Evaluating the Severity and Prognosis of Acute Traumatic Cervical Spinal Cord Injury: A Novel Classification Using Diffusion Tensor Imaging and Diffusion Tensor Tractography.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 05 2021
15 05 2021
Historique:
pubmed:
5
1
2021
medline:
22
6
2021
entrez:
4
1
2021
Statut:
ppublish
Résumé
Retrospective observational cohort study. We explored the relationship between diffusion tensor imaging (DTI) parameters and prognosis in patients with acute traumatic cervical spinal cord injury (ATCSCI). DTI has been used to diagnose spinal cord injury; nevertheless, its role remains controversial. We analyzed retrospectively 24 patients with ATCSCI who were examined using conventional T2-weighted imaging and DTI. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were recorded at the injured site. Diffusion tensor tractography (DTT) was used to measure the spinal cord white matter fiber volume (MWFV). American Spinal Injury Association (ASIA) grades were recorded. Correlations between DTI parameters and ASIA scores were evaluated using Spearman correlation coefficients. FA values at injured sites were significantly lower than those of the control group, whereas ADC values in injured and control groups were not significantly different. DTT revealed that ATCSCI could be divided into four types: Type A1-complete rupture of spinal cord white matter fiber (MWF); Type A2-partial rupture of MWF; Type B-most MWF retained with severe compression or abnormal fiber conduction direction; and Type C-MWF basically complete with slight compression. Preoperative physical examinations revealed complete injury (ASIA A) in patients with A1 (n = 4) and A2 (n = 4). The ASIA grades or scores of A2 were improved to varying degrees, whereas there was no significant improvement in A1. FA values and MWFV of ASIA B, C, and D were significantly higher than those of ASIA A. FA and MWFV were correlated with ASIA motor score preoperatively and at final follow-up. We propose a classification for the severity of ATCSCI based on DTI and DTT that may explain why some patients with ASIA A recover, whereas others do not.Level of Evidence: 4.
Sections du résumé
STUDY DESIGN
Retrospective observational cohort study.
OBJECTIVE
We explored the relationship between diffusion tensor imaging (DTI) parameters and prognosis in patients with acute traumatic cervical spinal cord injury (ATCSCI).
SUMMARY OF BACKGROUND DATA
DTI has been used to diagnose spinal cord injury; nevertheless, its role remains controversial.
METHODS
We analyzed retrospectively 24 patients with ATCSCI who were examined using conventional T2-weighted imaging and DTI. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were recorded at the injured site. Diffusion tensor tractography (DTT) was used to measure the spinal cord white matter fiber volume (MWFV). American Spinal Injury Association (ASIA) grades were recorded. Correlations between DTI parameters and ASIA scores were evaluated using Spearman correlation coefficients.
RESULTS
FA values at injured sites were significantly lower than those of the control group, whereas ADC values in injured and control groups were not significantly different. DTT revealed that ATCSCI could be divided into four types: Type A1-complete rupture of spinal cord white matter fiber (MWF); Type A2-partial rupture of MWF; Type B-most MWF retained with severe compression or abnormal fiber conduction direction; and Type C-MWF basically complete with slight compression. Preoperative physical examinations revealed complete injury (ASIA A) in patients with A1 (n = 4) and A2 (n = 4). The ASIA grades or scores of A2 were improved to varying degrees, whereas there was no significant improvement in A1. FA values and MWFV of ASIA B, C, and D were significantly higher than those of ASIA A. FA and MWFV were correlated with ASIA motor score preoperatively and at final follow-up.
CONCLUSION
We propose a classification for the severity of ATCSCI based on DTI and DTT that may explain why some patients with ASIA A recover, whereas others do not.Level of Evidence: 4.
Identifiants
pubmed: 33395024
doi: 10.1097/BRS.0000000000003923
pii: 00007632-202105150-00013
doi:
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
687-694Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Références
GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18:56–87.
Kang Y, Ding H, Zhou H-X, et al. Epidemiology of worldwide spinal cord injury: a 307 literature review. J Neurorestoratology 2018; 6:1–9.
Talbott JF, Whetstone WD, Readdy WJ, et al. The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings. J Neurosurg Spine 2015; 23:495–504.
Kulkarni MV, Bondurant FJ, Rose SL, et al. 1.5 tesla magnetic resonance imaging of acute spinal trauma. Radiographics 1988; 8:1059–1082.
Matsushita A, Maeda T, Mori E, et al. Can the acute magnetic resonance imaging features reflect neurologic prognosis in patients with cervical spinal cord injury? Spine J 2017; 17:1319–1324.
Asan Ziya. SCIWORA in adults: clinical and radiological discordance. World Neurosurg 2018; 114:e1147–e1151.
Freund P, Seif M, Weiskopf N, et al. MRI in traumatic spinal cord injury: from clinical assessment to neuroimaging biomarkers. Lancet Neurol 2019; 18:1123–1135.
Martin AR, Aleksanderek I, Cohen-Adad J, et al. Translating state-of-the-art spinal cord MRI techniques to clinical use: a systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI. Neuroimage Clin 2016; 4:192–238.
Vedantam A, Jirjis MB, Schmit BD, et al. Diffusion tensor imaging of the spinal cord: insights from animal and human studies. Neurosurgery 2014; 74:1–8.
Cohen Y, Anaby D, Morozov D. Diffusion MRI of the spinal cord: from structural studies to pathology. NMR Biomed 2016; 30:
Nouri A, Tetreault L, Dalzell K, et al. The relationship between preoperative clinical presentation and quantitative magnetic resonance imaging features in patients with degenerative cervical myelopathy. Neurosurgery 2017; 80:121–128.
