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Izzy S. Traumatic Spinal Cord Injury. Continuum (Minneap Minn) 2024; 30:53-72. [PMID: 38330472 PMCID: PMC10869103 DOI: 10.1212/con.0000000000001392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article provides a review of the initial clinical and radiologic evaluation and treatment of patients with traumatic spinal cord injuries. It specifically highlights essential knowledge for neurologists who encounter patients with these complex injuries. LATEST DEVELOPMENTS There has been improvement in the care of patients with traumatic spinal cord injuries, particularly in the prehospital evaluation, approach for immediate immobilization, standardized spinal clearance, efficient triage, and transportation of appropriate patients to traumatic spinal cord injury specialized centers. Advancements in spinal instrumentation have improved the surgical management of spinal fractures and the ability to manage patients with spinal mechanical instability. The clinical evidence favors performing early surgical decompression and spine stabilization within 24 hours of traumatic spinal cord injuries, regardless of the severity or location of the injury. There is no evidence that supports the use of neuroprotective treatments to improve outcomes in patients with traumatic spinal cord injuries. The administration of high-dose methylprednisolone, which is associated with significant systemic adverse effects, is strongly discouraged. Early and delayed mortality rates continue to be high in patients with traumatic spinal cord injuries, and survivors often confront substantial long-term physical and functional impairments. Whereas the exploration of neuroregenerative approaches, such as stem cell transplantation, is underway, these methods remain largely investigational. Further research is still necessary to advance the functional recovery of patients with traumatic spinal cord injuries. ESSENTIAL POINTS Traumatic spinal cord injury is a complex and devastating condition that leads to long-term neurologic deficits with profound physical, social, and vocational implications, resulting in a diminished quality of life, particularly for severely affected patients. The initial management of traumatic spinal cord injuries demands comprehensive interdisciplinary care to address the potentially catastrophic multisystem effects. Ongoing endeavors are focused on optimizing and customizing initial management approaches and developing effective therapies for neuroprotection and neuroregeneration to enhance long-term functional recovery.
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Pfyffer D, Zimmermann S, Şimşek K, Kreis R, Freund P, Seif M. Magnetic resonance spectroscopy investigation in the right human hippocampus following spinal cord injury. Front Neurol 2023; 14:1120227. [PMID: 37251221 PMCID: PMC10213741 DOI: 10.3389/fneur.2023.1120227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/20/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Preclinical studies have shown that cognitive impairments following spinal cord injury (SCI), such as impaired spatial memory, are linked to inflammation, neurodegeneration, and reduced neurogenesis in the right hippocampus. This cross-sectional study aims to characterize metabolic and macrostructural changes in the right hippocampus and their association to cognitive function in traumatic SCI patients. Methods Within this cross-sectional study, cognitive function was assessed in 28 chronic traumatic SCI patients and 18 age-, sex-, and education-matched healthy controls by a visuospatial and verbal memory test. A magnetic resonance spectroscopy (MRS) and structural MRI protocol was performed in the right hippocampus of both groups to quantify metabolic concentrations and hippocampal volume, respectively. Group comparisons investigated changes between SCI patients and healthy controls and correlation analyses investigated their relationship to memory performance. Results Memory performance was similar in SCI patients and healthy controls. The quality of the recorded MR spectra was excellent in comparison to the best-practice reports for the hippocampus. Metabolite concentrations and volume of the hippocampus measured based on MRS and MRI were not different between two groups. Memory performance in SCI patients and healthy controls was not correlated with metabolic or structural measures. Conclusion This study suggests that the hippocampus may not be pathologically affected at a functional, metabolic, and macrostructural level in chronic SCI. This points toward the absence of significant and clinically relevant trauma-induced neurodegeneration in the hippocampus.
