目的揭示急性脊髓损伤(SCI)后创伤诱发的神经退行性改变的直接程度,并确定定量MRI(qMRI)的预测临床价值。
24例急性SCI患者和23例健康对照者接受了高分辨率T1加权方案。其中18例患者和20例对照还接受了对组织结构内容敏感的多参数映射(MPM)MRI方案,包括髓鞘和铁.患者在基线时进行临床检查,SCI后2、6、12和24个月。我们使用T1加权MRI评估脊髓和大脑的体积和微结构变化,磁化转移(MT),纵向弛豫率(R1),和有效横向弛豫率(R2*)图。回归分析确定了急性qMRI参数与恢复之间的关联。
在基线,患者的脊髓面积及其前后宽度减少,而MT,R1和R2*参数在帘线中保持不变。在小脑内,体积的减少与MT和R2*参数的增加平行。在初级运动皮层和边缘系统中观察到早期灰质变化。重要的是,脊髓和小脑的早期体积和微观结构变化可预测损伤后的功能恢复。
脊髓损伤早期发生神经退行性改变,具有不同的时间和空间动力学。脊髓和小脑的早期qMRI标记可预测功能恢复。这些神经影像学生物标志物可以补充临床评估,并提供对治疗干预以增强神经可塑性的潜力的见解。
To reveal the immediate extent of trauma-induced neurodegenerative changes rostral to the level of lesion and determine the predictive clinical value of quantitative MRI (qMRI) following acute spinal cord injury (SCI).
Twenty-four acute SCI patients and 23 healthy controls underwent a high-resolution T1-weighted protocol. Eighteen of those patients and 20 of controls additionally underwent a multi-parameter mapping (MPM) MRI protocol sensitive to the content of tissue structure, including myelin and iron. Patients were examined clinically at baseline, 2, 6, 12, and 24 months post-SCI. We assessed volume and microstructural changes in the spinal cord and brain using T1-weighted MRI, magnetization transfer (MT), longitudinal relaxation rate (R1), and effective transverse relaxation rate (R2*) maps. Regression analysis determined associations between acute qMRI parameters and recovery.
At baseline, cord area and its anterior-posterior width were decreased in patients, whereas MT, R1, and R2* parameters remained unchanged in the cord. Within the cerebellum, volume decrease was paralleled by increases of MT and R2* parameters. Early grey matter changes were observed within the primary motor cortex and limbic system. Importantly, early volume and microstructural changes of the cord and cerebellum predicted functional recovery following injury.
Neurodegenerative changes rostral to the level of lesion occur early in SCI, with varying temporal and spatial dynamics. Early qMRI markers of spinal cord and cerebellum are predictive of functional recovery. These neuroimaging biomarkers may supplement clinical assessments and provide insights into the potential of therapeutic interventions to enhance neural plasticity.