Mummaneni Nikhil, Burke John F, DiGiorgio Anthony M, Thomas Leigh H, Duong-Fernandez Xuan, Harris Mark, Pascual Lisa U, Ferguson Adam R, Russell Huie J, Pan Jonathan Z, Hemmerle Debra D, Singh Vineeta, Torres-Espin Abel, Omondi Cleopa, Kyritsis Nikos, Weinstein Phillip R, Whetstone William D, Manley Geoffrey T, Bresnahan Jacqueline C, Beattie Michael S, Cohen-Adad Julien, Dhall Sanjay S, Talbott Jason F
Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
J Clin Neurosci. 2020 Dec;82(Pt B):231-236. doi: 10.1016/j.jocn.2020.11.003. Epub 2020 Nov 25.
Conventional MRI measures of traumatic spinal cord injury severity largely rely on 2-dimensional injury characteristics such as intramedullary lesion length and cord compression. Recent advances in spinal cord (SC) analysis have led to the development of a robust anatomic atlas incorporated into an open-source platform called the Spinal Cord Toolbox (SCT) that allows for quantitative volumetric injury analysis. In the current study, we evaluate the prognostic value of volumetric measures of spinal cord injury on MRI following registration of T2-weighted (T2w) images and segmented lesions from acute SCI patients with a standardized atlas. This IRB-approved prospective cohort study involved the image analysis of 60 blunt cervical SCI patients enrolled in the TRACK-SCI clinical research protocol. Axial T2w MRI data obtained within 24 h of injury were processed using the SCT. Briefly, SC MRIs were automatically segmented using the sct_deepseg_sc tool in the SCT and segmentations were manually corrected by a neuro-radiologist. Lesion volume data were used as predictor variables for correlation with lower extremity motor scores at discharge. Volumetric MRI measures of T2w signal abnormality comprising the SCI lesion accurately predict lower extremity motor scores at time of patient discharge. Similarly, MRI measures of injury volume significantly correlated with motor scores to a greater degree than conventional 2-D metrics of lesion size. The volume of total injury and of injured spinal cord motor regions on T2w MRI is significantly and independently associated with neurologic outcome at discharge after injury.
传统的创伤性脊髓损伤严重程度的MRI测量主要依赖于二维损伤特征，如髓内病变长度和脊髓压迫。脊髓（SC）分析的最新进展导致了一个强大的解剖图谱的开发，该图谱被纳入一个名为脊髓工具箱（SCT）的开源平台，该平台允许进行定量体积损伤分析。在本研究中，我们使用标准化图谱对急性脊髓损伤患者的T2加权（T2w）图像和分割病变进行配准后，评估MRI上脊髓损伤体积测量的预后价值。这项经机构审查委员会批准的前瞻性队列研究涉及对60名纳入TRACK-SCI临床研究方案的钝性颈髓损伤患者的图像分析。使用SCT对受伤后24小时内获得的轴向T2w MRI数据进行处理。简而言之，使用SCT中的sct_deepseg_sc工具自动分割脊髓MRI，并由神经放射科医生手动校正分割结果。病变体积数据用作预测变量，以与出院时的下肢运动评分进行相关性分析。包含脊髓损伤病变的T2w信号异常的体积MRI测量准确预测患者出院时的下肢运动评分。同样，损伤体积的MRI测量与运动评分的相关性比传统的二维病变大小指标更大。T2w MRI上的总损伤体积和受损脊髓运动区域的体积与损伤后出院时的神经功能结果显著且独立相关。