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Affiliation(s)
- Dario Pfyffer
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Sandra Zimmermann
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Kadir Şimşek
- Magnetic Resonance Methodology, Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Roland Kreis
- Magnetic Resonance Methodology, Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Maryam Seif
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Richter JK, Vallesi V, Zölch N, Chan KL, Hunkeler N, Abramovic M, Hashagen C, Christiaanse E, Shetty G, Verma RK, Berger MF, Frotzler A, Eisenlohr H, Eriks Hoogland I, Scheel-Sailer A, Wyss PO. Metabolic profile of complete spinal cord injury in pons and cerebellum: A 3T 1H MRS study. Sci Rep 2023; 13:7245. [PMID: 37142669 PMCID: PMC10160051 DOI: 10.1038/s41598-023-34326-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 04/27/2023] [Indexed: 05/06/2023] Open
Abstract
The aim of this exploratory study was the assessment of the metabolic profiles of persons with complete spinal cord injury (SCI) in three region-of-interests (pons, cerebellar vermis, and cerebellar hemisphere), with magnetic resonance spectroscopy, and their correlations to clinical scores. Group differences and association between metabolic and clinical scores were examined. Fifteen people with chronic SCI (cSCI), five people with subacute SCI (sSCI) and fourteen healthy controls were included. Group comparison between cSCI and HC showed lower total N-acetyl-aspartate (tNAA) in the pons (p = 0.04) and higher glutathione (GSH) in the cerebellar vermis (p = 0.02). Choline levels in the cerebellar hemisphere were different between cSCI and HC (p = 0.02) and sSCI and HC (p = 0.02). A correlation was reported for choline containing compounds (tCho) to clinical scores in the pons (rho = - 0.55, p = 0.01). tNAA to total creatine (tNAA/tCr ratio) correlated to clinical scores in the cerebellar vermis (rho = 0.61, p = 0.004) and GSH correlated to the independence score in the cerebellar hemisphere (rho = 0.56, p = 0.01). The correlation of tNAA, tCr, tCho and GSH to clinical scores might be indicators on how well the CNS copes with the post-traumatic remodeling and might be further examined as outcome markers.
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Affiliation(s)
- Johannes K Richter
- Department of Radiology, Swiss Paraplegic Centre, Guido A. Zaech - Strasse 1, 6207, Nottwil, Switzerland
- Department of Diagnostic, Interventional, and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
- Institute of Radiology and Nuclear Medicine, GZO Hospital Wetzikon, Wetzikon, Switzerland
| | - Vanessa Vallesi
- Department of Radiology, Swiss Paraplegic Centre, Guido A. Zaech - Strasse 1, 6207, Nottwil, Switzerland
- Support Center for Advanced Neuroimaging (SCAN), Neuroradiology, University Hospital of Bern, Inselspital, Bern, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Niklaus Zölch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Kimberly L Chan
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nadine Hunkeler
- Department of Radiology, Swiss Paraplegic Centre, Guido A. Zaech - Strasse 1, 6207, Nottwil, Switzerland
| | - Mihael Abramovic
- Department of Radiology, Swiss Paraplegic Centre, Guido A. Zaech - Strasse 1, 6207, Nottwil, Switzerland
| | - Claus Hashagen
- Department of Radiology, Swiss Paraplegic Centre, Guido A. Zaech - Strasse 1, 6207, Nottwil, Switzerland
| | - Ernst Christiaanse
- Department of Radiology, Swiss Paraplegic Centre, Guido A. Zaech - Strasse 1, 6207, Nottwil, Switzerland
- Image Science Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ganesh Shetty
- Department of Radiology, Swiss Paraplegic Centre, Guido A. Zaech - Strasse 1, 6207, Nottwil, Switzerland
| | - Rajeev K Verma
- Department of Radiology, Swiss Paraplegic Centre, Guido A. Zaech - Strasse 1, 6207, Nottwil, Switzerland
| | - Markus F Berger
- Department of Radiology, Swiss Paraplegic Centre, Guido A. Zaech - Strasse 1, 6207, Nottwil, Switzerland
| | - Angela Frotzler
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
- Digital Trial Intervention Platform, ETH Zurich, Zurich, Switzerland
| | - Heidrun Eisenlohr
- Department of Radiology, Swiss Paraplegic Centre, Guido A. Zaech - Strasse 1, 6207, Nottwil, Switzerland
| | | | - Anke Scheel-Sailer
- Department of Paraplegia, Rehabilitation and Quality Management, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Patrik O Wyss
- Department of Radiology, Swiss Paraplegic Centre, Guido A. Zaech - Strasse 1, 6207, Nottwil, Switzerland.
