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.authorMartin, Allan R.
dc.contributor.authorDe Leener, Benjamin
dc.contributor.authorCohen-Adad, Julien
dc.contributor.authorCadotte, David W.
dc.contributor.authorNouri, Aria
dc.contributor.authorWilson, Jefferson R.
dc.contributor.authorTetreault, Lindsay A.
dc.contributor.authorCrawley, Adrian P.
dc.contributor.authorMikulis, David J.
dc.contributor.authorGinsberg, Howard
dc.contributor.authorFehlings, Michael G.
dc.contributor.funderRick Hansen Institute
dc.contributor.funderAOSpine
dc.contributor.funderChristopher and Dana Reeve Foundation
dc.contributor.funderDeZwirek
dc.contributor.funderSherman Clinical Research Unit
dc.contributor.funderGerald and Tootsie Halbert Chair
dc.contributor.funderCanadian Institutes of Health Research
dc.date.accessioned2018-05-31T11:56:27Z
dc.date.available2018-05-31T11:56:27Z
dc.description.abstractObjectives: 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.sponsorshipRick Hansen Institute/AOSpine (Riluzole in Spinal Cord Injury Study (RISCIS) RHI-2014-12); Canadian Institutes of Health Research (201511MFE-359116-246227).en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleide019809
dc.identifier.citationMartin, 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-2017-019809en
dc.identifier.doi10.1136/bmjopen-2017-019809
dc.identifier.endpage11
dc.identifier.issn2044-6055
dc.identifier.issued2018
dc.identifier.journaltitleBMJ Openen
dc.identifier.startpage1
dc.identifier.urihttps://hdl.handle.net/10468/6221
dc.identifier.volume8
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.relation.urihttp://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.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.subjectCervical myelopathyen
dc.subjectSpinal cord compressionen
dc.subjectTissue injuryen
dc.titleCan microstructural MRI detect subclinical tissue injury in subjects with asymptomatic cervical spinal cord compression? A prospective cohort studyen
dc.typeArticle (peer-reviewed)en
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