Martin Allan R, De Leener Benjamin, Cohen-Adad Julien, Cadotte David W, Nouri Aria, Wilson Jefferson R, Tetreault Lindsay, Crawley Adrian P, Mikulis David J, Ginsberg Howard, Fehlings Michael G
Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Institute of Biomedical Engineering, École Polytechnique de Montréal, Montréal, Québec, Canada.
BMJ Open. 2018 Apr 13;8(4):e019809. doi: 10.1136/bmjopen-2017-019809.
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.
Prospective observational longitudinal cohort study.
Single centre, tertiary care and research institution.
40 neurologically intact subjects (19 female, 21 male) divided into groups with and without ASCC.
None.
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.
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.
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.
退行性颈椎脊髓病（DCM）涉及脊髓外部受压，导致组织损伤和神经功能障碍。无症状脊髓受压（ASCC）更为常见，但其意义尚不明确。本研究调查：（1）能否使用脊髓形态分析自动诊断ASCC；（2）多参数定量MRI能否检测到与先前在DCM中观察到的类似脊髓组织损伤。
前瞻性观察性纵向队列研究。
单中心三级医疗和研究机构。
40名神经功能正常的受试者（19名女性，21名男性），分为有ASCC组和无ASCC组。
无。
临床评估：改良日本骨科协会评分和体格检查。3T MRI评估：自动形态计量分析与脊髓受压的一致性评级比较，以及组织损伤测量：从延髓（C1 - 3）、尾端（C6 - 7）和最大受压水平提取的横截面积、扩散分数各向异性、磁化传递率和T2加权成像白质与灰质信号强度比（T2WI WM/GM）。
40名受试者中有20名存在ASCC。自动形状分析诊断的曲线下面积>97%。与未受压受试者相比，5项MRI指标显示ASCC中存在提示组织损伤的差异（p<0.05），而所有10项测量指标的综合指标（z评分平均值）显示出高度显著差异（p = 0.002）。随访（中位时间21个月）时，2名ASCC受试者发展为DCM。
ASCC似乎很常见，可通过自动形态计量分析准确、客观地诊断。定量MRI似乎能在神经症状和体征出现之前检测到ASCC中的亚临床组织损伤。这些发现需要进一步验证，但为DCM和其他脊柱疾病的症状前诊断和治疗提供了有趣的可能性。