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.
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Trolle C, Goldberg E, Linnman C. Spinal cord atrophy after spinal cord injury - A systematic review and meta-analysis. Neuroimage Clin 2023; 38:103372. [PMID: 36931004 PMCID: PMC10026037 DOI: 10.1016/j.nicl.2023.103372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/12/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023]
Abstract
Cervical spinal cord atrophy occurs after spinal cord injury. The atrophy and how level of injury affects atrophy differs between studies. A systematic review and metaanalysis were done after systematic searches of PubMed, CINAHL, APA PsycInfo and Web of Science. English language original studies analyzing MRI cervical spinal cord cross-sectional area in adults with spinal cord injury were included. Atrophy and correlation between injury level and atrophy were estimated with random-effects models, standardized mean differences, and 95% confidence intervals. 24 studies were identified. 13/24 studies had low risk of bias. Cord atrophy meta-analysis of 18 articles corresponded to a standardized mean difference of -1.48 (95% CI -1.78 to -1.19) with moderate to large interstudy heterogeneity. Logarithmic time since injury influenced heterogeneity. Longitudinal atrophy was best described by a logarithmic model, indicating that rate of spinal atrophy decreases over time. Meta-correlation of eight studies indicated more severe atrophy in more rostral injuries (0.41, 95% CI 0.20-0.59). Larger and preferably longitudinal studies, data sharing, and standardized protocols are warranted.
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Affiliation(s)
- Carl Trolle
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Department of Medical Sciences, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden.
| | - Estee Goldberg
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Clas Linnman
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
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Glutathione in the Pons Is Associated With Clinical Status Improvements in Subacute Spinal Cord Injury. Invest Radiol 2023; 58:131-138. [PMID: 35926077 DOI: 10.1097/rli.0000000000000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES In spinal cord injury (SCI), the primary mechanical injury is followed by secondary sequelae that develop over the subsequent months and manifests in biochemical, functional, and microstructural alterations, at the site of direct injury but also in the spinal cord tissue above and below the actual lesion site. Noninvasive magnetic resonance spectroscopy (MRS) can be used to assess biochemical modulation occurring in the secondary injury phase, in addition to and supporting conventional MRI, and might help predict and improve patient outcome. In this article, we aimed to examine the metabolic levels in the pons of subacute SCI by means of in vivo proton MRS at 3 T and explore the association to clinical scores. MATERIALS AND METHODS In this prospective study, between November 2015 and February 2018, single-voxel short-echo MRS data were acquired in healthy controls and in SCI subjects in the pons once during rehabilitation. Besides the single-point MRS examination, in addition, in participants with SCI, the clinical status (ie, motor, light touch, and pinprick scores) was assessed twice: (1) around the MRS session (approximately 10 weeks postinjury) and (2) before discharge (at approximately 9 months postinjury). The group differences were assessed with Kruskal-Wallis test, the post hoc comparison was assessed with Wilcoxon rank sum test, and the clinical correlations were conducted with Spearman rank correlation test. Bayes factor calculations completed the statistical part providing relevant evidence values. RESULTS Twenty healthy controls (median age, 50 years; interquartile range, 41-55 years; 18 men) and 18 subjects with traumatic SCI (median age, 50 years; interquartile range, 32-58 years; 16 men) are included. Group comparison showed an increase of total N -acetylaspartate and combined glutamate and glutamine levels in complete SCI and a reduction of total creatine in incomplete paraplegic SCI. The proton MRS-based glutathione levels at baseline correlate to the motor score improvement during rehabilitation in incomplete subacute SCI. CONCLUSIONS This exploratory study showed an association of the metabolite concentration of glutathione in the pons assessed at approximately 10 weeks after injury with the improvements of the motor score during the rehabilitation. Pontine glutathione levels in subjects with traumatic subacute incomplete SCI acquired remote from the injury site correlate to clinical score and might therefore be beneficial in the rehabilitation assessments.
