Monitoring for myelopathic progression with multiparametric quantitative MRI.
Monitoring for myelopathic progression with multiparametric quantitative MRI.
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DOI：
10.1371/journal.pone.0195733
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Fehlings MG
中科院分区：
文献类型：
--
作者：
Martin AR;De Leener B;Cohen-Adad J;Kalsi-Ryan S;Cadotte DW;Wilson JR;Tetreault L;Nouri A;Crawley A;Mikulis DJ;Ginsberg H;Massicotte EM;Fehlings MG
轻度退行性颈椎病（DCM）患者通常采用非手术治疗，如果发生神经系统进展，则建议手术治疗。然而，进展的检测往往是主观的。定量MRI（qMRI）直接测量脊髓（SC）组织变化，检测轴突损伤、脱髓鞘和萎缩。这项纵向研究比较了非手术DCM患者的多参数qMRI与临床进展指标。对26例DCM患者进行随访。临床数据包括改良的日本骨科协会（mJOA）和其他评估。3 T qMRI数据包括横截面积、扩散分数各向异性、磁化传递比和T2* 加权白色/灰质信号比，从压缩SC和上方/下方提取。进展定义为：1）患者的主观印象，2）2分mJOA降低，3）≥3项临床指标恶化≥ 5%，4）MRI压迫增加，或5）10项qMRI指标中≥1项或复合评分恶化（p < 0.004，校正）。随访（13.5 ± 4.9个月）包括所有26例患者的mJOA、25例患者的MRI和22例患者的临床/qMRI。与mJOA（11.5%）、MRI（20%）、综合评估（54.6%）和qMRI（68.2%）相比，42.3%的患者报告了主观恶化。相对于主观恶化，与综合评估（75%，60%）、mJOA（27.3%，100%）和MRI（18.2%，81.3%）相比，qMRI显示出100%的灵敏度和53.3%的特异性。结合qMRI的决策算法确定了11例受试者（42.3%）的进展并建议手术。定量MRI显示检测脊髓病变进展的高灵敏度。我们的研究结果表明，神经可塑性和行为适应可能掩盖进行性SC组织损伤。qMRI似乎是一种有用的方法，以确认微妙的脊髓病变进展的个别患者，代表了一个进步的临床翻译的qMRI。
Patients with mild degenerative cervical myelopathy (DCM) are often managed non-operatively, and surgery is recommended if neurological progression occurs. However, detection of progression is often subjective. Quantitative MRI (qMRI) directly measures spinal cord (SC) tissue changes, detecting axonal injury, demyelination, and atrophy. This longitudinal study compared multiparametric qMRI with clinical measures of progression in non-operative DCM patients. 26 DCM patients were followed. Clinical data included modified Japanese Orthopedic Association (mJOA) and additional assessments. 3T qMRI data included cross sectional area, diffusion fractional anisotropy, magnetization transfer ratio, and T2*-weighted white/grey matter signal ratio, extracted from the compressed SC and above/below. Progression was defined as 1) patients’ subjective impression, 2) 2-point mJOA decrease, 3) ≥3 clinical measures worsening ≥5%, 4) increased compression on MRI, or 5) ≥1 of 10 qMRI measures or composite score worsening (p < 0.004, corrected). Follow-up (13.5 ± 4.9 months) included mJOA in all 26 patients, MRI in 25, and clinical/qMRI in 22. 42.3% reported subjective worsening, compared with mJOA (11.5%), MRI (20%), comprehensive assessments (54.6%), and qMRI (68.2%). Relative to subjective worsening, qMRI showed 100% sensitivity and 53.3% specificity compared with comprehensive assessments (75%, 60%), mJOA (27.3%, 100%), and MRI (18.2%, 81.3%). A decision-making algorithm incorporating qMRI identified progression and recommended surgery for 11 subjects (42.3%). Quantitative MRI shows high sensitivity to detect myelopathic progression. Our results suggest that neuroplasticity and behavioural adaptation may mask progressive SC tissue injury. qMRI appears to be a useful method to confirm subtle myelopathic progression in individual patients, representing an advance toward clinical translation of qMRI.
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影响因子：
5.3
作者：
Fehlings, Michael G.;Wilson, Jefferson R.;Gokaslan, Ziya L.
通讯作者：
Gokaslan, Ziya L.
影响因子：
2.8
作者：
Kadanka, Z;Bednarík, J;Urbánek, I
通讯作者：
Urbánek, I
影响因子：
3
作者：
Matsumoto, M;Chiba, K;Toyama, Y
通讯作者：
Toyama, Y
影响因子：
3.5
作者：
Martin, A. R.;De Leener, B.;Fehlings, M. G.
通讯作者：
Fehlings, M. G.
DOI：
10.1016/j.nicl.2015.11.019
发表时间：
2016
期刊：
NeuroImage. Clinical
影响因子：
--
作者：
Martin AR;Aleksanderek I;Cohen-Adad J;Tarmohamed Z;Tetreault L;Smith N;Cadotte DW;Crawley A;Ginsberg H;Mikulis DJ;Fehlings MG
通讯作者：
Fehlings MG