Degeneration of the injured cervical cord is associated with remote changes in corticospinal tract integrity and upper limb impairment.
Degeneration of the injured cervical cord is associated with remote changes in corticospinal tract integrity and upper limb impairment.
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DOI：
10.1371/journal.pone.0051729
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Thompson AJ
中科院分区：
文献类型：
--
作者：
Freund P;Schneider T;Nagy Z;Hutton C;Weiskopf N;Friston K;Wheeler-Kingshott CA;Thompson AJ
创伤性脊髓损伤（SCI）导致轴突破坏和肉眼可见的组织损失。应用扩散张量成像（DTI）技术，对创伤性病变上方颈髓皮质脊髓束（CST）的退变进行了研究，并探讨了其与颈部萎缩、脑皮质脊髓束远端轴突改变及上肢功能的关系。研究了9名双侧运动和感觉障碍的颈椎损伤志愿者和10名对照者。颈髓和脑的DTI提供了各向异性分数（FA）的测量，而解剖MRI评估了脊髓横截面面积（即脊髓萎缩）。脊髓和中央感兴趣区（ROI）包括颈髓和脑中的双侧CST。回归分析确定了CST和残疾的脊髓FA和颅FA之间的相关性。在SCI患者中，与对照组相比，整个颈髓和大脑的两个CST中的FA显著较低（p≤0.05）。SCI患者颈髓FA减少与较小的脊髓面积（p = 0.002）和内囊水平的颅侧CST FA较低（p = 0.001）相关。 颈椎CST的FA较低也与上肢功能受损相关，与脊髓面积无关（p = 0.03）。 在损伤部位近端的萎缩颈髓中，CST的轴突变性与颅侧CST变性平行，并与残疾相关。该DTI方案可用于损伤后即刻纵向评估显微结构变化，并可用于预测进展和监测旨在促进脊髓修复的干预措施。
Traumatic spinal cord injury (SCI) leads to disruption of axons and macroscopic tissue loss. Using diffusion tensor imaging (DTI), we assessed degeneration of the corticospinal tract (CST) in the cervical cord above a traumatic lesion and explored its relationship with cervical atrophy, remote axonal changes within the cranial CST and upper limb function. Nine cervical injured volunteers with bilateral motor and sensory impairment and ten controls were studied. DTI of the cervical cord and brain provided measurements of fractional anisotropy (FA), while anatomical MRI assessed cross-sectional spinal cord area (i.e. cord atrophy). Spinal and central regions of interest (ROI) included the bilateral CST in the cervical cord and brain. Regression analysis identified correlations between spinal FA and cranial FA in the CST and disability. In individuals with SCI, FA was significantly lower in both CSTs throughout the cervical cord and brain when compared with controls (p≤0.05). Reduced FA of the cervical cord in patients with SCI was associated with smaller cord area (p = 0.002) and a lower FA of the cranial CST at the internal capsule level (p = 0.001). Lower FA in the cervical CST also correlated with impaired upper limb function, independent of cord area (p = 0.03). Axonal degeneration of the CST in the atrophic cervical cord, proximal to the site of injury, parallels cranial CST degeneration and is associated with disability. This DTI protocol can be used in longitudinal assessment of microstructural changes immediately following injury and may be utilised to predict progression and monitor interventions aimed at promoting spinal cord repair.
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