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Abstract：
OBJECTIVE: 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.
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.
摘要：
目的：在多个中心同时评估颈髓和脑神经变性可以提高临床试验的有效性。因此，这项研究旨在在一项多中心研究中使用定量磁共振成像(MRI)同时评估退行性脊髓型颈椎病(DCM)患者颈髓和狭窄上方大脑的微观结构变化.
方法：我们使用嵌入统计参数映射（SPM-BSC）的概率脑/脊髓模板进行体素分析，以处理多参数映射（MPM），包括有效横向松弛率（R2*），纵向弛豫率(R1)，和磁化转移(MT)，对铁和髓鞘含量间接敏感。进行回归分析以建立神经变性和临床损害之间的关联。在Balgrist大学医院招募了38名DCM患者（平均年龄±SD=58.45±11.47岁）和38名健康对照（平均年龄±SD=41.18±12.75岁），瑞士和多伦多西部医院，加拿大。
结果：在DCM组的颈索（p=0.002）和左丘脑（0.026）中观察到远端萎缩。R1在导水管周围灰质中降低（p=0.014），丘脑（p=0.001），call体（p=0.0001），和颅骨皮质脊髓束（p=0.03）。在初级体感皮层中R2*增加(p=0.008)。感觉障碍与DCM丘脑和导水管周围灰质中铁敏感性R2*增加有关。
结论：同时评估脊髓和大脑显示DCM诱导的脱髓鞘，铁沉积,和萎缩。远端神经变性的程度与感觉障碍有关，强调DCM中微结构神经变性的复杂性和扩张性，超过狭窄水平。
方法：我们使用嵌入统计参数映射（SPM-BSC）的概率脑/脊髓模板进行体素分析，以处理多参数映射（MPM），包括有效横向松弛率（R2*），纵向弛豫率(R1)，和磁化转移(MT)，对铁和髓鞘含量间接敏感。进行回归分析以建立神经变性和临床损害之间的关联。在Balgrist大学医院招募了38名DCM患者（平均年龄±SD=58.45±11.47岁）和38名健康对照（平均年龄±SD=41.18±12.75岁），瑞士和多伦多西部医院，加拿大。
结果：在DCM组的颈索（p=0.002）和左丘脑（0.026）中观察到远端萎缩。R1在导水管周围灰质中降低（p=0.014），丘脑（p=0.001），call体（p=0.0001），和颅骨皮质脊髓束（p=0.03）。在初级体感皮层中R2*增加(p=0.008)。感觉障碍与DCM丘脑和导水管周围灰质中铁敏感性R2*增加有关。
结论：同时评估脊髓和大脑显示DCM诱导的脱髓鞘，铁沉积,和萎缩。远端神经变性的程度与感觉障碍有关，强调DCM中微结构神经变性的复杂性和扩张性，超过狭窄水平。
