Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
J Neurotrauma. 2020 Feb 1;37(3):458-465. doi: 10.1089/neu.2019.6394. Epub 2019 Aug 2.
This prospective longitudinal study compares the ability of conventional and diffusion tensor imaging (DTI) parameters made at the cervical spinal cord injury (CSCI) site to predict long-term neurological and functional outcomes. Twenty patients with CSCI, with follow-up at 6 or 12 months, and 15 control volunteers were included. Conventional magnetic resonance imaging (MRI) and DTI parameters were measured on admission and follow-up studies. Stepwise regression analysis was performed to find relevant parameters (normalized DTI values, conventional MRI measurements, hemorrhagic contusion [HC] or non-HC [NHC]) that correlated with three primary outcome measures: patient International Standards for Neurological Classification of Spinal Cord Injury total motor score (ISNCSCI-TMS), ability to walk, and expected recovery of upper limb motor scores (ER-ULMS) at 6 or 12 months. Univariate analysis showed HC ( < 0.0001 to 0.0098), lesion length on follow-up MRI ( < 0.0001 to 0.019), mean diffusivity ( = 0.01 to 0.045), and axial diffusivity ( = 0.004 to 0.023) predicted all three primary outcomes. Conspicuity of HC was significantly better on axial susceptibility-weighted imaging (SWI) compared with T2* images ( = 0.0009). A negative correlation existed between HC volumes on sagittal SWI images and follow-up ISNCSCI-TMS ( = 0.02). The regression model identified NHC as the best predictor of the ability to walk (sensitivity = 88.9%; specificity = 100%; positive predictive value = 100%; negative predictive value = 91%; < 0.0001) and lesion length on follow-up MRI as the best predictor of ER-ULMS (β coefficient = 0.12, standard error [SE] = 0.07; R = 0.64; = 0.0002). Finally, NHC (β coefficient = 24.2, SE = 3.7; < 0.0001) and lesion length on initial MRI (β coefficient = 0.78, SE = 0.2; = 0.002) were the best predictors of ISNCSCI-TMS (R = 0.83; < 0.0001). Our study demonstrates HC and follow-up lesion length are potential neuroimaging biomarkers in predicting long-term neurological and functional outcome following blunt CSCI.
本前瞻性纵向研究比较了颈椎脊髓损伤（CSCI）部位常规和弥散张量成像（DTI）参数预测长期神经和功能结局的能力。纳入 20 例 CSCI 患者，在 6 或 12 个月时进行随访，以及 15 名对照志愿者。在入院和随访研究中测量常规磁共振成像（MRI）和 DTI 参数。进行逐步回归分析以寻找与三个主要结局测量相关的相关参数（归一化 DTI 值、常规 MRI 测量、出血性挫伤[HC]或非 HC[NHC]）：患者国际脊髓损伤神经分类标准总运动评分（ISNCSCI-TMS）、行走能力和上肢运动评分的预期恢复（ER-ULMS）在 6 或 12 个月时。单变量分析显示 HC（ < 0.0001 至 0.0098）、随访 MRI 上的病变长度（ < 0.0001 至 0.019）、平均弥散度（ = 0.01 至 0.045）和轴向弥散度（ = 0.004 至 0.023）预测了所有三个主要结局。轴位磁化率加权成像（SWI）上 HC 的显影明显优于 T2*图像（ = 0.0009）。矢状 SWI 图像上 HC 体积与随访 ISNCSCI-TMS 之间存在负相关（ = 0.02）。回归模型确定 NHC 是行走能力（灵敏度 = 88.9%；特异性 = 100%；阳性预测值 = 100%；阴性预测值 = 91%； < 0.0001）和随访 MRI 上病变长度的最佳预测因子（β系数 = 0.12，标准误差[SE] = 0.07；R = 0.64； = 0.0002）。最后，NHC（β系数 = 24.2，SE = 3.7； < 0.0001）和初始 MRI 上的病变长度（β系数 = 0.78，SE = 0.2； = 0.002）是 ISNCSCI-TMS（R = 0.83； < 0.0001）的最佳预测因子。我们的研究表明，HC 和随访病变长度是预测钝性 CSCI 后长期神经和功能结局的潜在神经影像学生物标志物。
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