Voxel-wise mapping of cervical cord damage in multiple sclerosis patients with different clinical phenotypes

Rocca, Maria A.; Valsasina, Paola; Damjanovic, Dusan; Horsfield, Mark A.; Mesaroš, Šarlota; Stošić-Opinćal, Tatjana; Drulović, Jelena; Filippi, Massimo

doi:10.1136/jnnp-2012-303821

Cited by 44 publications

(45 citation statements)

References 38 publications

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“…Morphometry studies using statistical mapping methods have so far only been performed on the cord itself to study SC atrophy in MS patients (Rocca et al, 2013;Valsasina et al, 2013) or aging (Valsasina et al, 2012). While demonstrating the feasibility of SC Voxel-Based Morphometry, potential GM alteration was not assessed in these studies, mainly because of a lack of contrast on the sequence used (T 1 -weighted acquisitions), but more generally, because of a lack of post-processing tools such as white and gray matter templates and common space for registration.…”

Section: Spinal Cord Tbm For Age-related Changes Characterizationmentioning

confidence: 99%

“…Nonetheless, although both VBM and TBM are widely used in neuroimaging to study brain structural alterations, their application in spinal cord studies have been very sparse and limited to the cord itself, without tissue-specific information on the WM and GM (Rocca et al, 2013;Valsasina et al, 2012Valsasina et al, , 2013 mainly because of the lack of robust automated GM segmentation method and proper non-linear normalization procedures. Having such tools at disposal would allow subtler morphometric studies of regional structural alterations in the SC and thereby give an increased understanding of some neurodegenerative processes occurring with age or central nervous system (CNS) pathologies such as amyotrophic lateral sclerosis (ALS), which specifically affects cortical and spinal motor neurons, as well as corticospinal tracts.…”

Section: Introductionmentioning

confidence: 99%

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A reliable spatially normalized template of the human spinal cord — Applications to automated white matter/gray matter segmentation and tensor-based morphometry (TBM) mapping of gray matter alterations occurring with age

et al. 2015

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Section: Spinal Cord Tbm For Age-related Changes Characterizationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A reliable spatially normalized template of the human spinal cord — Applications to automated white matter/gray matter segmentation and tensor-based morphometry (TBM) mapping of gray matter alterations occurring with age

et al. 2015

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“…The use of this method in a multicenter study to investigate the correlation between cord atrophy and clinical disability in a large sample of MS patients has demonstrated that CSA differs significantly among the main MS clinical phenotypes and it is correlated with EDSS, with a differential effect among disease clinical phenotypes: no association in either CIS patients or in benign MS; association in RRMS, SPMS and primary progressive (PP) MS (Rocca et al, 2011). Combining the AS method with voxel based analysis of structural scans of the spinal cord has the potential to provide an insight into localized changes in patients with MS (Rocca et al, 2013; Valsasina et al, 2013). These results suggest that cervical cord atrophy provides a relevant and useful marker for the characterization of clinical heterogeneity of MS patients.…”

Section: Multiple Sclerosismentioning

confidence: 99%

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

et al. 2014

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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.

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“…Previous spinal cord voxel-based analyses have relied on sagittal-based registration. 9 Axial imaging can provide higher cross-sectional resolution than sagittal imaging for anisotropic voxel dimensions. We defined upper and lower limits of C1 and C5 individually to maintain some degree of longitudinal anatomical correspondence.…”

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confidence: 99%

Voxel-based cervical spinal cord mapping of diffusion abnormalities in MS-related myelitis

et al. 2014

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Objective: To apply a novel postprocessing voxel-based analysis for diffusion tensor imaging of the cervical spinal cord in multiple sclerosis (MS) in a prospective cross-sectional study.Methods: Fourteen patients with MS who were within 4 weeks of the onset of cervical myelitis (lesion C1-3) and 11 healthy controls underwent cervical spinal cord diffusion tensor imaging. Cervical spinal cord maps of fractional anisotropy (FA), mean diffusivity, radial diffusivity (RD), and axial diffusivity were registered and compared between patients and controls. Mean FA and RD values from significant thresholded clusters were regressed with clinical scores, after adjusting for cord area and age, to determine associations with physical disability.Results: Cord registrations for subjects were qualitatively assessed (scored out of 5) and those with low scores (1 or 2) were excluded from further analysis. Cord registration was considered good in 11 patients (6 females; mean age 5 35.5 years) and 10 controls (6 females; mean age 44 years). Voxel-based comparisons showed patients with MS had lower FA and higher RD at C2-3 levels (left .right mainly in gray matter; p , 0.01, uncorrected). Extracted values of both FA and RD from thresholded clusters were significantly associated with greater disability measured using the Expanded Disability Status Scale and Timed 25-Foot Walk Test in patients with MS.Conclusions: Mapping diffusion abnormalities within the cervical spinal cord using a novel voxelbased approach can localize clinically relevant pathology. Most studies reporting multiple sclerosis (MS)-related diffusion tensor imaging (DTI) changes in the cervical spinal cord have utilized region-of-interest or histogram-based analyses.1-3 Voxel-based analysis is technically challenging because of difficulties with registration due to the cord's small diameter and relative lack of spatial features 4 but can spatially localize abnormalities in an unbiased manner and can direct region-of-interest analyses to investigate clinicopathologic correlations, effectively providing greater statistical power. Clinically, localizing pathology to specific tracts may help to predict long-term clinical motor or sensory disability and guide treatment trials. As an early step toward this goal, we present findings from a novel postprocessing DTI voxel-based analysis for people with MS-related acute cervical myelitis. We hypothesized that fractional anisotropy (FA) reductions are spatially localized in the cord and correlate with measures of disability.METHODS We recruited 14 patients with MS who attended the MS outpatient clinic from 2005 to 2006 at the National Hospital for Neurology and Neurosurgery, London, UK, with acute motor and sensory signs attributable to at least one cervical lesion between C1-3 on conventional MRI. The clinical and radiologic characteristics of these patients have been previously described.3 Eleven age-and sex-matched healthy controls were also recruited.

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Voxel-wise mapping of cervical cord damage in multiple sclerosis patients with different clinical phenotypes

Abstract: Voxel-based assessment of cervical cord damage is feasible and may contribute to a better characterisation of the clinical heterogeneity of MS patients.

Cited by 44 publications

References 38 publications

A reliable spatially normalized template of the human spinal cord — Applications to automated white matter/gray matter segmentation and tensor-based morphometry (TBM) mapping of gray matter alterations occurring with age

A reliable spatially normalized template of the human spinal cord — Applications to automated white matter/gray matter segmentation and tensor-based morphometry (TBM) mapping of gray matter alterations occurring with age

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

Voxel-based cervical spinal cord mapping of diffusion abnormalities in MS-related myelitis

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