Neurosurg Focus. 2019 Mar 1;46(3):E2. doi: 10.3171/2018.12.FOCUS18595.
OBJECTIVEConventional MRI is routinely used to demonstrate the anatomical site of spinal cord injury (SCI). However, quantitative and qualitative imaging parameters have limited use in predicting neurological outcomes. Currently, there are no reliable neuroimaging biomarkers to predict short- and long-term outcome after SCI.METHODSA prospective cohort of 23 patients with SCI (19 with cervical SCI [CSCI] and 4 with thoracic SCI [TSCI]) treated between 2007 and 2014 was included in the study. The American Spinal Injury Association (ASIA) score was determined at the time of arrival and at 1-year follow-up. Only 15 patients (12 with CSCI and 3 with TSCI) had 1-year follow-up. Whole-cord fractional anisotropy (FA) was determined at C1-2, following which C1-2 was divided into upper, middle, and lower segments and the corresponding FA value at each of these segments was calculated. Correlation analysis was performed between FA and ASIA score at time of arrival and 1-year follow-up.RESULTSCorrelation analysis showed a positive but nonsignificant correlation (p = 0.095) between FA and ASIA score for all patients (CSCI and TCSI) at the time of arrival. Additional regression analysis consisting of only patients with CSCI showed a significant correlation (p = 0.008) between FA and ASIA score at time of arrival as well as at 1-year follow-up (p = 0.025). Furthermore, in case of patients with CSCI, a significant correlation between FA value at each of the segments (upper, middle, and lower) of C1-2 and ASIA score at time of arrival was found (p = 0.017, p = 0.015, and p = 0.002, respectively).CONCLUSIONSIn patients with CSCI, the measurement of diffusion anisotropy of the high cervical cord (C1-2) correlates significantly with injury severity and long-term follow-up. However, this correlation is not seen in patients with TSCI. Therefore, FA can be used as an imaging biomarker for evaluating neural injury and monitoring recovery in patients with CSCI.
常规 MRI 用于显示脊髓损伤（SCI）的解剖部位。然而，定量和定性成像参数在预测神经功能预后方面的作用有限。目前，尚无可靠的神经影像学生物标志物可预测 SCI 后的短期和长期预后。
本研究纳入了 2007 年至 2014 年间收治的 23 例 SCI 患者（19 例颈髓 SCI [CSCI]，4 例胸髓 SCI [TSCI]），前瞻性队列研究。患者入院时和 1 年随访时均进行美国脊髓损伤协会（ASIA）评分。仅 15 例患者（12 例 CSCI，3 例 TSCI）进行了 1 年随访。在 C1-2 水平测定整个脊髓的各向异性分数（FA），然后将 C1-2 分为上、中、下三段，计算各段相应的 FA 值。对 FA 值与入院时和 1 年随访时的 ASIA 评分进行相关性分析。
相关性分析显示，所有患者（CSCI 和 TSCI）入院时 FA 值与 ASIA 评分呈正相关，但无统计学意义（p = 0.095）。仅纳入 CSCI 患者的进一步回归分析显示，入院时和 1 年随访时 FA 值与 ASIA 评分呈显著相关性（p = 0.008，p = 0.025）。此外，对于 CSCI 患者，还发现 C1-2 各段（上、中、下）FA 值与入院时 ASIA 评分之间存在显著相关性（p = 0.017，p = 0.015，p = 0.002）。
在 CSCI 患者中，高颈段脊髓（C1-2）弥散各向异性的测量与损伤严重程度和长期随访结果显著相关。然而，在 TSCI 患者中则没有这种相关性。因此，FA 可作为一种影像学生物标志物，用于评估 CSCI 患者的神经损伤和监测恢复情况。
