Tissue bridges predict recovery after traumatic and ischemic thoracic spinal cord injury
Tissue bridges predict recovery after traumatic and ischemic thoracic spinal cord injury
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DOI：
10.1212/wnl.0000000000008318
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发表时间：
2019-10-15
期刊：
影响因子：
9.9
通讯作者：
Freund, Patrick
中科院分区：
文献类型：
--
作者：
Pfyffer, Dario;Huber, Eveline;Freund, Patrick
目的探讨髓内损伤和正中矢状面组织桥的时空演变和预测性能在震中的胸脊髓损伤（SCI）using MRI.MethodsWe回顾性评估正中矢状面T2加权扫描从25例胸脊髓损伤（14创伤，11缺血）在1个月后SCI。在12例SCI患者中，采用线性混合效应模型对序列MRI进行研究，探讨可量化的病变标记物（面积、长度和宽度）和组织桥的时间轨迹。使用偏相关分析，我们评估了SCI后1个月的结构性损伤特征与伤后1年的恢复之间的关系，调整了基线临床状态，年龄和性别。（p = 0.005），病变长度每月增加2.14 mm（p = 0.004），病变宽度每月增加0.13 mm（p = 0.004）。组织桥宽度每月增加0.06 mm（p = 0.019），创伤性和缺血性SCI相似（p = 0.576）。较小的病变面积，长度，宽度和更广泛的组织桥在1个月后SCI预测更好的恢复在1年follow-up.ConclusionsOver时间，脊髓损伤的直接面积缩小，而囊腔成为划定。邻近囊肿，中矢状面组织桥可见。SCI后1个月的组织桥宽度预测了1年随访时的恢复。因此，创伤性和缺血性胸段脊髓损伤后早期的损伤面积和组织桥的测量可以表征局灶性脊髓损伤的演变，并预测胸段脊髓损伤的恢复。因此，病变范围和组织桥有可能改善介入试验中的诊断和患者分层。
ObjectiveTo investigate the spatiotemporal evolution and predictive properties of intramedullary damage and midsagittal tissue bridges at the epicenter of a thoracic spinal cord injury (SCI) using MRI.MethodsWe retrospectively assessed midsagittal T2-weighted scans from 25 patients with thoracic SCI (14 traumatic, 11 ischemic) at 1 month post-SCI. In 12 patients with SCI, linear mixed-effects models on serial MRI explored temporal trajectories of quantifiable lesion markers (area, length, and width) and tissue bridges. Using partial correlation analysis, we assessed associations between structural lesion characteristics at 1 month post-SCI and recovery at 1 year postinjury, adjusting for baseline clinical status, age, and sex.ResultsLesion area decreased by 5.68 mm(2) (p = 0.005), lesion length by 2.14 mm (p = 0.004), and lesion width by 0.13 mm (p = 0.004) per month. Width of tissue bridges increased by 0.06 mm (p = 0.019) per month, being similar in traumatic and ischemic SCI (p = 0.576). Smaller lesion area, length, width, and wider tissue bridges at 1 month post-SCI predicted better recovery at 1-year follow-up.ConclusionsOver time, the immediate area of cord damage shrunk while the cystic cavity became demarcated. Adjacent to the cyst, midsagittal tissue bridges became visible. The width of tissue bridges at 1 month post-SCI predicted recovery at 1 year follow-up. Measures of lesion area and tissue bridges early after traumatic and ischemic thoracic SCI therefore allow characterizing the evolution of focal cord damage and are predictive of recovery in thoracic SCI. Thus, lesion extent and tissue bridges hold potential to improve diagnosis and patient stratification in interventional trials.