Test-Retest and Interreader Reproducibility of Semiautomated Atlas-Based Analysis of Diffusion Tensor Imaging Data in Acute Cervical Spine Trauma in Adult Patients

Peterson, Daniel J.; Rutman, Aaron M.; Hippe, Daniel S.; Jarvik, Jeffrey G.; Chokshi, Falgun H.; Reyes, Maria R.; Bombardier, Charles H.; Mossa‐Basha, Mahmud

doi:10.3174/ajnr.a5334

Cited by 9 publications

(4 citation statements)

References 30 publications

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“…The reason why no significant difference was found at other levels of the cervical cord is unclear. It could be due to (i) technical limitations (DTI metrics are more robust at C2–C3 in normal subjects and other disease settings) ; (ii) limited statistical power due to the small number of enrolled subjects; (iii) the fact that in AMN the degeneration of the dorsal columns is dying back, and therefore more rostral cervical regions may be more sensitive to change than more caudal cervical regions. No longitudinal modification of DTI metrics was observed in the brain portion of the CSTs and the cervical cord gray matter.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal quantitative magnetic resonance imaging in adrenomyeloneuropathy

Politi

Castellano

Papinutto

et al. 2019

Euro J of Neurology

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Background and purpose Adrenomyeloneuropathy (AMN) is the most frequent metabolic hereditary spastic paraplegia. Accordingly, its main site of pathological changes is the spinal cord. It is difficult to quantify AMN progression because commonly used clinical scales have limitations and reliable biomarkers are lacking. The goal was to investigate whether spinal cord and brain quantitative magnetic resonance imaging may assess structural changes in AMN over a relatively short time period. Methods In this longitudinal observational study, the total cord areas (TCAs) from the C2–C3 to T2–T3 level and diffusion tensor imaging (DTI) metrics of the cervical spinal cord and brain portion of the corticospinal tracts in six AMN and six age‐matched control subjects at baseline and at a mean follow‐up of 22.6 months were assessed. Results A significant reduction of the mean TCA at the T1–T2 level (−3.79%) and a trend of reduction at the lowest cervical levels were observed only in AMN patients. Additionally, DTI metrics revealed significant changes in fractional anisotropy (−8.84%), mean diffusivity (+12.62%) and radial diffusivity (+25.91%) at the C2–C3 level. Discussion The study encourages the assessment of TCAs and spinal cord DTI metrics as surrogate outcome measures in AMN, by focusing on the cervical–thoracic junction and the uppermost part of the cervical spinal cord. Despite the limitation of the results due to the small number of investigated subjects, these observations are useful for forthcoming clinical trials in AMN and possibly other hereditary diseases with predominant spinal cord involvement.

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Section: Discussionmentioning

confidence: 99%

Longitudinal quantitative magnetic resonance imaging in adrenomyeloneuropathy

Politi

Castellano

Papinutto

et al. 2019

Euro J of Neurology

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“…Moreover, while MRI does not provide the resolution to assess integrity of spinal blood vessels and local perfusion, recent advances in diffusion tensor imaging have suggested a potential role of this technique in the quantification of tract injury. 20,29 Future studies are needed to compare diffusion tensor imaging with CEUS. Finally, in the patient population, time to surgery after tSCI is likely to be variable.…”

Section: Limitationsmentioning

confidence: 99%

Contrast-enhanced ultrasound to visualize hemodynamic changes after rodent spinal cord injury

