A Novel MRI Biomarker of Spinal Cord White Matter Injury: T2*-Weighted White Matter to Gray Matter Signal Intensity Ratio
A Novel MRI Biomarker of Spinal Cord White Matter Injury: T2*-Weighted White Matter to Gray Matter Signal Intensity Ratio
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DOI：
10.3174/ajnr.a5162
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发表时间：
2017-06-01
影响因子：
3.5
通讯作者：
Fehlings, M. G.
中科院分区：
文献类型：
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作者：
Martin, A. R.;De Leener, B.;Fehlings, M. G.
背景和目的：T2* 加权成像提供了脊髓GM和WM之间的鲜明对比，允许它们的分割和横截面积测量。损伤的WM表现为T2*WI高信号，但需要标准化定量使用。我们介绍T2*WI WM/GM信号强度比，并比较它对横截面积，DTI度量分数各向异性，和磁化转移率在退行性颈椎病。材料和方法：58例退行性颈椎病和40例健康人进行了3 T MR成像，覆盖C1-C7。在最大压缩和未压缩的头侧/尾侧节段自动提取椎体。将标准化指标与t检验、曲线下面积和逻辑回归进行比较。结果：最大压缩节段横截面积显示出上级差异（P = 1 × 10（-13）），诊断准确性（曲线下面积= 0.890），与改良的日本骨科协会评分（0.66）单变量相关。T2*WI、WM/GM表现出较强的差异性（吻侧：P = 8 x 10（-7）;最大压缩水平：P = 1 x 10（-11）;尾侧：P = 1 x 10（-4）），相关性（改良日本骨科协会评分;头侧：-0.52;最大压缩节段：-0.59;尾侧：-0.36）和诊断准确性（头侧：0.775;最大压缩水平：0.860;尾侧：0.721），在大多数比较和头侧/尾侧水平的横截面积中优于分数各向异性和磁化传递比。头侧T2*WI WM/GM与局灶运动相关性最强（-0.45）和感官（-0.49）缺陷，是改良日本骨科协会评分的最强独立预测因子（P = 0.01）和诊断（P = 0.02）在多变量模型中（R-2 = 0.59，P = 8 × 10（-13）;曲线下面积分别= 0.954）。结论：T2*WI WM/GM显示有望作为WM损伤的新生物标志物。它可以检测压缩和未压缩区域的损伤，并为诊断和与损伤相关的多变量模型做出重大贡献。我们的多参数方法克服了个体测量的局限性，具有改善诊断、监测进展和预测结果的潜力。
BACKGROUND AND PURPOSE: T2*-weighted imaging provides sharp contrast between spinal cord GM and WM, allowing their segmentation and cross-sectional area measurement. Injured WM demonstrates T2*WI hyperintensity but requires normalization for quantitative use. We introduce T2*WI WM/GM signal-intensity ratio and compare it against cross-sectional area, the DTI metric fractional anisotropy, and magnetization transfer ratio in degenerative cervical myelopathy.MATERIALS AND METHODS: Fifty-eight patients with degenerative cervical myelopathy and 40 healthy subjects underwent 3T MR imaging, covering C1-C7. Metrics were automatically extracted at maximally compressed and uncompressed rostral/caudal levels. Normalized metrics were compared with t tests, area under the curve, and logistic regression. Relationships with clinical measures were analyzed by using Pearson correlation and multiple linear regression.RESULTS: The maximally compressed level cross-sectional area demonstrated superior differences (P = 1 x 10(-13)), diagnostic accuracy (area under the curve = 0.890), and univariate correlation with the modified Japanese Orthopedic Association score (0.66). T2*WI WM/GM showed strong differences (rostral: P = 8 x 10(-7); maximally compressed level: P = 1 x 10(-11); caudal: P = 1 x 10(-4)), correlations (modified Japanese Orthopedic Association score; rostral: -0.52; maximally compressed level: -0.59; caudal: -0.36), and diagnostic accuracy (rostral: 0.775; maximally compressed level: 0.860; caudal: 0.721), outperforming fractional anisotropy and magnetization transfer ratio in most comparisons and cross-sectional area at rostral/caudal levels. Rostral T2*WI WM/GM showed the strongest correlations with focal motor (-0.45) and sensory (-0.49) deficits and was the strongest independent predictor of the modified Japanese Orthopedic Association score (P = .01) and diagnosis (P = .02) in multivariate models (R-2 = 0.59, P = 8 x 10(-13); area under the curve = 0.954, respectively).CONCLUSIONS: T2*WI WM/GM shows promise as a novel biomarker of WM injury. It detects damage in compressed and uncompressed regions and contributes substantially to multivariate models for diagnosis and correlation with impairment. Our multiparametric approach overcomes limitations of individual measures, having the potential to improve diagnostics, monitor progression, and predict outcomes.