Spinal Cord Injury Center Balgrist, University Hospital, Zurich, Switzerland.
Spinal Cord Injury Center Balgrist, University Hospital, Zurich, Switzerland.
Neuroimage Clin. 2020;26:102221. doi: 10.1016/j.nicl.2020.102221. Epub 2020 Feb 25.
To quantify neurodegenerative changes along the cervical spinal cord rostral to a spinal cord injury (SCI) by means of quantitative MRI (qMRI) and to determine its relationship with clinical impairment.
Thirty chronic SCI patients (15 tetraplegics and 15 paraplegics) and 23 healthy controls underwent a high-resolution T1-weighted and myelin-sensitive magnetization transfer (MT) MRI. We assessed macro- and microstructural changes along the cervical cord from levels C1 to C4, calculating cross-sectional spinal cord area, its anterior-posterior and left-right width and myelin content (i.e. MT). Regression analysis determined associations between qMRI parameters and clinical impairment.
In SCI patients, cord area decreased by 2.67 mm (p = 0.004) and left-right width decreased by 0.35 mm (p = 0.002) per cervical cord level in the caudal direction when compared to the healthy controls. This gradient of neurodegeneration was greater in tetraplegic than paraplegics in the cross-sectional cervical cord area (by 3.28 mm, p = 0.011), left-right width (by 0.36 mm, p = 0.03), and mean cord MT (by 0.13%, p = 0.04), but independant of lesion severity (p > 0.05). Higher lesion level was associated with greater magnitudes of neurodegeneration. Greater loss in myelin content in the dorsal columns and spinothalamic tract was associated with worse light touch (p = 0.016) and pin prick score (p = 0.024), respectively.
A gradient of neurodegeneration is evident in the cervical cord remote from a SCI. Tract-specific associations with appropriate clinical outcomes highlight that remote neurodegenerative changes are clinically eloquent. Monitoring the neurodegenerative gradient could be used to track treatment effects of regenerative and neuroprotective agents, both in trials targeting cervical and thoracic SCI patients.
通过定量磁共振成像（qMRI）量化脊髓损伤（SCI）上方颈椎脊髓的神经退行性变化，并确定其与临床损伤的关系。
30 名慢性 SCI 患者（15 名四肢瘫痪患者和 15 名截瘫患者）和 23 名健康对照者接受了高分辨率 T1 加权和髓鞘敏感磁化传递（MT）MRI 检查。我们评估了 C1 至 C4 颈椎水平的脊髓的宏观和微观结构变化，计算了脊髓横截面积、前后和左右宽度以及髓鞘含量（即 MT）。回归分析确定了 qMRI 参数与临床损伤之间的关联。
与健康对照组相比，SCI 患者的脊髓面积在尾部方向每颈椎水平下降 2.67mm（p=0.004），左右宽度下降 0.35mm（p=0.002）。四肢瘫痪患者的这种神经退行性变化梯度在横断颈椎脊髓面积（大 3.28mm，p=0.011）、左右宽度（大 0.36mm，p=0.03）和平均脊髓 MT（大 0.13%，p=0.04）方面均大于截瘫患者，但与损伤严重程度无关（p>0.05）。较高的损伤水平与更大程度的神经退行性变化相关。背柱和脊髓丘脑束的髓鞘含量损失越大，轻触（p=0.016）和刺痛评分（p=0.024）越差。
在远离 SCI 的颈椎脊髓中存在神经退行性变化梯度。与适当的临床结果相关的特定于束的关联突出表明，远处的神经退行性变化在临床上是明显的。监测神经退行性变化梯度可用于跟踪再生和神经保护剂的治疗效果，无论是针对颈椎还是胸段 SCI 患者的试验。