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Gao F, Li JJ, Liu JY, Li YJ, Cong XY, Talifu Z, Zhang X. Association between brain N-acetylaspartate levels and sensory and motor dysfunction in patients who have spinal cord injury with spasticity: an observational case-control study. Neural Regen Res 2023; 18:582-586. [DOI: 10.4103/1673-5374.350216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Valošek J, Bednařík P, Keřkovský M, Hluštík P, Bednařík J, Svatkova A. Quantitative MR Markers in Non-Myelopathic Spinal Cord Compression: A Narrative Review. J Clin Med 2022; 11:2301. [PMID: 35566426 PMCID: PMC9105390 DOI: 10.3390/jcm11092301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
Degenerative spinal cord compression is a frequent pathological condition with increasing prevalence throughout aging. Initial non-myelopathic cervical spinal cord compression (NMDC) might progress over time into potentially irreversible degenerative cervical myelopathy (DCM). While quantitative MRI (qMRI) techniques demonstrated the ability to depict intrinsic tissue properties, longitudinal in-vivo biomarkers to identify NMDC patients who will eventually develop DCM are still missing. Thus, we aim to review the ability of qMRI techniques (such as diffusion MRI, diffusion tensor imaging (DTI), magnetization transfer (MT) imaging, and magnetic resonance spectroscopy (1H-MRS)) to serve as prognostic markers in NMDC. While DTI in NMDC patients consistently detected lower fractional anisotropy and higher mean diffusivity at compressed levels, caused by demyelination and axonal injury, MT and 1H-MRS, along with advanced and tract-specific diffusion MRI, recently revealed microstructural alterations, also rostrally pointing to Wallerian degeneration. Recent studies also disclosed a significant relationship between microstructural damage and functional deficits, as assessed by qMRI and electrophysiology, respectively. Thus, tract-specific qMRI, in combination with electrophysiology, critically extends our understanding of the underlying pathophysiology of degenerative spinal cord compression and may provide predictive markers of DCM development for accurate patient management. However, the prognostic value must be validated in longitudinal studies.
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Affiliation(s)
- Jan Valošek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (J.V.); (P.H.)
- Department of Radiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
- Department of Biomedical Engineering, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Petr Bednařík
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark;
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Miloš Keřkovský
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (J.B.)
- Department of Radiology and Nuclear Medicine, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Petr Hluštík
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (J.V.); (P.H.)
- Department of Neurology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Josef Bednařík
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (J.B.)
- Department of Neurology, University Hospital Brno, 625 00 Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, 625 00 Brno, Czech Republic
| | - Alena Svatkova
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark;
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, 1090 Vienna, Austria
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Roussel T, Le Fur Y, Guye M, Viout P, Ranjeva JP, Callot V. Respiratory-triggered quantitative MR spectroscopy of the human cervical spinal cord at 7 T. Magn Reson Med 2022; 87:2600-2612. [PMID: 35181915 DOI: 10.1002/mrm.29182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Ultra-high field 1 H MR spectroscopy (MRS) is of great interest to help characterizing human spinal cord pathologies. However, very few studies have been reported so far in this small size structure at these fields due to challenging experimental difficulties caused by static and radiofrequency field heterogeneities, as well as physiological motion. In this work, in line with the recent developments proposed to strengthen spinal cord MRS feasibility at 7 T, a respiratory-triggered acquisition approach was optimized to compensate for dynamic B 0 field heterogeneities and to provide robust cervical spinal cord MRS data. METHODS A semi-LASER sequence was purposely used, and a dedicated raw data processing algorithm was developed to enhance MR spectral quality by discarding corrupted scans. To legitimate the choices done during the optimization stage, additional tests were carried out to determine the impact of breathing, voluntary motion, body mass index, and fitting algorithm. An in-house quantification tool was concomitantly designed for accurate estimation of the metabolite concentration ratios for choline, N-acetyl-aspartate (NAA), myo-inositol and glutathione. The method was tested on a cohort of 14 healthy volunteers. RESULTS Average water linewidth and NAA signal-to-noise ratio reached 0.04 ppm and 11.01, respectively. The group-average metabolic ratios were in good agreement with previous studies and showed intersession reproducibility variations below 30%. CONCLUSION The developed approach allows a rise of the acquired MRS signal quality and of the quantification robustness as compared to previous studies hence offering strengthened possibilities to probe the metabolism of degenerative and traumatic spinal cord pathologies.
