Cervical Spinal Cord Atrophy Above Level of Asymptomatic Degenerative Cervical Cord Compression

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F65269705%3A_____%2F20%3A00073383" target="_blank" >RIV/65269705:_____/20:00073383 - isvavai.cz</a>

Výsledek na webu

<a href="https://ww4.aievolution.com/hbm2001/index.cfm?do=abs.pubSearchAbstracts" target="_blank" >https://ww4.aievolution.com/hbm2001/index.cfm?do=abs.pubSearchAbstracts</a>

DOI - Digital Object Identifier

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Jazyk výsledku

angličtina

Název v původním jazyce

Cervical Spinal Cord Atrophy Above Level of Asymptomatic Degenerative Cervical Cord Compression

Popis výsledku v původním jazyce

Introduction: Degenerative changes of the spine are almost ubiquitous in the elderly and often lead to development of asymptomatic degenerative cervical spinal cord compression (ADCSCC). The prevalence of ADCSCC in population over 50 years old is over 50% (Kovalova et al., 2016) and up to 25% of them may ultimately develop irreversible degenerative cervical myelopathy (DCM) within 4 years (Bednarik et al., 2008). Many previous studies used cross-sectional area (CSA) and compression ratio (CR) for validation of maximally compressed level (MCL) but did not investigate non-compressed rostral levels although decreases of CSA and CR were shown in these levels in DCM (Grabher et al., 2016). Therefore, we examined degenerative changes and possible atrophy above the compression level in groups of patients with mild or severe ADCSCC before clinical manifestation of DCM. Methods: Forty-six healthy controls (53.6+-8.9 y.o., 18 males), 48 patients with mild ADCSCC (57.4+-10.1 y.o., 26 males, mean CSA at MCL=65.1 mm2, mean CR at MCL=0.45) and 32 patients with severe ADCSCC (57.1+-9.5 y.o., 10 males, mean CSA at MCL=56.7 mm2, mean CR at MCL=0.36) were scanned on 3T Prisma scanner (Siemens Healthcare). Severe ADCSCC group was defined as both CR&lt;0.40 and CSA&lt;70.1 mm2. Structural T2*-w axial (MEDIC sequence, voxel size 0.35x0.35x2.5 mm3 (after interpolation in Fourier domain)) and T2-w sagittal (turbo spin-echo sequence, voxel size 0.28x1.3x0.28 mm3 (after interpolation in Fourier domain)) images of cervical SC were collected. T2* and T2-w images were normalized and bias-field corrected. T2*-w scans acquired with interleaved sequence were slice-by-slice corrected. Images were analyzed by Spinal Cord Toolbox (SCT) v3.2.3 (De Leener et al., 2017) using SC and gray matter (GM) segmentations and SC labeling. Iterative multi-step registration of the PAM50 template and atlas (De Leener et al., 2018) accounted for the shape of white matter (WM) and GM was performed. Six masks were defined based on the PAM50 atlas - SC, WM, GM and three WM columns (dorsal, lateral and ventral). All segmentations were visually inspected and corrected as needed. Slice corresponding to C2/3 intervertebral disc was manually identified in all subjects and an experienced radiologist performed identification of MCL and determined CSA and CR at MCL. Areas of individual masks together with CSA and CR from C2/3 slice and 5 continuous caudal slices were extracted from T2*-w image using SCT v4.1.0 and averaged across these 6 slices. To compensate for various SC size across subjects, ratio between WM and GM volumes and ratios between individual WM columns and SC were calculated. Between group comparison was done using Kruskal-Wallis test and subsequent posthoc tests. Results: Between-group comparison of subject characteristics revealed significant differences only in CR and CSA at MCL as expected. MCL was identified at the C4/5 level or below in all patients except for 1 patient in each group with MCL at C3/4. Testing of the region above the compression revealed significantly (p&lt;0.05) lower values of CSA (71.9 vs 66.6 mm2), CR (0.63 vs 0.58) and areas of WM (58.5 vs 53.5 mm2) and lateral and ventral columns between the group of severe ADCSCC patients and controls (Table 1). Testing of ratios showed significantly lower WM/GM ratio in severe ADCSCC patients. Conclusions: Selective region-of-interest analysis revealed reduced areas of lateral and ventral WM columns which is also confirmed by lower WM/GM ratio. This finding implies degeneration and atrophy of long WM tracts in patients with severe ADCSCC. Our findings provide evidence of incipient WM changes rostrally to MCL in ADCSCC patients with severe compression, which may predict development of DCM, however, this has to be confirmed in a longitudinal study.

