Can microstructural MRI detect subclinical tissue injury in subjects with asymptomatic cervical spinal cord compression? A prospective cohort study

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dc.contributor.author Martin, Allan R.
dc.contributor.author De Leener, Benjamin
dc.contributor.author Cohen-Adad, Julien
dc.contributor.author Cadotte, David W.
dc.contributor.author Nouri, Aria
dc.contributor.author Wilson, Jefferson R.
dc.contributor.author Tetreault, Lindsay A.
dc.contributor.author Crawley, Adrian P.
dc.contributor.author Mikulis, David J.
dc.contributor.author Ginsberg, Howard
dc.contributor.author Fehlings, Michael G.
dc.date.accessioned 2018-05-31T11:56:27Z
dc.date.available 2018-05-31T11:56:27Z
dc.identifier.citation Martin, A. R., De Leener, B., Cohen-Adad, J., Cadotte, D. W., Nouri, A., Wilson, J. R., Tetreault, L., Crawley, A. P., Mikulis, D. J., Ginsberg, H. and Fehlings, M. G. (2018) 'Can microstructural MRI detect subclinical tissue injury in subjects with asymptomatic cervical spinal cord compression? A prospective cohort study', BMJ Open, 8(4), e019809 (11pp). doi: 10.1136/bmjopen-2017-019809 en
dc.identifier.volume 8
dc.identifier.issued 2018
dc.identifier.startpage 1
dc.identifier.endpage 11
dc.identifier.issn 2044-6055
dc.identifier.uri http://hdl.handle.net/10468/6221
dc.identifier.doi 10.1136/bmjopen-2017-019809
dc.description.abstract Objectives: Degenerative cervical myelopathy (DCM) involves extrinsic spinal cord compression causing tissue injury and neurological dysfunction. Asymptomatic spinal cord compression (ASCC) is more common, but its significance is poorly defined. This study investigates if: (1) ASCC can be automatically diagnosed using spinal cord shape analysis; (2) multiparametric quantitative MRI can detect similar spinal cord tissue injury as previously observed in DCM. Design: Prospective observational longitudinal cohort study. Setting: Single centre, tertiary care and research institution. Participants: 40 neurologically intact subjects (19 female, 21 male) divided into groups with and without ASCC. Interventions: None. Outcome: measures Clinical assessments: modified Japanese Orthopaedic Association score and physical examination. 3T MRI assessments: automated morphometric analysis compared with consensus ratings of spinal cord compression, and measures of tissue injury: cross-sectional area, diffusion fractional anisotropy, magnetisation transfer ratio and T2*-weighted imaging white to grey matter signal intensity ratio (T2*WI WM/GM) extracted from rostral (C1–3), caudal (C6–7) and maximally compressed levels. Results: ASCC was present in 20/40 subjects. Diagnosis with automated shape analysis showed area under the curve >97%. Five MRI metrics showed differences suggestive of tissue injury in ASCC compared with uncompressed subjects (p<0.05), while a composite of all 10 measures (average of z scores) showed highly significant differences (p=0.002). At follow-up (median 21 months), two ASCC subjects developed DCM. Conclusions: ASCC appears to be common and can be accurately and objectively diagnosed with automated morphometric analysis. Quantitative MRI appears to detect subclinical tissue injury in ASCC prior to the onset of neurological symptoms and signs. These findings require further validation, but offer the intriguing possibility of presymptomatic diagnosis and treatment of DCM and other spinal pathologies. en
dc.description.sponsorship Rick Hansen Institute/AOSpine (Riluzole in Spinal Cord Injury Study (RISCIS) RHI-2014-12); Canadian Institutes of Health Research (201511MFE-359116-246227). en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BMJ Publishing Group en
dc.relation.uri http://bmjopen.bmj.com/content/8/4/e019809
dc.rights © 2018, Article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. en
dc.rights.uri https://creativecommons.org/licenses/by-nc/4.0/
dc.subject Cervical myelopathy en
dc.subject Spinal cord compression en
dc.subject Tissue injury en
dc.title Can microstructural MRI detect subclinical tissue injury in subjects with asymptomatic cervical spinal cord compression? A prospective cohort study en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Lindsay A. Tetreault, Medicine, University College Cork, Cork, Ireland. +353-21-490-3000 Email: 116100017@umail.ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder Rick Hansen Institute
dc.contributor.funder AOSpine
dc.contributor.funder Christopher and Dana Reeve Foundation
dc.contributor.funder DeZwirek
dc.contributor.funder Sherman Clinical Research Unit
dc.contributor.funder Gerald and Tootsie Halbert Chair
dc.contributor.funder Canadian Institutes of Health Research
dc.description.status Peer reviewed en
dc.identifier.journaltitle BMJ Open en
dc.internal.IRISemailaddress 116100017@umail.ucc.ie en
dc.identifier.articleid e019809


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© 2018, Article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. Except where otherwise noted, this item's license is described as © 2018, Article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
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