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Affiliation(s)
- Tangi Roussel
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Yann Le Fur
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Patrick Viout
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Jean-Philippe Ranjeva
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Virginie Callot
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.,APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
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Horak T, Horakova M, Svatkova A, Kadanka Z, Kudlicka P, Valosek J, Rohan T, Kerkovsky M, Vlckova E, Kadanka Z, Deelchand DK, Henry PG, Bednarik J, Bednarik P. In vivo Molecular Signatures of Cervical Spinal Cord Pathology in Degenerative Compression. J Neurotrauma 2021; 38:2999-3010. [PMID: 34428934 PMCID: PMC8917902 DOI: 10.1089/neu.2021.0151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a severe consequence of degenerative cervical spinal cord (CSC) compression. The non-myelopathic stage of compression (NMDC) is highly prevalent and often progresses to disabling DCM. This study aims to disclose markers of progressive neurochemical alterations in NMDC and DCM by utilizing an approach based on state-of-the-art proton magnetic resonance spectroscopy (1H-MRS). Proton-MRS data were prospectively acquired from 73 participants with CSC compression and 47 healthy controls (HCs). The MRS voxel was centered at the C2 level. Compression-affected participants were clinically categorized as NMDC and DCM, radiologically as mild (MC) or severe (SC) compression. CSC volumes and neurochemical concentrations were compared between cohorts (HC vs. NMDC vs. DCM and HC vs. MC vs. SC) with general linear models adjusted for age and height (pFWE < 0.05) and correlated to stenosis severity, electrophysiology, and myelopathy symptoms (p < 0.05). Whereas the ratio of total creatine (tCr) to total N-acetylaspartate (tNAA) increased in NMDC (+11%) and in DCM (+26%) and SC (+21%), myo-inositol/tNAA, glutamate + glutamine/tNAA, and volumes changed only in DCM (+20%, +73%, and −14%) and SC (+12%, +46%, and −8%, respectively) relative to HCs. Both tCr/tNAA and myo-inositol/tNAA correlated with compression severity and volume (−0.376 < r < −0.259). Myo-inositol/tNAA correlated with myelopathy symptoms (r = −0.670), whereas CSC volume did not. Short-echo 1H-MRS provided neurochemical signatures of CSC impairment that reflected compression severity and clinical significance. Whereas volumetry only reflected clinically manifest myelopathy (DCM), MRS detected neurochemical changes already before the onset of myelopathy symptoms.
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Affiliation(s)
- Tomas Horak
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Magda Horakova
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Alena Svatkova
- Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria.,Department of Imaging Methods, Faculty of Medicine, University of Ostrava, Czechia
| | - Zdenek Kadanka
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia
| | - Petr Kudlicka
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Jan Valosek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czechia.,Department of Biomedical Engineering, University Hospital, Olomouc, Czechia
| | - Tomas Rohan
- Department of Radiology, University Hospital Brno, Brno, Czechia
| | - Milos Kerkovsky
- Department of Radiology, University Hospital Brno, Brno, Czechia
| | - Eva Vlckova
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Zdenek Kadanka
- Department of Neurology, University Hospital Brno, Brno, Czechia
| | - Dinesh K Deelchand
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Pierre-Gilles Henry
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Josef Bednarik
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia
| | - Petr Bednarik
- Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czechia.,Department of Biomedical Imaging and Image-guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, Austria
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Pfyffer D, Wyss PO, Huber E, Curt A, Henning A, Freund P. Metabolites of neuroinflammation relate to neuropathic pain after spinal cord injury. Neurology 2020; 95:e805-e814. [PMID: 32591473 PMCID: PMC7605501 DOI: 10.1212/wnl.0000000000010003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine whether cervical cord levels of metabolites are associated with pain sensation after spinal cord injury (SCI) by performing magnetic resonance spectroscopy in patients with SCI with and without neuropathic pain (NP). METHODS Cervical cord single-voxel spectroscopic data of 24 patients with SCI (14 with NP, 10 pain-free) and 21 healthy controls were acquired at C2/3 to investigate metabolite ratios associated with neuroinflammation (choline-containing compounds to myoinositol [tCho/mI]) and neurodegeneration (total N-acetylaspartate to myo-inositol [tNAA/mI]). NP levels were measured, and