 248 publications

References 51 publications

Clinical correlates of cerebral diffusion tensor imaging findings in chronic traumatic spinal cord injury

Clinical correlates of cerebral diffusion tensor imaging findings in chronic traumatic spinal cord injury

Tracking sensory system atrophy and outcome prediction in spinal cord injury

Cortical morphometric changes associated with completeness, level, and duration of spinal cord injury in humans: A case–control study

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