Ex vivo 1H MR spectroscopy and histology after experimental chronic spinal cord compression

Duetzmann, Stephan; Pilatus, Ulrich; Seifert, Volker; Marquardt, Gerhard; Setzer, Matthias

doi:10.21037/jss.2017.05.08

Cited by 7 publications

(4 citation statements)

References 25 publications

(37 reference statements)

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“…This finding is in line with a preclinical study reporting higher tNAA levels in a rabbit model of SCI with a light compared to a severe injury. 43 …”

Section: Discussionmentioning

confidence: 99%

Metabolites of neuroinflammation relate to neuropathic pain after spinal cord injury

et al. 2020

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Objective:To determine whether cervical cord levels of metabolites are associated with pain sensation after spinal cord injury (SCI), we performed magnetic resonance spectroscopy in SCI patients with and without neuropathic pain (NP).Methods:Cervical cord single-voxel spectroscopic data of 24 SCI patients (14 with NP, 10 pain-free) and 21 healthy controls were acquired at C2/3 to investigate metabolite ratios associated with neuroinflammation (choline-containing compounds to myo-inositol (tCho/mI)) and neurodegeneration (total N-acetylaspartate to myo-inositol (tNAA/mI)). NP levels were measured and Spearman’s correlation tests assessed associations between metabolite levels, cord atrophy, and pin-prick score.Results:In patients with NP, tCho/mI levels were increased (p=0.024) compared to pain-free patients and negatively related to cord atrophy (p=0.006, r=0.714). Better pin-prick score was associated with higher tCho/mI levels (p=0.032, r=0.574). In pain-free patients, tCho/mI levels were not related to cord atrophy (p=0.881, r=0.055) or pin-prick score (p=0.676, r=0.152). tNAA/mI levels were similar in both patient groups (p=0.396) and were not associated with pin-prick score in patients with NP (p=0.405, r=0.242) and pain-free patients (p=0.117, r=0.527).Conclusions:Neuroinflammatory metabolite levels (i.e. tCho/mI) were elevated in patients with NP; its magnitude being associated with less cord atrophy and greater pain sensation (e.g. pin-prick score). This suggests that patients with NP have more residual spinal tissue and greater metabolite turnover than pain-free patients. Neurodegenerative metabolite levels (i.e. tNAA/mI) were associated with greater cord atrophy, but unrelated to NP. Identifying the metabolic NP signature provides new NP treatment targets and could improve patient stratification in interventional trials.Classification of Evidence:This study provides Class II evidence that levels of MR-spectroscopy-identified metabolites of neuroinflammation were elevated in SCI patients with NP compared to those without NP.

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“…This finding is in line with a preclinical study reporting higher tNAA levels in a rabbit model of SCI with a light compared to a severe injury. 43 …”

Section: Discussionmentioning

confidence: 99%

Metabolites of neuroinflammation relate to neuropathic pain after spinal cord injury

et al. 2020

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“…In addition to being a non-invasive method of detecting neuronal activity, and not limited to a single site of recording, spinal fMRI can be performed on any standard clinical MR scanner without special modifications. Thus, we expect that the development of the spinal cord fMRI technology combined with other MR technologies ( 40 – 42 ) will demonstrate great clinical value for the location of spinal cord function, therapeutic monitoring, and treatment guidance.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Spinal Cord Activity and Blood Biochemical Changes in Individuals With Diabetic Peripheral Neuropathy During Electrical Stimulation

