Lateral Corticospinal Tract Damage Correlates With Motor Output in Incomplete Spinal Cord Injury

Smith, Andrew C.; Weber, Kenneth A.; O'Dell, Denise R; Parrish, Todd B.; Wasielewski, Marie; Elliott, James M.

doi:10.1016/j.apmr.2017.10.002

Cited by 31 publications

(33 citation statements)

References 28 publications

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“…Recently, using axial T 2 -weighted sequences and quantifying the signal hyperintensity after SCI, two novel MRI biomarkers have been reported: (1) axial damage ratio, (2) region-specific damage [16,17]. The axial damage ratio is determined by finding the axial slice where the area of cord hyperintensity is the largest in relationship to its surrounding cord diameter and calculating the ratio of hyperintensity area divided by cord area (see Fig.…”

Section: Introductionmentioning

confidence: 99%

“…For the region-specific damage biomarker, the T 2 -weighted images are registered to a standard spinal cord template image with a corresponding white matter atlas, permitting estimation of damage to specific regions such as the lateral corticospinal tract (see Fig. 2) [17]. In the same cohort as above, damage to the left or right lateral corticospinal tract was significantly related to the ability to generate maximum voluntary torque in the ipsilateral lower extremity [17].…”

Section: Introductionmentioning

confidence: 99%

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Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

et al. 2020

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Study design Retrospective. Objectives Primary: to assess if axial damage ratios are predictors of future walking after spinal cord injury (SCI), and if they add any predictive value if initial neurological impairment grades are available. Secondary: to determine if lateral spinal cord regions are predictors of future lower extremity motor scores (LEMS). Setting University/hospital. Methods Axial T2-weighted MRIs were used. Axial damage ratios and non-damaged lateral cord volumes were calculated. Each participant answered at 1 year after SCI, “Are you able to walk for 150 feet? (45.72 meters)” For the secondary aim, right and left LEMS were used. Results In total, 145 participants were selected. Individuals that could walk had smaller ratios than those that were unable. Walking and axial damage ratios were negatively correlated. A 0.374 ratio cut-off showed optimal sensitivity/specificity. When initial neurological grades were used, axial damage ratios did not add predictive value. Forty-two participants had LEMS available and were included for the secondary aim. Right cord regions and right LEMS were positively correlated and left regions and left LEMS, but these variables were also correlated with each other. Conclusions Axial damage ratios were significant predictors of walking ability 1 year after SCI. However, this measure did not add predictive value over initial neurological grades. Lateral cord regions correlated with same-side LEMS, but the opposite was also found, calling this biomarker’s specificity into question. Axial damage ratios may be useful in predicting walking after SCI if initial neurological grades are unavailable. Sponsorship This research was funded by a National Institutes of Health award, National Institute of Child Health and Development—NIH R03HD094577.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

et al. 2020

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“…Another limitation with our manual measurement approaches is the variability in spinal cord anatomy across research participants. While the axial damage ratio attempts to account for spinal cord diameter variability, standardized spinal cord template-based approaches may be beneficial to compare anatomy and damage across participants [8,22] (i.e., extent of edema encroaching into dorsal or ventral spinal columns). Fig.…”

Section: Discussionmentioning

confidence: 99%

“…This project was a retrospective analysis of MRI data from published studies [5,8,19]. It was approved by Northwestern University and Regis University Institutional Review Boards.…”

Section: Participant Characteristicsmentioning

confidence: 99%

“…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%

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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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Spinal cord imaging markers and recovery of standing with epidural stimulation in individuals with clinically motor complete spinal cord injury

et al. 2021

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Spinal cord epidural stimulation (scES) is an intervention to restore motor function in those with severe spinal cord injury (SCI). Spinal cord lesion characteristics assessed via magnetic resonance imaging (MRI) may contribute to understand motor recovery. This study assessed relationships between standing ability with scES and spared spinal cord tissue characteristics at the lesion site. We hypothesized that the amount of lateral spared cord tissue would be related to independent extension in the ipsilateral lower limb. Eleven individuals with chronic, clinically motor complete SCI underwent spinal cord MRI, and were subsequently implanted with scES. Standing ability and lower limb activation patterns were assessed during an overground standing experiment with scES. This assessment occurred prior to any activity-based intervention with scES. Lesion hyperintensity was segmented from T2 axial images, and template-based analysis was used to estimate spared tissue in anterior, posterior, right, and left spinal cord regions. Regression analysis was used to assess relationships between imaging and standing outcomes. Total volume of spared tissue was related to left (p = 0.007), right (p = 0.005), and bilateral (p = 0.011) lower limb extension. Spared tissue in the left cord region was related to left lower limb extension (p = 0.019). A positive trend (p = 0.138) was also observed between right spared cord tissue and right lower limb extension. In this study, MRI measures of spared spinal cord tissue were significantly related to standing outcomes with scES. These preliminary results warrant future investigation of roles of supraspinal input and MRI-detected spared spinal cord tissue on lower limb motor responsiveness to scES.

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Lateral Corticospinal Tract Damage Correlates With Motor Output in Incomplete Spinal Cord Injury

Abstract: MRI measures of spinal cord damage were correlated to motor function, and this measure appears to have spatial specificity to descending tracts, which may offer prognostic value after SCI.

Cited by 31 publications

References 28 publications

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

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

Spinal cord imaging markers and recovery of standing with epidural stimulation in individuals with clinically motor complete spinal cord injury

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