Spearman correlation tests assessed associations between metabolite levels, cord atrophy, and pinprick score. RESULTS In patients with NP, tCho/mI levels were increased (p = 0.024) compared to pain-free patients and negatively related to cord atrophy (p = 0.006, r = 0.714). Better pinprick score was associated with higher tCho/mI levels (p = 0.032, r = 0.574). In pain-free patients, tCho/mI levels were not related to cord atrophy (p = 0.881, r = 0.055) or pinprick score (p = 0.676, r = 0.152). tNAA/mI levels were similar in both patient groups (p = 0.396) and were not associated with pinprick score in patients with NP (p = 0.405, r = 0.242) and pain-free patients (p = 0.117, r = 0.527). CONCLUSIONS Neuroinflammatory metabolite levels (i.e., tCho/mI) were elevated in patients with NP, its magnitude being associated with less cord atrophy and greater pain sensation (e.g., pinprick score). This suggests that patients with NP have more residual spinal tissue and greater metabolite turnover than pain-free patients. Neurodegenerative metabolite levels (i.e., tNAA/mI) were associated with greater cord atrophy but unrelated to NP. Identifying the metabolic NP signature provides new NP treatment targets and could improve patient stratification in interventional trials. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that levels of magnetic resonance spectroscopy-identified metabolites of neuroinflammation were elevated in patients with SCI with NP compared to those without NP.
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Affiliation(s)
- Dario Pfyffer
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Patrik O Wyss
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Eveline Huber
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Armin Curt
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Anke Henning
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Patrick Freund
- From the Spinal Cord Injury Center (D.P., E.H., A.C., P.F.), Balgrist University Hospital, University of Zurich; Institute for Biomedical Engineering (A.H., P.O.W.), University and ETH, Zurich; Department of Radiology (P.O.W.), Swiss Paraplegic Centre, Nottwil, Switzerland; Max Planck Institute for Biological Cybernetics (P.O.W., A.H.), Tuebingen, Germany; Advanced Imaging Research Center (A.H.), UT Southwestern Medical Center, Dallas TX; Department of Brain Repair and Rehabilitation (P.F.) and Wellcome Trust Centre for Neuroimaging (P.F.), UCL Institute of Neurology, University College London, UK; and Department of Neurophysics (P.F.), Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
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David G, Mohammadi S, Martin AR, Cohen-Adad J, Weiskopf N, Thompson A, Freund P. Traumatic and nontraumatic spinal cord injury: pathological insights from neuroimaging. Nat Rev Neurol 2019; 15:718-731. [PMID: 31673093 DOI: 10.1038/s41582-019-0270-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 01/23/2023]
Abstract
Pathophysiological changes in the spinal cord white and grey matter resulting from injury can be observed with MRI techniques. These techniques provide sensitive markers of macrostructural and microstructural tissue integrity, which correlate with histological findings. Spinal cord MRI findings in traumatic spinal cord injury (tSCI) and nontraumatic spinal cord injury - the most common form of which is degenerative cervical myelopathy (DCM) - have provided important insights into the pathophysiological processes taking place not just at the focal injury site but also rostral and caudal to the spinal injury. Although tSCI and DCM have different aetiologies, they show similar degrees of spinal cord pathology remote from the injury site, suggesting the involvement of similar secondary degenerative mechanisms. Advanced quantitative MRI protocols that are sensitive to spinal cord pathology have the potential to improve diagnosis and, more importantly, predict outcomes in patients with tSCI or nontraumatic spinal cord injury. This Review describes the insights into tSCI and DCM that have been revealed by neuroimaging and outlines current activities and future directions for the field.
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Affiliation(s)
- Gergely David
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Siawoosh Mohammadi
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, London, UK
| | - Allan R Martin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada
| | - Nikolaus Weiskopf
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, London, UK.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Alan Thompson
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - Patrick Freund
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, London, UK. .,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany. .,Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK. .,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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