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Can microstructural MRI detect subclinical tissue injury in subjects with asymptomatic cervical spinal cord compression? A prospective cohort study

Allan R. Martin, Benjamin De Leener, Julien Cohen-Adad, David W. Cadotte, Aria Nouri, Jefferson R. Wilson, Lindsay Tetreault, Adrian P. Crawley, David J. Mikulis, Howard Ginsberg and Michael G. Fehlings

Article (2018)

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OBJECTIVES: Degenerative cervical myelopathy (DCM) involves extrinsic spinal cord compression causing tissue injury and neurological dysfunction. Asymptomatic spinal cord compression (ASCC) is more common, but its significance is poorly defined. This study investigates if: (1) ASCC can be automatically diagnosed using spinal cord shape analysis; (2) multiparametric quantitative MRI can detect similar spinal cord tissue injury as previously observed in DCM. DESIGN: Prospective observational longitudinal cohort study. SETTING: Single centre, tertiary care and research institution. PARTICIPANTS: 40 neurologically intact subjects (19 female, 21 male) divided into groups with and without ASCC. INTERVENTIONS: None. OUTCOME MEASURES: Clinical assessments: modified Japanese Orthopaedic Association score and physical examination. 3T MRI assessments: automated morphometric analysis compared with consensus ratings of spinal cord compression, and measures of tissue injury: cross-sectional area, diffusion fractional anisotropy, magnetisation transfer ratio and T2*-weighted imaging white to grey matter signal intensity ratio (T2*WI WM/GM) extracted from rostral (C1-3), caudal (C6-7) and maximally compressed levels. RESULTS: ASCC was present in 20/40 subjects. Diagnosis with automated shape analysis showed area under the curve >97%. Five MRI metrics showed differences suggestive of tissue injury in ASCC compared with uncompressed subjects (p<0.05), while a composite of all 10 measures (average of z scores) showed highly significant differences (p=0.002). At follow-up (median 21 months), two ASCC subjects developed DCM. CONCLUSIONS: ASCC appears to be common and can be accurately and objectively diagnosed with automated morphometric analysis. Quantitative MRI appears to detect subclinical tissue injury in ASCC prior to the onset of neurological symptoms and signs. These findings require further validation, but offer the intriguing possibility of presymptomatic diagnosis and treatment of DCM and other spinal pathologies.

Uncontrolled Keywords

Adult; Cervical Vertebrae; Female; Humans; Longitudinal Studies; *Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Spinal Cord; *Spinal Cord Compression/diagnostic imaging; Spinal Cord Diseases; *diffusion tensor imaging; *magnetization transfer; *myelopathy; *preclinical; *quantitative mri; *spinal cord injury

Subjects: 1900 Biomedical engineering > 1901 Biomedical technology
9000 Health sciences > 9000 Health sciences
Department: Institut de génie biomédical
Funders: Rick Hansen Institute, Dezwirek Foundation, Sherman Clinical Research Unit, Gerald and Tootsie Halbert Chair in Spinal Cord Research, Canadian Institutes of Health Research
Grant number: RHI-2014-12, 201511MFE-359116-246227
PolyPublie URL: https://publications.polymtl.ca/5020/
Journal Title: BMJ Open (vol. 8, no. 4)
Publisher: BMJ Publishing Group Ltd
DOI: 10.1136/bmjopen-2017-019809
Official URL: https://doi.org/10.1136/bmjopen-2017-019809
Date Deposited: 06 Jan 2022 14:03
Last Modified: 12 May 2023 23:22
Cite in APA 7: Martin, A. R., De Leener, B., Cohen-Adad, J., Cadotte, D. W., Nouri, A., Wilson, J. R., Tetreault, L., Crawley, A. P., Mikulis, D. J., Ginsberg, H., & Fehlings, M. G. (2018). Can microstructural MRI detect subclinical tissue injury in subjects with asymptomatic cervical spinal cord compression? A prospective cohort study. BMJ Open, 8(4), e019809 (11 pages). https://doi.org/10.1136/bmjopen-2017-019809


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