Department of Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.
Spinal Cord Injury Center, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.
Eur Radiol. 2021 May;31(5):2923-2932. doi: 10.1007/s00330-020-07388-2. Epub 2020 Oct 30.
Wallerian degeneration (WD) is a well-known process after nerve injury. In this study, occurrence of remote intramedullary signal changes, consistent with WD, and its correlation with clinical and neurophysiological impairment were assessed after traumatic spinal cord injury (tSCI).
In 35 patients with tSCI, WD was evaluated by two radiologists on T2-weighted images of serial routine MRI examinations of the cervical spine. Dorsal column (DC), lateral corticospinal tract (CS), and lateral spinothalamic tract (ST) were the analyzed anatomical regions. Impairment scoring according to the American Spinal Injury Association Impairment Scale (AIS, A-D) as well as a scoring system (0-4 points) for motor evoked potential (MEP) and sensory evoked potential (SEP) was included. Mann-Whitney U test was used to test for differences.
WD in the DC occurred in 71.4% (n = 25), in the CS in 57.1% (n = 20), and in 37.1% (n = 13) in the ST. With WD present, AIS grades were worse for all tracts. DC: median AIS B vs D, p < 0.001; CS: B vs D, p = 0.016; and ST: B vs D, p = 0.015. More pathological MEP scores correlated with WD in the DC (median score 0 vs 3, p < 0.001) and in the CS (0 vs 2, p = 0.032). SEP scores were lower with WD in the DC only (1 vs 2, p = 0.031).
WD can be detected on T2-weighted scans in the majority of cervical spinal cord injury patients and should be considered as a direct effect of the trauma. When observed, it is associated with higher degree of impairment.
• Wallerian degeneration is commonly seen in routine MRI after traumatic spinal cord injury. • Wallerian degeneration is visible in the anatomical regions of the dorsal column, the lateral corticospinal tract, and the lateral spinothalamic tract. • Presence of Wallerian degeneration is associated with higher degree of impairment.
Wallerian 变性（WD）是神经损伤后的一种已知过程。本研究评估了外伤性脊髓损伤（tSCI）后，与 WD 一致的远隔髓内信号变化的发生及其与临床和神经生理学损伤的相关性。
在 35 例 tSCI 患者中，由两位放射科医生在颈椎常规 MRI 序列的 T2 加权图像上评估 WD。分析的解剖区域为背柱（DC）、外侧皮质脊髓束（CS）和外侧脊髓丘脑束（ST）。根据美国脊髓损伤协会损伤量表（AIS，A-D）进行损伤评分，以及运动诱发电位（MEP）和感觉诱发电位（SEP）评分系统（0-4 分）。采用 Mann-Whitney U 检验进行差异检验。
DC 中的 WD 发生率为 71.4%（n=25），CS 为 57.1%（n=20），ST 为 37.1%（n=13）。出现 WD 时，所有束的 AIS 分级均更差。DC：AIS B 与 D 相比，p<0.001；CS：B 与 D 相比，p=0.016；ST：B 与 D 相比，p=0.015。更多病理性 MEP 评分与 DC 中的 WD 相关（中位数评分 0 与 3，p<0.001）和 CS 中的 WD 相关（中位数评分 0 与 2，p=0.032）。仅在 DC 中，SEP 评分随 WD 降低（1 与 2，p=0.031）。
在大多数颈髓损伤患者的常规 MRI 上可以检测到 WD，应将其视为创伤的直接影响。当观察到 WD 时，它与更高程度的损伤相关。
Wallerian 变性在创伤性脊髓损伤后的常规 MRI 中很常见。
在背柱、外侧皮质脊髓束和外侧脊髓丘脑束的解剖区域可见 Wallerian 变性。
Wallerian 变性的存在与更高程度的损伤相关。
