Quantifying neurodegeneration of the cervical cord and brain in degenerative cervical myelopathy: A multicentre study using quantitative magnetic resonance imaging

Patrick Freund; Viveka Boller; Tim M Emmenegger; Muhammad Akbar; Markus Hupp; Nikolai Pfender; Claudia Angela Michela Gandini Wheeler-Kingshott; Julien Cohen-Adad; Michael G Fehlings; Armin Curt; Maryam Seif

doi:10.1111/ene.16297

Quantifying neurodegeneration of the cervical cord and brain in degenerative cervical myelopathy: A multicentre study using quantitative magnetic resonance imaging

Eur J Neurol. 2024 May 7:e16297. doi: 10.1111/ene.16297. Online ahead of print.

Authors

Affiliations

¹ Spinal Cord Injury Centre, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.
² Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
³ Spine Program Division of Neurosurgery, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada.
⁴ NMR Research Unit, Queen Square MS Centre, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, London, UK.
⁵ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
⁶ Digital Neuroscience Research Unit, IRCCS Mondino Foundation, Pavia, Italy.
⁷ NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada.
⁸ Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, Quebec, Canada.

PMID: 38713645
DOI: 10.1111/ene.16297

Abstract

Background and purpose: Simultaneous assessment of neurodegeneration in both the cervical cord and brain across multiple centres can enhance the effectiveness of clinical trials. Thus, this study aims to simultaneously assess microstructural changes in the cervical cord and brain above the stenosis in degenerative cervical myelopathy (DCM) using quantitative magnetic resonance imaging (MRI) in a multicentre study.

Methods: We applied voxelwise analysis with a probabilistic brain/spinal cord template embedded in statistical parametric mappin (SPM-BSC) to process multi parametric mapping (MPM) including effective transverse relaxation rate (R2*), longitudinal relaxation rate (R1), and magnetization transfer (MT), which are indirectly sensitive to iron and myelin content. Regression analysis was conducted to establish associations between neurodegeneration and clinical impairment. Thirty-eight DCM patients (mean age ± SD = 58.45 ± 11.47 years) and 38 healthy controls (mean age ± SD = 41.18 ± 12.75 years) were recruited at University Hospital Balgrist, Switzerland and Toronto Western Hospital, Canada.

Results: Remote atrophy was observed in the cervical cord (p = 0.002) and in the left thalamus (0.026) of the DCM group. R1 was decreased in the periaqueductal grey matter (p = 0.014), thalamus (p = 0.001), corpus callosum (p = 0.0001), and cranial corticospinal tract (p = 0.03). R2* was increased in the primary somatosensory cortices (p = 0.008). Sensory impairments were associated with increased iron-sensitive R2* in the thalamus and periaqueductal grey matter in DCM.

Conclusions: Simultaneous assessment of the spinal cord and brain revealed DCM-induced demyelination, iron deposition, and atrophy. The extent of remote neurodegeneration was associated with sensory impairment, highlighting the intricate and expansive nature of microstructural neurodegeneration in DCM, reaching beyond the stenosis level.

Keywords: DCM; brain; multicentre study; multiparametric mapping; spinal cord.

Abstract

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