Semi-automated detection of cervical spinal cord compression with the Spinal Cord Toolbox.

Background

Degenerative cervical spinal cord compression is becoming increasingly prevalent, yet the MRI criteria that define compression are vague, and vary between studies. This contribution addresses the detection of compression by means of the Spinal Cord Toolbox (SCT) and assesses the variability of the morphometric parameters extracted with it.

Methods

Prospective cross-sectional study. Two types of MRI examination, 3 and 1.5 T, were performed on 66 healthy controls and 118 participants with cervical spinal cord compression. Morphometric parameters from 3T MRI obtained by Spinal Cord Toolbox (cross-sectional area, solidity, compressive ratio, torsion) were combined in multivariate logistic regression models with the outcome (binary dependent variable) being the presence of compression determined by two radiologists. Inter-trial (between 3 and 1.5 T) and inter-rater (three expert raters and SCT) variability of morphometric parameters were assessed in a subset of 35 controls and 30 participants with compression.

Results

The logistic model combining compressive ratio, cross-sectional area, solidity, torsion and one binary indicator, whether or not the compression was set at level C6/7, demonstrated outstanding compression detection (area under curve =0.947). The single best cut-off for predicted probability calculated using a multiple regression equation was 0.451, with a sensitivity of 87.3% and a specificity of 90.2%. The inter-trial variability was better in Spinal Cord Toolbox (intraclass correlation coefficient was 0.858 for compressive ratio and 0.735 for cross-sectional area) compared to expert raters (mean coefficient for three expert raters was 0.722 for compressive ratio and 0.486 for cross-sectional area). The analysis of inter-rater variability demonstrated general agreement between SCT and three expert raters, as the correlations between SCT and raters were generally similar to those of the raters between one another.

Conclusions

This study demonstrates successful semi-automated compression detection based on four parameters. The inter-trial variability of parameters established through two MRI examinations was conclusively better for Spinal Cord Toolbox compared with that of three experts' manual ratings.

Informations de copyright

2022 Quantitative Imaging in Medicine and Surgery. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-21-782/coif). MH, TH, JK, TS, ZK, PB, AS and JB report that this research was supported by Czech Health Research Council grant (ref. NV18-04-00159), Ministry of Health of the Czech Republic (ref. 65269705) and The Ministry of Education, Youth and Sports of the Czech Republic (ref. MUNI/A/1600/2020). JV and PH report that this research was supported by Czech Health Research Council grant (ref. NV18-04-00159), Ministry of Health of the Czech Republic (ref. 00098892). TR, MD, and MK report that this research was supported by Czech Health Research Council grant (ref. NV18-04-00159) and Ministry of Health of the Czech Republic (ref. 65269705). EK reports that this research was supported by Czech Health Research Council grant (ref. NV18-04-00159). PB received funding from the European Union Horizon 2020 research and innovation program under Marie Skłodowska-Curie grant agreement (No. 846793), and by a NARSAD Young Investigator Grant from the Brain and Behavior Research Foundation (No. 27238) for duration of this project. AS received funding from the European Union Horizon 2020 research and innovation program under Marie Skłodowska-Curie grant agreement (No. 794986) for the duration of this project. The authors have no other conflicts of interest to declare.