ISMRM 24th Annual Meeting & Exhibition • 07-13 May 2016 • Singapore

Scientific Session: Spinal Cord: Clinical Applications

Thursday Thursday, May 12, 2016
Room 334-336
10:30 - 12:30
Moderators: Suchandrima Banerjee, Masaaki Hori

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
Allan R. Martin1, Izabela Aleksanderek1, Julien Cohen-Adad2, Zenovia Tarmohamed3, Lindsay Tetreault1, Nathaniel Smith4, David W. Cadotte1, Adrian Crawley5, Howard Ginsberg1, David J. Mikulis5, and Michael G. Fehlings1
1Neurosurgery, University of Toronto, Toronto, ON, Canada, 2Electrical Engineering, Polytechnique Montreal, Montreal, QC, Canada, 3Royal College of Surgeons Ireland, Dublin, Ireland, 4McMaster University, Hamilton, ON, Canada, 5Medical Imaging, University of Toronto, Toronto, ON, Canada
5 state-of-the-art spinal cord MRI techniques have been identified with great clinical potential. This systematic review finds trends in the technical methods employed and measures the progress of these techniques toward clinical translation. 104 studies were identified, with 69 DTI, 25 MT, 1 MWF, 11 MRS, and 8 fMRI studies. The DTI metric FA has the strongest evidence of utility, correlating with disability in numerous spinal conditions. Large, well-designed studies with a priori hypotheses, standardized acquisition methods, detailed clinical data collection, and robust automated analysis techniques are needed to fully demonstrate the potential of these rapidly evolving techniques.

Combining biomechanical finite element analysis and multi-parametric MRI to assess mechanical and structural damage in cervical spondylotic myelopathy
Manuel Taso1,2,3,4, Pierre-Jean Arnoux2,4, Léo Fradet4,5, Arnaud Le Troter1,3, Jean-Philippe Ranjeva1,3,4, Kathia Chaumoître4,6, Pierre-Hugues Roche4,7, and Virginie Callot1,3,4
1CRMBM UMR 7339, Aix-Marseille Université, CNRS, Marseille, France, 2LBA UMR T 24, Aix-Marseille Université, IFSTTAR, Marseille, France, 3CEMEREM, AP-HM, Pôle d'imagerie médicale, Marseille, France,4iLab-Spine international associate laboratory, Marseille/Montréal, France, 5Mechanical Engineering, Ecole Polytechnique de Montréal, Montréal, QC, Canada, 6Service de Radiologie, Hôpital Nord, AP-HM, Pôle d'imagerie médicale, Marseille, France, 7Service de Neurochirurgie, Hôpital Nord, AP-HM, Trauma Center, Marseille, France
While diagnosis of cervical spondylotic myelopathy is easily done with MRI, patient outcome is still difficult to predict. It is nonetheless associated to a strong mechanical cause as spinal cord’s (SC) compression is the first event leading to tissue alterations and neurological deficits. This work proposes an original approach using biomechanical numerical simulation, to apprehend the mechanisms of SC compression by the disk, and multi-parametric MRI, to probe the consequent microstructural alterations (axonal loss, demyelination …). Thanks to spatial normalization, first results on 3 patients are presented, allowing co-localization of personalized simulation of mechanical stress and structural MR alterations.

Application of APT CEST in Cervical Spinal Cord Normal Appearing White Matter of MS Patients at 3T
Samantha By1,2, Alex K. Smith1,2, Adrienne N. Dula2,3, Bailey D. Lyttle2, Siddharama Pawate4, and Seth A. Smith2,3
1Biomedical Engineering, Vanderbilt University, Nashville, TN, United States, 2Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, United States, 3Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, United States, 4Neurology, Vanderbilt University, Nashville, TN, United States
Amide proton transfer (APT) CEST was applied to healthy and multiple sclerosis (MS) cohorts to determine its sensitivity to changes in normal appearing white matter in MS. Using a Lorentzian difference analysis, differences in the z-spectra of the MS and healthy cohorts around the APT frequency (Δω=+3.5 ppm) were observed. Significant differences in APT effect between MS and healthy controls were seen in the whole cord (p=0.0159), dorsal column (p=0.0159), and gray matter (p=0.0317). Lastly, a group-wise analysis highlights the ability to detect a decrease in mean APT effect in the MS cohort, despite the difficulty in detecting lesions in the anatomical.  

Assessing Structure and Function of Myelin in Cervical Spondylotic Myelopathy: Evidence of Focal Demyelination in the Dorsal Column
Hanwen Liu1, Erin MacMillan 1, Emil Ljungberg1, Burkhard Mädler2, Shannon Kolind 1, Marcel Dvorak1, David Li1, Alex MacKay1, John Kramer1, Cornelia Laule1, and Armin Curt3
1University of British Columbia, Vancouver, BC, Canada, 2University of Bonn, Bonn, Germany, 3Balgrist University, Zürich, Switzerland
Cervical spondylotic myelopathy (CSM) is a major cause of spinal cord dysfunction. To better understand the pathophysiology underlying CSM, we used somatosensory evoked potentials (SSEPs) and myelin water imaging to study patients with CSM and healthy controls. Significant differences were found in the myelin water fraction (MWF) of the dorsal column between subjects classified as normal or pathological based on SSEPs. A strong correlation between tibial SSEP latency and MWF was found in CSM. Our findings suggest that MWF can monitor cervical spinal cord demyelination and may be a valuable tool to assess clinical interventions in spinal cord injury.