Název v anglickém jazyce

Cervical Spinal Cord Atrophy Above Level of Asymptomatic Degenerative Cervical Cord Compression

Popis výsledku anglicky

Introduction: Degenerative changes of the spine are almost ubiquitous in the elderly and often lead to development of asymptomatic degenerative cervical spinal cord compression (ADCSCC). The prevalence of ADCSCC in population over 50 years old is over 50% (Kovalova et al., 2016) and up to 25% of them may ultimately develop irreversible degenerative cervical myelopathy (DCM) within 4 years (Bednarik et al., 2008). Many previous studies used cross-sectional area (CSA) and compression ratio (CR) for validation of maximally compressed level (MCL) but did not investigate non-compressed rostral levels although decreases of CSA and CR were shown in these levels in DCM (Grabher et al., 2016). Therefore, we examined degenerative changes and possible atrophy above the compression level in groups of patients with mild or severe ADCSCC before clinical manifestation of DCM. Methods: Forty-six healthy controls (53.6+-8.9 y.o., 18 males), 48 patients with mild ADCSCC (57.4+-10.1 y.o., 26 males, mean CSA at MCL=65.1 mm2, mean CR at MCL=0.45) and 32 patients with severe ADCSCC (57.1+-9.5 y.o., 10 males, mean CSA at MCL=56.7 mm2, mean CR at MCL=0.36) were scanned on 3T Prisma scanner (Siemens Healthcare). Severe ADCSCC group was defined as both CR&lt;0.40 and CSA&lt;70.1 mm2. Structural T2*-w axial (MEDIC sequence, voxel size 0.35x0.35x2.5 mm3 (after interpolation in Fourier domain)) and T2-w sagittal (turbo spin-echo sequence, voxel size 0.28x1.3x0.28 mm3 (after interpolation in Fourier domain)) images of cervical SC were collected. T2* and T2-w images were normalized and bias-field corrected. T2*-w scans acquired with interleaved sequence were slice-by-slice corrected. Images were analyzed by Spinal Cord Toolbox (SCT) v3.2.3 (De Leener et al., 2017) using SC and gray matter (GM) segmentations and SC labeling. Iterative multi-step registration of the PAM50 template and atlas (De Leener et al., 2018) accounted for the shape of white matter (WM) and GM was performed. Six masks were defined based on the PAM50 atlas - SC, WM, GM and three WM columns (dorsal, lateral and ventral). All segmentations were visually inspected and corrected as needed. Slice corresponding to C2/3 intervertebral disc was manually identified in all subjects and an experienced radiologist performed identification of MCL and determined CSA and CR at MCL. Areas of individual masks together with CSA and CR from C2/3 slice and 5 continuous caudal slices were extracted from T2*-w image using SCT v4.1.0 and averaged across these 6 slices. To compensate for various SC size across subjects, ratio between WM and GM volumes and ratios between individual WM columns and SC were calculated. Between group comparison was done using Kruskal-Wallis test and subsequent posthoc tests. Results: Between-group comparison of subject characteristics revealed significant differences only in CR and CSA at MCL as expected. MCL was identified at the C4/5 level or below in all patients except for 1 patient in each group with MCL at C3/4. Testing of the region above the compression revealed significantly (p&lt;0.05) lower values of CSA (71.9 vs 66.6 mm2), CR (0.63 vs 0.58) and areas of WM (58.5 vs 53.5 mm2) and lateral and ventral columns between the group of severe ADCSCC patients and controls (Table 1). Testing of ratios showed significantly lower WM/GM ratio in severe ADCSCC patients. Conclusions: Selective region-of-interest analysis revealed reduced areas of lateral and ventral WM columns which is also confirmed by lower WM/GM ratio. This finding implies degeneration and atrophy of long WM tracts in patients with severe ADCSCC. Our findings provide evidence of incipient WM changes rostrally to MCL in ADCSCC patients with severe compression, which may predict development of DCM, however, this has to be confirmed in a longitudinal study.

Druh

O - Ostatní výsledky

CEP obor

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OECD FORD obor

30210 - Clinical neurology

Projekt

<a href="/cs/project/NV18-04-00159" target="_blank" >NV18-04-00159: Využití pokročilých magneticko-rezonančních technik k odhalení patofyziologie a zlepšení diagnostiky a praktického managementu degenerativní komprese krční míchy</a><br>

Návaznosti

P - Projekt vyzkumu a vyvoje financovany z verejnych zdroju (s odkazem do CEP)

Rok uplatnění

2020

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů