Post-mortem diffusion MRI of the cervical spine and its nerve roots

Haakma, Wieke; Froeling, Martijn; Pedersen, Michael; Uhrenholt, Lars; Douven, Perla; Leemans, Alexander; Boel, Lene Warner Thorup

doi:10.1016/j.jofri.2018.02.006

Cited by 6 publications

(5 citation statements)

References 32 publications

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“…We could reconstruct nearly all nerve roots with FT and calculate DTI parameters with the “isotropic” resolution DTI scan, which was in line with previous findings (Haakma et al, 2018). Although DTI parameters were lower in patients compared to controls at nearly all segments (C3-C8), differences in MD, AD and RD were most pronounced at the more rostral segments (C3-C5).…”

Section: Discussionsupporting

confidence: 88%

Magnetic resonance imaging of the cervical spinal cord in spinal muscular atrophy

Stam

Haakma

Kuster

et al. 2019

NeuroImage: Clinical

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ObjectiveIn this study we investigated the potential value of magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) in characterizing changes in the cervical spinal cord and peripheral nerve roots in vivo in patients with spinal muscular atrophy (SMA).MethodsWe developed an MRI protocol with 4 sequences to investigate the cervical spinal cord and nerve roots on a 3 Tesla MRI system. We used 2 anatomical MRI sequences to investigate cross-sectional area (CSA) at each spinal segment and the diameter of ventral and dorsal nerve roots, and two diffusion tensor imaging (DTI) techniques to estimate the fractional anisotropy (FA), mean (MD), axial (AD) and radial diffusivity (RD) in 10 SMA patients and 20 healthy controls.ResultsThere were no significant differences in CSA (p > .1), although an 8.5% reduction of CSA in patients compared to healthy controls was apparent at segment C7. DTI data showed a higher AD in grey matter of patients compared to healthy controls (p = .033). Significantly lower MD, AD and RD values were found in rostral nerve roots (C3-C5) in patients (p < .045).ConclusionsWe showed feasibility of an advanced 3 T MRI protocol that allowed differences to be determined between patients and healthy controls, confirming the potential of this technique to assess pathological mechanisms in SMA. After further development and confirmation of findings in a larger sample, these techniques may be used to study disease course of SMA in vivo and evaluate response to survival motor neuron (SMN) augmenting therapy.

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Section: Discussionsupporting

confidence: 88%

Magnetic resonance imaging of the cervical spinal cord in spinal muscular atrophy

Stam

Haakma

Kuster

et al. 2019

NeuroImage: Clinical

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“…The DWI protocol used in this study has previously showed good correlation between anatomical MRI and diffusion tensor imaging (DTI) in a post-mortem study [ 24 ]. Our study found no significant differences in FA or ADC values between the groups examined.…”

Section: Discussionmentioning

confidence: 99%

“…We are aware that measurements at different locations may provide other results. The applied DWI methods and analyses used in this manuscript have previously showed good correlation in a post-mortem study [ 24 ]. Applying them to this in-vivo study may however have led to less accurate estimates of the diffusion metrics.…”

Section: Discussionmentioning

confidence: 99%

“…A recent post-mortem diffusion weighted imaging (DWI)-based magnetic resonance imaging (MRI) study introduced three-dimensional reconstruction of the spinal cord and the cervical spine nerve roots, demonstrating a positive correlation between morphological MRI and DWI [ 24 ]. Hence, this method may be valuable in evaluating patients suffering from symptoms related to the cervical spine nerve roots and/or spinal cord.…”

Section: Introductionmentioning

confidence: 99%

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Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study

