McCoy D B, Talbott J F, Wilson Michael, Mamlouk M D, Cohen-Adad J, Wilson Mark, Narvid J
From the Department of Radiology and Biomedical Imaging (D.B.M., J.F.T., M.D.M., Mark Wilson, J.N.), University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
Brain and Spinal Injury Center (J.F.T.), Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
AJNR Am J Neuroradiol. 2017 Feb;38(2):410-417. doi: 10.3174/ajnr.A5044. Epub 2016 Dec 15.
Recent advances in spinal cord imaging analysis have led to the development of a robust anatomic template and atlas incorporated into an open-source platform referred to as the Spinal Cord Toolbox. Using the Spinal Cord Toolbox, we sought to correlate measures of GM, WM, and cross-sectional area pathology on T2 MR imaging with motor disability in patients with acute flaccid myelitis.
Spinal cord imaging for 9 patients with acute flaccid myelitis was analyzed by using the Spinal Cord Toolbox. A semiautomated pipeline using the Spinal Cord Toolbox measured lesion involvement in GM, WM, and total spinal cord cross-sectional area. Proportions of GM, WM, and cross-sectional area affected by T2 hyperintensity were calculated across 3 ROIs: 1) center axial section of lesion; 2) full lesion segment; and 3) full cord atlas volume. Spearman rank order correlation was calculated to compare MR metrics with clinical measures of disability.
Proportion of GM metrics at the center axial section significantly correlated with measures of motor impairment upon admission ( [9] = -0.78; = .014) and at 3-month follow-up ( [9] = -0.66; = .05). Further, proportion of GM extracted across the full lesion segment significantly correlated with initial motor impairment ( [9] = -0.74, = .024). No significant correlation was found for proportion of WM or proportion of cross-sectional area with clinical disability.
Atlas-based measures of proportion of GM T2 signal abnormality measured on a single axial MR imaging section and across the full lesion segment correlate with motor impairment and outcome in patients with acute flaccid myelitis. This is the first atlas-based study to correlate clinical outcomes with segmented measures of T2 signal abnormality in the spinal cord.
脊髓成像分析的最新进展促使了一个强大的解剖模板和图谱的开发，并将其整合到一个名为脊髓工具箱的开源平台中。利用脊髓工具箱，我们试图将急性弛缓性脊髓炎患者T2加权磁共振成像上的灰质、白质和横截面积病理测量值与运动功能障碍相关联。
使用脊髓工具箱对9例急性弛缓性脊髓炎患者的脊髓成像进行分析。一个使用脊髓工具箱的半自动流程测量了病变在灰质、白质和脊髓总横截面积中的累及情况。计算了在3个感兴趣区域中受T2高信号影响的灰质、白质和横截面积的比例：1）病变的中心轴位截面；2）整个病变节段；3）整个脊髓图谱体积。计算Spearman等级相关以比较磁共振指标与残疾的临床测量值。
中心轴位截面的灰质指标比例与入院时的运动损伤测量值显著相关（r[9] = -0.78；P = 0.014）以及在3个月随访时（r[9] = -0.66；P = 0.05）。此外，在整个病变节段提取的灰质比例与初始运动损伤显著相关（r[9] = -0.74，P = 0.024）。未发现白质比例或横截面积比例与临床残疾之间存在显著相关性。
基于图谱的在单个轴位磁共振成像截面以及整个病变节段上测量的灰质T2信号异常比例与急性弛缓性脊髓炎患者的运动损伤和预后相关。这是第一项将临床结果与脊髓T2信号异常的分段测量相关联的基于图谱的研究。