et al. 2019

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It is difficult to perform an in vivo evaluation of the nerve conduction mechanism in a patient with diabetic peripheral neuropathy (DPN). We aim to explore possible activation differences to enable a further understanding of the nerve conduction mechanisms of diabetic neuropathy and to present a novel clinical method to evaluate nerve injury and recovery. DPN patients (n = 20) and healthy volunteers (n = 20) were included in this study to detect the functional activation of the lumbar spinal cord via electric stimulation. Spinal fMRI data sets were acquired via a single-shot fast spin echo (SSFSE) sequence. A task-related fMRI was performed via low-frequency electrical stimulation. After post-processing, the active voxels and the percentage of signal changes were calculated for the DPN evaluation and the correlations between the blood biochemical indexes, such as glucose, total cholesterol, and hemoglobin A1c were explored. Activation in the DPN patients was primarily observed in the T12 (10/13) vertebral level. The percentage of signal changes in DPN patients was higher than that in the control group (Z = −2.757, P < 0.05). Positive correlation between the percentage of signal changes and the total cholesterol/glucose in the DNP group was found (P < 0.05). Lumbar spinal cord fMRI, based on the SEEP effect, was determined to be feasible. The repetitive activation distribution was primarily located at the T12 vertebral level. Lumbar spinal cord fMRI might be used as a potential tool to assess and reveal the nerve conduction mechanisms in DPN.

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“…As a result, there is an increasing interest in the utility of advanced MRI techniques that can provide such information. 9,10 Diffusion tensor imaging (DTI) has been recently used to quantify SC tracts microstructure in this patient population [11][12][13][14] and demonstrated that axonal disruption at the level of maximal SC compression is moderately associated with preand postoperative dysfunction (as evaluated by modified Japanese Orthopaedic Association, mJOA). 15 Importantly, when other clinical tools than mJOA have been employed, different results were found.…”

Section: Introductionmentioning

confidence: 99%

The role of spared spinal cord in post-surgery recovery depends on age in cervical spondylotic myelopathy–a case series study

Cirstea

2018

IPMRJ

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Object: New evidence shows that the degree of microscopic alterations in spinal cord (SC) regions appearing normal on conventional MRI has some predictive value of neurological impairment and recovery in patients with cervical spondylotic myelopathy (CSM). Although SC physiological reserves and plastic potential are likely to decrease as a function of age, the effects of age on such relationships remain unknown. We hypothesized that the preoperative level of spared SC microscopic alterations projects the postoperative functional outcome and this prediction is age-dependent Methods: Nine CSM patients exhibiting neurological symptoms less than one year underwent decompressive surgery. Preoperative neuronal (N-acetylaspartate, NAA) and cellular turnover (choline, Cho) biomarkers were quantified by means of MR spectroscopy (MRS) in spared SC regions in the closed proximity to the compression level (C2 level). Pre-and postoperative (at six months after surgery) clinical status were assessed using modified Japanese Orthopaedic Association (mJOA) and 9-Hole Peg test (9HPT). Relationships between MRS biomarkers and clinical changes were determined and controlled for patient's age.Results: Consistent with prior findings, significant clinical improvement was detected at six months after surgery (mJOA, p=0.002; 9HPT, p=0.001). As predicted, NAA and NAA/Cho significantly related to changes in mJOA (p=0.02) and 9HPT (p=0.005) scores respectively. Notably, these relationships did not survive age correction (p=0.1 and p=0.06 respectively). Conclusions:Our preliminary results are consistent with MRS potential to assay the degree of microscopic injury and viability of the spared SC to prognosticate functional recovery after decompressive surgery in this population. Likewise, our findings provide initial evidence that the contribution of the spared SC in postoperative recovery depends on the patient's age at the diagnosis.

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Ex vivo 1H MR spectroscopy and histology after experimental chronic spinal cord compression

Abstract: MR spectroscopy (MRS) may be helpful for clinicians in improving the prognostic accuracy in cervical myelopathies since this method nicely reflects the extent and severity of spinal cord damage.

Cited by 7 publications

References 25 publications

Metabolites of neuroinflammation relate to neuropathic pain after spinal cord injury

Metabolites of neuroinflammation relate to neuropathic pain after spinal cord injury

Lumbar Spinal Cord Activity and Blood Biochemical Changes in Individuals With Diabetic Peripheral Neuropathy During Electrical Stimulation

The role of spared spinal cord in post-surgery recovery depends on age in cervical spondylotic myelopathy–a case series study

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