Wyss Patrik O, Richter Johannes K, Zweers Peter, Brust Anne K, Funk Corinne, Zoelch Niklaus, Vallesi Vanessa, Verma Rajeev K, Hock Andreas, Berger Markus F, Scheel-Sailer Anke, Henning Anke
From the Department of Radiology, Swiss Paraplegic Centre, Nottwil.
Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil.
Invest Radiol. 2023 Feb 1;58(2):131-138. doi: 10.1097/RLI.0000000000000905. Epub 2022 Aug 2.
In spinal cord injury (SCI), the primary mechanical injury is followed by secondary sequelae that develop over the subsequent months and manifests in biochemical, functional, and microstructural alterations, at the site of direct injury but also in the spinal cord tissue above and below the actual lesion site. Noninvasive magnetic resonance spectroscopy (MRS) can be used to assess biochemical modulation occurring in the secondary injury phase, in addition to and supporting conventional MRI, and might help predict and improve patient outcome. In this article, we aimed to examine the metabolic levels in the pons of subacute SCI by means of in vivo proton MRS at 3 T and explore the association to clinical scores.
In this prospective study, between November 2015 and February 2018, single-voxel short-echo MRS data were acquired in healthy controls and in SCI subjects in the pons once during rehabilitation. Besides the single-point MRS examination, in addition, in participants with SCI, the clinical status (ie, motor, light touch, and pinprick scores) was assessed twice: (1) around the MRS session (approximately 10 weeks postinjury) and (2) before discharge (at approximately 9 months postinjury). The group differences were assessed with Kruskal-Wallis test, the post hoc comparison was assessed with Wilcoxon rank sum test, and the clinical correlations were conducted with Spearman rank correlation test. Bayes factor calculations completed the statistical part providing relevant evidence values.
Twenty healthy controls (median age, 50 years; interquartile range, 41-55 years; 18 men) and 18 subjects with traumatic SCI (median age, 50 years; interquartile range, 32-58 years; 16 men) are included. Group comparison showed an increase of total N -acetylaspartate and combined glutamate and glutamine levels in complete SCI and a reduction of total creatine in incomplete paraplegic SCI. The proton MRS-based glutathione levels at baseline correlate to the motor score improvement during rehabilitation in incomplete subacute SCI.
This exploratory study showed an association of the metabolite concentration of glutathione in the pons assessed at approximately 10 weeks after injury with the improvements of the motor score during the rehabilitation. Pontine glutathione levels in subjects with traumatic subacute incomplete SCI acquired remote from the injury site correlate to clinical score and might therefore be beneficial in the rehabilitation assessments.
在脊髓损伤（SCI）中，原发性机械损伤之后会出现继发性后遗症，这些后遗症会在随后的几个月中逐渐发展，并在直接损伤部位以及实际损伤部位上方和下方的脊髓组织中表现为生化、功能和微观结构的改变。除了传统的MRI并作为其辅助手段外，无创磁共振波谱（MRS）可用于评估继发性损伤阶段发生的生化调节，并且可能有助于预测和改善患者的预后。在本文中，我们旨在通过3T的体内质子MRS检查亚急性SCI患者脑桥中的代谢水平，并探讨其与临床评分的相关性。
在这项前瞻性研究中，于2015年11月至2018年2月期间，在康复期间对健康对照者和SCI患者的脑桥进行了单体素质子短回波MRS数据采集。除了单点MRS检查外，对于SCI患者，还对其临床状态（即运动、轻触觉和针刺觉评分）进行了两次评估：（1）在MRS检查期间（受伤后约10周）；（2）出院前（受伤后约9个月）。采用Kruskal-Wallis检验评估组间差异，采用Wilcoxon秩和检验进行事后比较，并采用Spearman秩相关检验进行临床相关性分析。贝叶斯因子计算完成了提供相关证据值的统计部分。
纳入了20名健康对照者（年龄中位数为50岁；四分位间距为41-55岁；男性18名）和18名创伤性SCI患者（年龄中位数为50岁；四分位间距为32-58岁；男性16名）。组间比较显示，完全性SCI患者的总N-乙酰天门冬氨酸以及谷氨酸和谷氨酰胺的总量增加，不完全性截瘫SCI患者的总肌酸减少。在亚急性不完全性SCI患者中，基于质子MRS的基线谷胱甘肽水平与康复期间运动评分的改善相关。
这项探索性研究表明，受伤后约10周评估的脑桥中谷胱甘肽代谢物浓度与康复期间运动评分的改善相关。在远离损伤部位采集的创伤性亚急性不完全性SCI患者中，脑桥谷胱甘肽水平与临床评分相关，因此可能有助于康复评估。
