Natural Course of Disease of Spinal Cord Injury

Schubert, Martin

doi:10.1007/978-3-319-46293-6_4

Cited by 3 publications

(1 citation statement)

References 154 publications

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“…Blood perfusion is frequently involved in spinal cord (SC) injuries. 1,2 Indeed, a prolonged SC compression such as in traumas may result in a local reduction of tissue perfusion and progressive ischemia, leading to metabolism alteration and potentially irreversible tissue necrosis. 3 In such a case, perfusion recovery is conditional to clinical presentation improvement.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of human spinal cord perfusion mapping using dynamic susceptibility contrast imaging at 7T: Preliminary results and identified guidelines

Levy

Roche

Guye

et al. 2020

Magnetic Resonance in Med

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Purpose: To explore the feasibility of dynamic susceptibility contrast MRI at 7 Tesla for human spinal cord perfusion mapping and fill the gap between brain and spinal cord perfusion mapping techniques. Methods: Acquisition protocols for high-resolution single shot EPI in the spinal cord were optimized for both spin-echo and gradient-echo preparations, including cardiac gating, acquisition times and breathing cycle recording. Breathing-induced MRI signal fluctuations were investigated in healthy volunteers. A specific image-and signalprocessing pipeline was implemented to address them. Dynamic susceptibility contrast was then evaluated in 3 healthy volunteers and 5 patients. Bolus depiction on slice-wise signal within cord was investigated, and maps of relative perfusion indices were computed. Results: Signal fluctuations were increased by 1.9 and 2.3 in free-breathing compared to apnea with spin-echo and gradient-echo, respectively. The ratio between signal fluctuations and bolus peak in healthy volunteers was 5.0% for spin-echo and 3.8% for gradient-echo, allowing clear depiction of the bolus on every slice and yielding relative blood flow and volume maps exhibiting the expected higher perfusion of gray matter. However, signal fluctuations in patients were increased by 4 in average (using spin-echo), compromising the depiction of the bolus in slice-wise signal. Moreover, 3 of 18 slices had to be discarded because of fat-aliasing artifacts. Conclusion: Dynamic susceptibility contrast MRI at 7 Tesla showed great potential for spinal cord perfusion mapping with a reliability never achieved thus far for single subject and single slice measurements. Signal stability needs to be improved in acquisition conditions associated with patients; guidelines to achieve that have been identified and shared.

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Section: Introductionmentioning

confidence: 99%

Feasibility of human spinal cord perfusion mapping using dynamic susceptibility contrast imaging at 7T: Preliminary results and identified guidelines

Levy

Roche

Guye

et al. 2020

Magnetic Resonance in Med

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Investigation of perfusion impairment in degenerative cervical myelopathy beyond the site of cord compression

Lebret,

Lévy,

Pfender

et al. 2023

Sci Rep

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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 ($$F$$ F ), blood velocity ($$D^{*}$$ D ∗ ), and blood flow ($$F \cdot D^{*}$$ F · D ∗ ) 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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Investigation of perfusion impairment in degenerative cervical myelopathy beyond the site of cord compression

Lebret,

Lévy,

Pfender

et al. 2023

Preprint

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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 (F), blood velocity (D*), and blood flow (F·D*) 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.

show abstract

Natural Course of Disease of Spinal Cord Injury

Cited by 3 publications

References 154 publications

Feasibility of human spinal cord perfusion mapping using dynamic susceptibility contrast imaging at 7T: Preliminary results and identified guidelines

Feasibility of human spinal cord perfusion mapping using dynamic susceptibility contrast imaging at 7T: Preliminary results and identified guidelines

Investigation of perfusion impairment in degenerative cervical myelopathy beyond the site of cord compression

Investigation of perfusion impairment in degenerative cervical myelopathy beyond the site of cord compression

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