Emmenegger Tim M, Pfyffer Dario, Curt Armin, Schading-Sassenhausen Simon, Hupp Markus, Ashburner John, Friston Karl, Weiskopf Nikolaus, Thompson Alan, Freund Patrick
Spinal Cord Injury Centre, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
Eur J Neurol. 2024 Apr;31(4):e16196. doi: 10.1111/ene.16196. Epub 2024 Jan 23.
In acute spinal cord injury (SCI), magnetic resonance imaging (MRI) reveals tissue bridges and neurodegeneration for 2 years. This 5-year study aims to track initial lesion changes, subsequent neurodegeneration, and their impact on recovery.
This prospective longitudinal study enrolled acute SCI patients and healthy controls who were assessed clinically-and by MRI-regularly from 3 days postinjury up to 60 months. We employed histologically cross-validated quantitative MRI sequences sensitive to volume, myelin, and iron changes, thereby reflecting indirectly processes of neurodegeneration and neuroinflammation. General linear models tracked lesion and remote changes in volume, myelin- and iron-sensitive magnetic resonance indices over 5 years. Associations between lesion, degeneration, and recovery (using the Spinal Cord Independence Measure [SCIM] questionnaire and the International Standards for Neurological Classification of Spinal Cord Injury total motor score) were assessed.
Patients' motor scores improved by an average of 12.86 (95% confidence interval [CI] = 6.70-19.00) points, and SCIM by 26.08 (95% CI = 17.00-35.20) points. Within 3-28 days post-SCI, lesion size decreased by more than two-thirds (3 days: 302.52 ± 185.80 mm , 28 days: 76.77 ± 88.62 mm ), revealing tissue bridges. Cervical cord and corticospinal tract volumes transiently increased in SCI patients by 5% and 3%, respectively, accompanied by cervical myelin decreases and iron increases. Over time, progressive atrophy was observed in both regions, which was linked to early lesion dynamics. Tissue bridges, reduced swelling, and myelin content decreases were predictive of long-term motor score recovery and improved SCIM score.
Studying acute changes and their impact on longer follow-up provides insights into SCI trajectory, highlighting the importance of acute intervention while indicating the potential to influence outcomes in the later stages.
在急性脊髓损伤（SCI）中，磁共振成像（MRI）可显示长达2年的组织桥接和神经退行性变。这项为期5年的研究旨在追踪初始损伤变化、随后的神经退行性变及其对恢复的影响。
这项前瞻性纵向研究纳入了急性SCI患者和健康对照，从受伤后3天至60个月定期进行临床评估和MRI检查。我们采用了经组织学交叉验证的定量MRI序列，这些序列对体积、髓鞘和铁含量变化敏感，从而间接反映神经退行性变和神经炎症过程。通用线性模型追踪了5年内病变和远隔部位在体积、髓鞘和铁敏感磁共振指数方面的变化。评估了病变、退变与恢复之间的关联（使用脊髓独立测量[SCIM]问卷和脊髓损伤神经学分类国际标准总运动评分）。
患者的运动评分平均提高了12.86（95%置信区间[CI]=6.70-19.00）分，SCIM评分提高了26.08（95%CI=17.00-35.20）分。在SCI后3-28天内，病变大小减少了三分之二以上（3天：302.52±185.80mm，28天：76.77±88.62mm），显示出组织桥接。SCI患者的颈髓和皮质脊髓束体积分别短暂增加了5%和3%，同时伴有颈髓髓鞘减少和铁含量增加。随着时间的推移，两个区域均观察到进行性萎缩，这与早期病变动态有关。组织桥接、肿胀减轻和髓鞘含量降低可预测长期运动评分恢复和SCIM评分改善。
研究急性变化及其对更长时间随访的影响有助于深入了解SCI的发展轨迹，突出了急性干预的重要性，同时表明在后期阶段影响预后的潜力。