et al. 2022

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Background Whiplash injury is common following road traffic crashes affecting millions worldwide, with up to 50% of the injured developing chronic symptoms and 15% having a reduced working capability due to ongoing disability. Many of these patients receive treatment in primary care settings based upon clinical and diagnostic imaging findings. Despite the identification of different types of injuries in the whiplash patients, clinically significant relationships between injuries and chronic symptoms remains to be fully established. This study investigated the feasibility of magnetic resonance imaging (MRI) techniques including quantitative diffusion weighted imaging and measurements of cerebrospinal fluid (CSF) flow as novel non-invasive biomarkers in a population of healthy volunteers and chronic whiplash patients recruited from a chiropractic clinic for the purpose of improving our understanding of whiplash injury. Methods Twenty chronic whiplash patients and 18 healthy age- and gender matched control subjects were included [mean age ± SD (sex ratio; females/males), case group: 37.8 years ± 9.1 (1.22), control group: 35.1 years ± 9.2 (1.25)]. Data was collected from May 2019 to July 2020. Data from questionnaires pertaining to the car crash, acute and current symptoms were retrieved and findings from clinical examination and MRI including morphologic, diffusion weighted and phase-contrast images were recorded. The apparent diffusion coefficient and fractional anisotropy were calculated, and measurement and analysis of CSF flow was conducted. Statistical analyses included Fisher’s exact test, Mann Whitney U test and analysis of variance between groups. Results The studied population was described in detail using readily available clinical tools. No statistically significant differences were found between the groups on MRI. Conclusions This study did not show that MRI‐based measures of morphology, spinal cord and nerve root diffusion or cerebrospinal fluid flow are sensitive biomarkers to distinguish between chronic whiplash patients and healthy controls. The detailed description of the chronic whiplash patients using readily available clinical tools may be of great relevance to the clinician. In the context of feasibility, clinical practice-based advanced imaging studies with a technical setup similar to the presented can be expected to have a high likelihood of successful completion.

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“…Apart from the detection of hemorrhages, special MRI techniques may provide further information regarding the extent and mechanism of neck injuries in strangulation cases. For example, Haakma et al [50] described high-resolution depictions of the cervical spine and its nerve roots in decedents using diffusion tensor imaging (DTI), which may be supportive in the assessment of injuries to the head and neck.…”

Section: Discussionmentioning

confidence: 99%

Relevant findings on postmortem CT and postmortem MRI in hanging, ligature strangulation and manual strangulation and their additional value compared to autopsy – a systematic review

Gascho

Heimer

Tappero

et al. 2019

Forensic Sci Med Pathol

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Several articles have described the use of postmortem computed tomography (CT) and postmortem magnetic resonance imaging (MRI) in forensic medicine. Although access to CT scanners and, particularly, access to MRI scanners, is still limited for several institutes, both modalities are being applied with increasing frequency in the forensic setting. Certainly, postmortem imaging can provide crucial information prior to autopsy, and this method has even been considered a replacement to autopsy in selected cases by some forensic institutes. However, the role of postmortem imaging has to be assessed individually according to various injury categories and causes of death. Therefore, this systematic review focuses on the role of postmortem CT and MRI in cases of hanging and ligature and manual strangulation. We assessed the most common and relevant findings on CT and MRI in cases of strangulation and compared the detectability of these findings among CT, MRI and autopsy. According to the available literature, mainly fractures of the hyoid bone or thyroid cartilage were investigated using postmortem CT. Compared to autopsy, CT demonstrated equivalent results concerning the detection of these fractures. A currently described "gas bubble sign" may even facilitate the detection of laryngeal fractures on CT. Regarding the detection of hemorrhages in the soft tissue of the neck, postmortem MRI is more suitable for the detection of this "vital sign" in strangulation. Compared to autopsy, postmortem MRI is almost equally accurate for the detection of hemorrhages in the neck. Another "vital sign", gas within the soft tissue in hanging, which is hardly detectable by conventional autopsy, can be clearly depicted by CT and MRI. The number of cases of manual and ligature strangulation that were investigated by means of postmortem CT and MRI is much smaller than the number of cases of hanging that were investigated by CT and MRI. Likewise, judicial hanging and the hangman's fracture on postmortem imaging were described in only a few cases. Based on the results of this systematic review, we discuss the additional value of CT and MRI in fatal strangulation compared to autopsy, and we reflect on where the literature is currently lacking.

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Post-mortem diffusion MRI of the cervical spine and its nerve roots

Cited by 6 publications

References 32 publications

Magnetic resonance imaging of the cervical spinal cord in spinal muscular atrophy

Magnetic resonance imaging of the cervical spinal cord in spinal muscular atrophy

Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study

Relevant findings on postmortem CT and postmortem MRI in hanging, ligature strangulation and manual strangulation and their additional value compared to autopsy – a systematic review

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