RT Journal Article
SR Electronic
T1 Can microstructural MRI detect subclinical tissue injury in subjects with asymptomatic cervical spinal cord compression? A prospective cohort study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e019809
DO 10.1136/bmjopen-2017-019809
VO 8
IS 4
A1 Allan R Martin
A1 Benjamin De Leener
A1 Julien Cohen-Adad
A1 David W Cadotte
A1 Aria Nouri
A1 Jefferson R Wilson
A1 Lindsay Tetreault
A1 Adrian P Crawley
A1 David J Mikulis
A1 Howard Ginsberg
A1 Michael G Fehlings
YR 2018
UL http://bmjopen.bmj.com/content/8/4/e019809.abstract
AB Objectives 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.