Spinal Cord Injury Centre, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.
Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
Eur J Neurol. 2024 Jul;31(7):e16297. doi: 10.1111/ene.16297. Epub 2024 May 7.
Simultaneous assessment of neurodegeneration in both the cervical cord and brain across multiple centres can enhance the effectiveness of clinical trials. Thus, this study aims to simultaneously assess microstructural changes in the cervical cord and brain above the stenosis in degenerative cervical myelopathy (DCM) using quantitative magnetic resonance imaging (MRI) in a multicentre study.
We applied voxelwise analysis with a probabilistic brain/spinal cord template embedded in statistical parametric mappin (SPM-BSC) to process multi parametric mapping (MPM) including effective transverse relaxation rate (R2*), longitudinal relaxation rate (R1), and magnetization transfer (MT), which are indirectly sensitive to iron and myelin content. Regression analysis was conducted to establish associations between neurodegeneration and clinical impairment. Thirty-eight DCM patients (mean age ± SD = 58.45 ± 11.47 years) and 38 healthy controls (mean age ± SD = 41.18 ± 12.75 years) were recruited at University Hospital Balgrist, Switzerland and Toronto Western Hospital, Canada.
Remote atrophy was observed in the cervical cord (p = 0.002) and in the left thalamus (0.026) of the DCM group. R1 was decreased in the periaqueductal grey matter (p = 0.014), thalamus (p = 0.001), corpus callosum (p = 0.0001), and cranial corticospinal tract (p = 0.03). R2* was increased in the primary somatosensory cortices (p = 0.008). Sensory impairments were associated with increased iron-sensitive R2* in the thalamus and periaqueductal grey matter in DCM.
Simultaneous assessment of the spinal cord and brain revealed DCM-induced demyelination, iron deposition, and atrophy. The extent of remote neurodegeneration was associated with sensory impairment, highlighting the intricate and expansive nature of microstructural neurodegeneration in DCM, reaching beyond the stenosis level.
在多个中心同时评估颈椎脊髓和脑部的神经退行性变可以提高临床试验的效果。因此，本研究旨在通过多参数磁共振成像（MRI）在多中心研究中同时评估退行性颈椎病（DCM）患者颈椎脊髓和狭窄上方脑部的微观结构变化。
我们应用嵌入在统计参数映射（SPM-BSC）中的体素分析方法对多参数映射（MPM）进行处理，其中包括对铁和髓鞘含量敏感的有效横向弛豫率（R2*）、纵向弛豫率（R1）和磁化转移（MT）。我们进行回归分析，以建立神经退行性变与临床损伤之间的关联。我们在瑞士巴格利斯特大学医院和加拿大多伦多西部医院招募了 38 名 DCM 患者（平均年龄 ± 标准差=58.45 ± 11.47 岁）和 38 名健康对照组（平均年龄 ± 标准差=41.18 ± 12.75 岁）。
DCM 组的颈椎（p=0.002）和左侧丘脑（0.026）存在远隔萎缩。DCM 组的导水管周围灰质（p=0.014）、丘脑（p=0.001）、胼胝体（p=0.0001）和颅皮质脊髓束（p=0.03）的 R1 降低。初级体感皮层的 R2增加（p=0.008）。感觉障碍与 DCM 患者丘脑和导水管周围灰质铁敏感的 R2增加相关。
同时评估脊髓和脑部显示 DCM 引起的脱髓鞘、铁沉积和萎缩。远隔神经退行性变的程度与感觉障碍相关，突出了 DCM 中小脑结构神经退行性变的复杂和广泛性质，超出了狭窄水平。
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