From the Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, CH-8092 Zurich, Switzerland (P.O.W., A.H.); Department of Radiology, Swiss Paraplegic Centre, Nottwil, Switzerland (P.O.W.); Max Planck Institute for Biological Cybernetics, Tuebingen, Germany (P.O.W., A.H.); Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland (E.H., A.C., P.F.); Institute of Neuroradiology, University Hospital, Zurich, Switzerland (S.K.); Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, England (P.F.); Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, University College London, England (P.F.); Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (P.F.); and Institute of Physics, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany (A.H.).
Radiology. 2019 Apr;291(1):131-138. doi: 10.1148/radiol.2018181037. Epub 2019 Jan 29.
Purpose To investigate metabolic changes in chronic spinal cord injury (SCI) by applying MR spectroscopy in the cervical spinal cord. Materials and Methods Single-voxel short-echo spectroscopic data in study participants with chronic SCI and healthy control subjects were prospectively acquired in the cervical spinal cord at C2 above the level of injury between March 2016 and January 2017 and were compared between groups. Concentrations of total N-acetylaspartate (tNAA), myo-inositol (mI), total choline-containing compounds (tCho), creatine, and glutamine and glutamate complex were estimated from the acquired spectra. Participants were assessed with a comprehensive clinical evaluation investigating sensory and motor deficits. Correlation analysis was applied to investigate relationships between observed metabolic differences, lesion severity, and clinical outcome. Results There were 18 male study participants with chronic SCI (median age, 51 years; range, 30-68 years) and 11 male healthy control subjects (median age, 45 years; range, 30-67 years). At cervical level C2, tNAA/mI and tCho/mI ratios were lower in participants with SCI (tNAA/mI: -26%, P = .003; tCho/mI: -18%; P = .04) than in healthy control subjects. The magnitude of difference was greater with the severity of cord atrophy (tNAA/mI: R = 0.44, P = .003; tCho/mI: R = 0.166, P = .09). Smaller tissue bridges at the lesion site correlated with lower ratios of tNAA/mI (R = 0.69, P = .006) and tCho/mI (R = 0.51, P = .03) at the C2 level. Lower tNAA/mI and tCho/mI ratios were associated with worse sensory and motor outcomes (P < .05). Conclusion Supralesional metabolic alterations are observed in chronic spinal cord injury, likely reflecting neurodegeneration, demyelination, and astrocytic gliosis in the injured cervical cord. Lesion severity and greater clinical impairment are both linked to the biochemical changes in the atrophied cervical cord after spinal cord injury. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Lin in this issue.
目的 通过颈髓磁共振波谱（MRS）研究慢性脊髓损伤（SCI）的代谢变化。
材料与方法 2016 年 3 月至 2017 年 1 月前瞻性采集了 18 名慢性 SCI 患者和 11 名健康对照者颈髓（损伤水平以上 C2）单体素短回波 MRS 数据，并对组间数据进行比较。从采集的光谱中估算总 N-乙酰天冬氨酸（tNAA）、肌醇（mI）、总胆碱化合物（tCho）、肌酸和谷氨酰胺和谷氨酸复合物的浓度。对参与者进行全面的临床评估，以评估感觉和运动缺陷。应用相关性分析来研究观察到的代谢差异、损伤严重程度和临床结果之间的关系。
结果 18 名慢性 SCI 患者（中位年龄 51 岁，范围 30-68 岁）和 11 名健康对照者（中位年龄 45 岁，范围 30-67 岁）纳入研究。在颈髓 C2 水平，SCI 患者的 tNAA/mI 和 tCho/mI 比值较低（tNAA/mI：-26%，P =.003；tCho/mI：-18%，P =.04）。与脊髓萎缩的严重程度相比，差异程度更大（tNAA/mI：R = 0.44，P =.003；tCho/mI：R = 0.166，P =.09）。损伤部位的小组织桥与 C2 水平较低的 tNAA/mI（R = 0.69，P =.006）和 tCho/mI（R = 0.51，P =.03）比值相关。较低的 tNAA/mI 和 tCho/mI 比值与较差的感觉和运动结果相关（P <.05）。
结论 在慢性脊髓损伤中观察到超损伤代谢改变，可能反映损伤颈髓中的神经退行性变、脱髓鞘和星形胶质细胞增生。损伤严重程度和更大的临床损伤与脊髓损伤后萎缩颈髓的生化变化有关。
© 2019 RSNA，在线补充材料可用于本文。请参阅本期 Lin 编辑的社论。