Khaing¹,

Cates²,

Dewees³

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVETraumatic spinal cord injury (tSCI) causes an almost complete loss of blood flow at the site of injury (primary injury) as well as significant hypoperfusion in the penumbra of the injury. Hypoperfusion in the penumbra progresses after injury to the spinal cord and is likely to be a major contributor to progressive cell death of spinal cord tissue that was initially viable (secondary injury). Neuroprotective treatment strategies seek to limit secondary injury. Clinical monitoring of the temporal and spatial patterns of blood flow within the contused spinal cord is currently not feasible. The purpose of the current study was to determine whether ultrafast contrast-enhanced ultrasound (CEUS) Doppler allows for detection of local hemodynamic changes within an injured rodent spinal cord in real time.METHODSA novel ultrafast CEUS Doppler technique was developed utilizing a research ultrasound platform combined with a 15-MHz linear array transducer. Ultrafast plane-wave acquisitions enabled the separation of higher-velocity blood flow in macrocirculation from low-velocity flow within the microcirculation (tissue perfusion). An FDA-approved contrast agent (microbubbles) was used for visualization of local blood flow in real time. CEUS Doppler acquisition protocols were developed to characterize tissue perfusion both during contrast inflow and during the steady-state plateau. A compression injury of the thoracic spinal cord of adult rats was induced using iris forceps.RESULTSHigh-frequency ultrasound enabled visualization of spinal cord vessels such as anterior spinal arteries as well as central arteries (mean diameter [± SEM] 145.8 ± 10.0 µm; 76.2 ± 4.5 µm, respectively). In the intact spinal cord, ultrafast CEUS Doppler confirmed higher perfusion of the gray matter compared to white matter. Immediately after compression injury of the thoracic rodent spinal cord, spinal cord vessels were disrupted in an area of 1.93 ± 1.14 mm2. Ultrafast CEUS Doppler revealed a topographical map of local tissue hypoperfusion with remarkable spatial resolution. Critical loss of perfusion, defined as less than 40% perfusion compared to the surrounding spared tissue, was seen within an area of 2.21 ± 0.6 mm2.CONCLUSIONSIn our current report, we introduce ultrafast CEUS Doppler for monitoring of spinal vascular structure and function in real time. Development and clinical implementation of this type of imaging could have a significant impact on the care of patients with tSCI.

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“…Moreover, recent developments of the spinal cord atlas with a probabilistic atlas of the spinal cord, e.g., the dorsal column, are available as a part of the Spinal Cord Toolbox (SCT) 31 . Spinal cord analysis based on SCT showed high reproducibility 32 , 33 and is expected to describe each anatomic structure in the spinal cord 34 more precisely than the past arbitrary region-of-interest-based studies.…”

Section: Introductionmentioning

confidence: 99%

Application of Quantitative Microstructural MR Imaging with Atlas-based Analysis for the Spinal Cord in Cervical Spondylotic Myelopathy

Hori

Hagiwara

Fukunaga

et al. 2018

Sci Rep

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Mapping of MR fiber g-ratio, which is the ratio of the diameter of the axon to the diameter of the neuronal fiber, is introduced in this article. We investigated the MR fiber g-ratio, the axon volume fraction (AVF) and the myelin volume fraction (MVF) to evaluate microstructural changes in the spinal cord in patients with cervical spondylotic myelopathy (CSM) in vivo, using atlas-based analysis. We used diffusion MRI data acquired with a new simultaneous multi-slice accelerated readout-segmented echo planar imaging sequence for diffusion analysis for AVF calculation and magnetization transfer saturation imaging for MVF calculation. The AVFs of fasciculus gracilis in the affected side spinal cord, fasciculus cuneatus and lateral corticospinal tracts (LSCT) in the affected and unaffected side spinal cord were significantly lower (P = 0.019, 0.001, 0019, 0.000, and 0.002, respectively) than those of normal controls. No difference was found in the MVFs. The fiber g-ratio of LSCT was significantly lower (P = 0.040) in the affected side spinal cords than in the normal controls. The pathological microstructural changes in the spinal cord in patients with CSM, presumably partial axonal degenerations with preserved myelin. This technique has the potential to be a clinical biomarker in patients with CSM in vivo.

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Test-Retest and Interreader Reproducibility of Semiautomated Atlas-Based Analysis of Diffusion Tensor Imaging Data in Acute Cervical Spine Trauma in Adult Patients

Abstract: BACKGROUND AND PURPOSE: DTI is a tool for microstructural spinal cord injury evaluation. This study evaluated the reproducibility of a semiautomated segmentation algorithm of spinal cord DTI.

Cited by 9 publications

References 30 publications

Longitudinal quantitative magnetic resonance imaging in adrenomyeloneuropathy

Longitudinal quantitative magnetic resonance imaging in adrenomyeloneuropathy

Contrast-enhanced ultrasound to visualize hemodynamic changes after rodent spinal cord injury

Application of Quantitative Microstructural MR Imaging with Atlas-based Analysis for the Spinal Cord in Cervical Spondylotic Myelopathy

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