The current state-of-the-art of spinal cord imaging: Applications

Abstract

A first-ever spinal cord imaging meeting was sponsored by the International Spinal Research Trust and the Wings for Life Foundation with the aim of identifying the current state-of-the-art of spinal cord imaging, the current greatest challenges, and greatest needs for future development. This meeting was attended by a small group of invited experts spanning all aspects of spinal cord imaging from basic research to clinical practice. The greatest current challenges for spinal cord imaging were identified as arising from the imaging environment itself; difficult imaging environment created by the bone surrounding the spinal canal, physiological motion of the cord and adjacent tissues, and small crosssectional dimensions of the spinal cord, exacerbated by metallic implants often present in injured patients. Challenges were also identified as a result of a lack of “critical mass” of researchers taking on the development of spinal cord imaging, affecting both the rate of progress in the field, and the demand for equipment and software to manufacturers to produce the necessary tools. Here we define the current state-of-the-art of spinal cord imaging, discuss the underlying theory and challenges, and present the evidence for the current and potential power of these methods. In two review papers (part I and part II), we propose that the challenges can be overcome with advances in methods, improving availability and effectiveness of methods, and linking existing researchers to create the necessary scientific and clinical network to advance the rate of progress and impact of the research.

Injury alters intrinsic functional connectivity within the primate spinal cord

“…The fMRI activation in contralateral dorsal horns has been reported in human spinal fMRI studies, but the results so far have been inconsistent with respect to which horn is engaged in pain versus touch processing, partly due to the relatively low spatial resolution in conventional human 3T MRI studies (22, 23) (for recent reviews, see refs. 24,25). The contralateral dorsal horn activation we detected may be a result of feedback-descending modulation (20,21) or from commissural connections between dorsal horns (26).…”

Characterizing the Location of Spinal and Vertebral Levels in the Human Cervical Spinal Cord

“…12,18 The development of methods to manage the hostile imaging environment and to account for cardiorespiratory-related motion has allowed improved applications to detect structural (such as diffusion and magnetization transfer imaging) and functional anomalies that occur in relation to traumatic injury of the spinal cord. 1,2,19,20 Other disorders, such as multiple sclerosis, have also benefited from spinal cord imaging.…”

“…12 To perform this characterization, we used the longitudinal axis of the brain stemspinal cord to perform measurements, therefore accounting for the unique anatomy of a single subject. A detailed understanding of a single subject's anatomy is an important aspect of using advanced MR imaging-based metrics (such as diffusion-or magnetization transfer-based measurements) to refine the diagnosis of spinal cord pathology and follow the effect of novel therapeutic agents.…”

A Novel MRI Biomarker of Spinal Cord White Matter Injury: T2*-Weighted White Matter to Gray Matter Signal Intensity Ratio

“…1,2 However, efforts to apply qMRI in clinical studies have thus far achieved only modest success. 3 The strongest results include cross-sectional area (CSA) as a measure of spinal cord atrophy, the DTI metric fractional anisotropy (FA) to evaluate axonal integrity, and the magnetization transfer ratio (MTR) as a measure of demyelination.…”