Department of Neurological Surgery, University of Washington, Seattle, WA 98105, USA.
University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, 50937 Cologne, North Rhine-Westphalia, Germany.
Sci Transl Med. 2024 Sep 18;16(765):eadn4970. doi: 10.1126/scitranslmed.adn4970.
Traumatic spinal cord injury (tSCI) causes an immediate loss of neurological function, and the prediction of recovery is difficult in the acute phase. In this study, we used contrast-enhanced ultrasound imaging to quantify intraspinal vascular disruption acutely after tSCI. In a rodent thoracic tSCI model, contrast-enhanced ultrasound revealed a perfusion area deficit that was positively correlated with injury severity and negatively correlated with hindlimb locomotor function at 8 weeks after injury. The spinal perfusion index was calculated by normalizing the contrast inflow at the injury center to the contrast inflow in the injury periphery. The spinal perfusion index decreased with increasing injury severity and positively correlated with hindlimb locomotor function at 8 weeks after injury. The feasibility of intraoperative contrast-enhanced ultrasound imaging was further tested in a cohort of 27 patients with acute tSCI of varying severity and including both motor-complete and motor-incomplete tSCIs. Both the perfusion area deficit and spinal perfusion index were different between motor-complete and motor-incomplete patients. Moreover, the perfusion area deficit and spinal perfusion index correlated with the injury severity at intake and exhibited a correlation with extent of functional recovery at 6 months. Our data suggest that intraoperative contrast-enhanced, ultrasound-derived metrics are correlated with injury severity and chronic functional outcome after tSCI. Larger clinical studies are required to better assess the reliability of the proposed contrast-enhanced ultrasound biomarkers and their prognostic capacity.
创伤性脊髓损伤（tSCI）会导致神经功能的即刻丧失，并且在急性期预测恢复情况较为困难。在本研究中，我们使用对比增强超声成像来定量分析 tSCI 后急性期的脊髓内血管损伤。在大鼠胸段 tSCI 模型中，对比增强超声显示的灌注面积缺损与损伤严重程度呈正相关，与损伤后 8 周的后肢运动功能呈负相关。通过将损伤中心的对比流入量与损伤周围的对比流入量进行归一化，计算脊髓灌注指数。脊髓灌注指数随损伤严重程度的增加而降低，与损伤后 8 周的后肢运动功能呈正相关。在一组严重程度不同的 27 例急性 tSCI 患者中进一步测试了术中对比增强超声成像的可行性，其中包括运动完全性和运动不完全性 tSCI。运动完全性和运动不完全性患者的灌注面积缺损和脊髓灌注指数均有差异。此外，灌注面积缺损和脊髓灌注指数与入院时的损伤严重程度相关，并与 6 个月时的功能恢复程度相关。我们的数据表明，术中对比增强超声衍生的指标与 tSCI 后的损伤严重程度和慢性功能结局相关。需要更大的临床研究来更好地评估所提出的对比增强超声生物标志物的可靠性及其预后能力。