Assaf Y, Pasternak O. Diffusion tensor imaging (DTI)-based white matter mapping in brain research: a review. J Mol Neurosci 2008; 34:51–61.
Maki S, Koda M, Kitamura M, et al. Diffusion tensor imaging can predict surgical outcomes of patients with cervical compression myelopathy. Eur Spine J 2017; 26:2459–2466.
Kim JH, Loy DN, Wang Q, et al. Diffusion Tensor imaging at 3 hours after traumatic spinal cord injury predicts long-term locomotor recovery. J Neurotrauma 2010; 27:587–598.
Alizadeh M, Fisher J, Saksena S, et al. Reduced field of view diffusion tensor imaging and fiber tractography of the pediatric cervical and thoracic spinal cord injury. J Neurotrauma 2017; 35:452–460.
Patel SP, Smith TD, Vanrooyen JL, et al. Serial diffusion tensor imaging in vivo predicts long-term functional recovery and histopathology in rats following different severities of spinal cord injury. J Neurotrauma 2016; 33:917–928.
Rutman AM, Peterson DJ, Cohen WA, et al. Diffusion tensor imaging of the spinal cord: clinical value, investigational applications, and technical limitations. Curr Probl Diagn Radiol 2017; 47:824–1824.
Bosma RL, Stroman PW. Diffusion tensor imaging in the human spinal cord: development, limitations, and clinical applications. Crit Rev Biomed Eng 2012; 40:1–20.
Fujiyoshi K, Konomi T, Yamada M, et al. Diffusion tensor imaging and tractography of the spinal cord: from experimental studies to clinical application. Exp Neurol 2012; 242:74–82.
Zaninovich OA, Avila MJ, Kay M, et al. The role of diffusion tensor imaging in the diagnosis, prognosis, and assessment of recovery and treatment of spinal cord injury: a systematic review. Neurosurg Focus 2019; 46:E7.
Kirshblum SC, Burns SP, Biering-Sorensen F, et al. International standards for neurological classification of spinal cord injury (Revised 2011). J Spinal Cord Med 2011; 34:535–546.
Aarabi B, Sansur CA, Ibrahimi DM, et al. Intramedullary lesion length on postoperative magnetic resonance imaging is a strong predictor of ASIA Impairment Scale Grade conversion following decompressive surgery in cervical spinal cord injury. Neurosurgery 2017; 80:610–620.
Diffusion tensor imaging in a large longitudinal series of patients with cervical spondylotic myelopathy correlated with long-term functional outcome. Neurosurgery 2018; 82:905.
D'souza MM, Choudhary A, Poonia M, et al. Diffusion tensor MR imaging in spinal cord injury. Injury 2017; 48:880–884.
Koskinen EA, Hakulinen U, Brander AE, et al. Clinical correlates of cerebral diffusion tensor imaging findings in chronic traumatic spinal cord injury. Spinal Cord 2014; 52:202–208.
Shanmuganathan K, Zhuo J, Chen HH, et al. Diffusion tensor imaging parameter obtained during acute blunt cervical spinal cord injury in predicting long term outcome. J Neurotrauma 2017; 34:2964–2971.
Chang Y, Jung TD, Yoo DS, et al. Diffusion tensor imaging and fiber tractography of patients with cervical spinal cord injury. J Neurotrauma 2010; 27:2033–2040.
Tu TW. Assessing White Matter Integrity in Experimental Spinal Cord Injury Using Diffusion Tensor Imaging. Journal of Neuroscience and Neuroengineering 2013; 2:1–16.
Li XH, Li JB, He XJ, et al. Timing of diffusion tensor imaging in the acute spinal cord injury of rats. Sci Rep 2015; 5:12639.
Fujiyoshi K, Konomi T, Yamada M, et al. Diffusion tensor imaging and tractography of the spinal cord: From experimental studies to clinical application. Exp Neurol 2012; 242:74–82.
Zhao C, Rao JS, Pei XJ, et al. Longitudinal study on diffusion tensor imaging and diffusion tensor tractography following spinal cord contusion injury in rats. Neuroradiology 2016; 58:607–614.
Cadotte DW, Fehlings MG. Will imaging biomarkers transform spinal cord injury trials? Lancet Neurol 2013; 12:843–844.
Vaccaro AR, Koerner JD, Radcliff KE, et al. AOSpine Subaxial Cervical Spine Injury Classification System. Eur Spine J 2016; 25:2173–2184.
Vaccaro AR, Hulbert RJ, Patel AA, et al. The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine (Phila Pa 1976) 2007; 32:2365–2374.
Telemacque D, Zhu F, Chen K, et al. Method of decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation. J Neurorestoratol 2018; 6:158–164.
Gelb DE, Aarabi B, Dhall SS, et al. Treatment of subaxial cervical spinal injuries. Neurosurgery 2013; 187–194.
Fehlings MG, Tetreault LA, Aarabi B, et al. A Clinical Practice Guideline for the management of patients with acute spinal cord injury: recommendations on the type and timing of rehabilitation. Global Spine J 2017; 7: (3_suppl): 231S–238S.
Zhu F, Yao S, Ren Z, et al. Early durotomy with duroplasty for severe adult spinal cord injury without radiographic abnormality: a novel concept and method of surgical decompression. Eur Spine J 2019; 28:2275–2282.
Boldin C, Raith J, Fankhauser F, et al. Predicting neurologic recovery in cervical spinal cord injury with postoperative MR imaging. Spine (Phila Pa 1976) 2006; 31:554–559.
David G, Mohammadi S, Martin AR, et al. Traumatic and nontraumatic spinal cord injury: pathological insights from neuroimaging. Nat Rev Neurol 2019; 15:718–731.