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Monitoring for myelopathic progression with multiparametric quantitative MRI

Allan R. Martin, Benjamin De Leener, Julien Cohen-Adad, Sukhvinder Kalsi-Ryan, David W. Cadotte, Jefferson R. Wilson, Lindsay Tétreault, Aria Nouri, Adrian Crawley, David J. Mikulis, Howard Ginsberg, Eric M. Massicotte and Michael G. Fehlings

Article (2018)

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Abstract

BACKGROUND: Patients with mild degenerative cervical myelopathy (DCM) are often managed non-operatively, and surgery is recommended if neurological progression occurs. However, detection of progression is often subjective. Quantitative MRI (qMRI) directly measures spinal cord (SC) tissue changes, detecting axonal injury, demyelination, and atrophy. This longitudinal study compared multiparametric qMRI with clinical measures of progression in non-operative DCM patients. METHODS: 26 DCM patients were followed. Clinical data included modified Japanese Orthopedic Association (mJOA) and additional assessments. 3T qMRI data included cross sectional area, diffusion fractional anisotropy, magnetization transfer ratio, and T2*-weighted white/grey matter signal ratio, extracted from the compressed SC and above/below. Progression was defined as 1) patients' subjective impression, 2) 2-point mJOA decrease, 3) >/=3 clinical measures worsening >/=5%, 4) increased compression on MRI, or 5) >/=1 of 10 qMRI measures or composite score worsening (p < 0.004, corrected). RESULTS: Follow-up (13.5 +/- 4.9 months) included mJOA in all 26 patients, MRI in 25, and clinical/qMRI in 22. 42.3% reported subjective worsening, compared with mJOA (11.5%), MRI (20%), comprehensive assessments (54.6%), and qMRI (68.2%). Relative to subjective worsening, qMRI showed 100% sensitivity and 53.3% specificity compared with comprehensive assessments (75%, 60%), mJOA (27.3%, 100%), and MRI (18.2%, 81.3%). A decision-making algorithm incorporating qMRI identified progression and recommended surgery for 11 subjects (42.3%). CONCLUSIONS: Quantitative MRI shows high sensitivity to detect myelopathic progression. Our results suggest that neuroplasticity and behavioural adaptation may mask progressive SC tissue injury. qMRI appears to be a useful method to confirm subtle myelopathic progression in individual patients, representing an advance toward clinical translation of qMRI.

Uncontrolled Keywords

Aged; Algorithms; Clinical Decision-Making; Disease Management; Disease Progression; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Longitudinal Studies; *Magnetic Resonance Imaging/methods; Male; Middle Aged; Spinal Cord Diseases/*diagnostic imaging/*pathology/therapy

Subjects: 1900 Biomedical engineering > 1900 Biomedical engineering
1900 Biomedical engineering > 1901 Biomedical technology
9000 Health sciences > 9000 Health sciences
Department: Department of Electrical Engineering
Department of Computer Engineering and Software Engineering
Institut de génie biomédical
PolyPublie URL: https://publications.polymtl.ca/5021/
Journal Title: PLOS One (vol. 13, no. 4)
Publisher: PLOS
DOI: 10.1371/journal.pone.0195733
Official URL: https://doi.org/10.1371/journal.pone.0195733
Date Deposited: 13 Jan 2022 10:55
Last Modified: 10 Apr 2024 20:39
Cite in APA 7: Martin, A. R., De Leener, B., Cohen-Adad, J., Kalsi-Ryan, S., Cadotte, D. W., Wilson, J. R., Tétreault, L., Nouri, A., Crawley, A., Mikulis, D. J., Ginsberg, H., Massicotte, E. M., & Fehlings, M. G. (2018). Monitoring for myelopathic progression with multiparametric quantitative MRI. PLOS One, 13(4), e0195733 (17 pages). https://doi.org/10.1371/journal.pone.0195733

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