Atrophy computation in the spinal cord using the Boundary Shift Integral
Ferran Prados1,2, Marios C Yiannakas2, Manuel Jorge Cardoso1, Francesco Grussu2, Floriana De Angelis2, Domenico Plantone2, David H Miller2, Olga Ciccarelli2, Claudia Angela Michela Gandini Wheeler-Kingshott2,3, and Sebastien Ourselin1
1Translational Imaging Group, Medical Physics and Biomedical Engineering, University College London, London, United Kingdom, 2NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, United Kingdom, 3Brain Connectivity Center, C. Mondino National Neurological Institute, Pavia, Italy
In this work, we introduce a new pipeline based on the latest iteration of the BSI for computing atrophy in the SC and compare its results with the most popular atrophy measurements for this region, mean CSA. We demonstrated for the first time the use of BSI in the SC, as a sensitive, quantitative and objective measure of longitudinal tissue volume change. The BSI pipeline presented in this work is repeatable, reproducible and standardises a pipeline for computing SC atrophy. 

Comparison of cervical cerebrospinal fluid flow between healthy controls and chronic spinal cord injury participants using cine phase contrast MRI
Kwan-Jin Jung1, Andrea Willhite2, and Susan Harkema2
1Radiology, University of Louisville, Louisville, KY, United States, 2Neurological Surgery, University of Louisville, Louisville, KY, United States
The cerebrospinal fluid (CSF) flow in the cervical spine was compared between healthy controls and persons with spinal cord injury (SCI) using phase contrast MRI.  The subarachnoid cross-section of SCI participants was smaller than that of healthy controls. The flow velocities in both diastolic and systolic cardiac phases were faster in SCI participants than that of healthy controls. Considering a slower heart rate and a reduced ejection fraction and stroke volume of the heart in SCI participants, the reduced subarachnoid area may be a main contributing factor to the increased velocity of CSF flow in SCI participants.

Quantitative measurements of the spinal cord blood flow of an animal model of relapsing-remitting MS.
Mohamed Tachrount1, Andrew Davies2, Roshni Desai2, Kenneth Smith2, David Thomas1, and Xavier Golay1
1Dept. of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, United Kingdom, 2Dept. of Neuroinflammation, UCL Institute of Neurology, London, United Kingdom
Perfusion-weighted imaging studies have demonstrated that there is a widespread cerebral hypoperfusion in patients with MS, regardless of the clinical subtype. The mechanism and the role of hypoxia are still unclear. The purpose of this work was to longitudinally investigate the SC blood flow (SCBF) during the different phases of disease progression in EAE rats using an optimized ASL technique. These measurements demonstrated for the first time on EAE animal model that the neurological deficits are strongly correlated with impaired blood flow.

A Prospective Longitudinal Study in Degenerative Cervical Myelopathy Using Quantitative Microstructural MRI with Tract-Specific Metrics
Allan R. Martin1, Benjamin De Leener2, Izabela Aleksanderek1, Julien Cohen-Adad2, David W. Cadotte1, Sukhvinder Kalsi-Ryan1, Lindsay Tetreault1, Adrian Crawley3, Howard Ginsberg1, David J. Mikulis3, and Michael G. Fehlings1
1Neurosurgery, University of Toronto, Toronto, ON, Canada, 2Electrical Engineering, Polytechnique Montreal, Montreal, QC, Canada, 3Medical Imaging, University of Toronto, Toronto, ON, Canada
This study investigates if DTI, MT, and T2*-weighted imaging of the rostral cervical cord can 1) detect injury of WM tracts, 2) correlate with global and focal disability, and 3) predict outcomes in degenerative cervical myelopathy (DCM). Data includes detailed clinical assessments, electrophysiology, and MRI, repeated at 1-year. Quantitative MRI in 37 DCM patients and 29 healthy controls provided reliable results and showed decreased CSA, FA, and MTR, and increased T2* WM/GM ratio. FA of individual tracts correlates well with clinical measures. Quantitative multimodal assessment of WM injury with a clinically feasible protocol is possible, with many potential clinical applications.

High Resolution Diffusion Tensor Imaging for Cervical Spondylotic Myelopathy: A Preliminary Follow-up Study
Yuhui Xiong1, Xiaodong Ma1, Xiaolong Chen2, Li Guan2, Yong Hai2, Zhe Zhang1, Le He1, Chun Yuan1,3, and Hua Guo1
1Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China, People's Republic of, 2Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China, People's Republic of, 3Vascular Imaging Laboratory, Department of Radiology, University of Washington, Seattle, WA, United States
As a conventional method in spinal cord assessment in cervical spondylotic myelopathy (CSM) patients, intramedullary high signal intensity (HSI) in T2W images is limited in diagnosis accuracy and predictive capacity for postoperative recovery. Single-shot EPI DTI can detect microstructural information, but it has low image resolution and distortion. In this work, a multi-shot interleaved EPI DTI using SYMPHONY reconstruction method is used to assess the pathologic conditions and the function of spinal cords of CSM patients quantitatively. The results show that the high resolution MS-EPI DTI can performs better than HSI or SS-EPI DTI in CSM diagnosis and recovery monitoring.

Diffusion Tensor Imaging Predicts Outcome ASIA Motor Scores in Acute Traumatic C-Spinal Injury
Jiachen Zhuo1, Hegang Chen2, Bizhan Aarabi3, Jay Menaker4, Rao Gullapalli1, and Kathirkamanathan Shanmuganathan1
1Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States, 2Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, United States, 3Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States, 4Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
Convention MRI is the imaging modality of choice to demonstrate the anatomical location and extent in spinal cord injury (SCI) following trauma. However, quantitative and qualitative lesion parameters within the cord are of limited use in predicting patient neurological outcomes. In this study we demonstrated that acute DTI measurements improve model prediction for 1 year AISA score following blunt cervical SCI. Among all DTI measurements, axial diffusivity, while not radial diffusivity, showed strong effect in predicting outcome, indicating that axonal injury in the cord may be the main factor affecting patient recovery.

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