Can microstructural MRI detect subclinical tissue injury in subjects with asymptomatic cervical spinal cord compression? A prospective cohort study

• Published in: BMJ open Vol. 8; no. 4; p. e019809
• Main Authors: Martin, Allan R, De Leener, Benjamin, Cohen-Adad, Julien, Cadotte, David W, Nouri, Aria, Wilson, Jefferson R, Tetreault, Lindsay, Crawley, Adrian P, Mikulis, David J, Ginsberg, Howard, Fehlings, Michael G
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2018; BMJ Publishing Group
• Subjects: Ataxia; Automation; Cohort analysis; Gait; Magnetic resonance imaging; Measurement techniques; Neurology; NMR; Nuclear magnetic resonance; Principal components analysis; Spinal cord; spinal cord injury; diffusion tensor imaging; magnetization transfer; preclinical; myelopathy; quantitative mri
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2017-019809

ObjectivesDegenerative 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.DesignProspective observational longitudinal cohort study.SettingSingle centre, tertiary care and research institution.Participants40 neurologically intact subjects (19 female, 21 male) divided into groups with and without ASCC.InterventionsNone.Outcome measuresClinical 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.ResultsASCC 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.ConclusionsASCC 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.