The current state of spinal cord functional magnetic resonance imaging and its application in clinical research

Abstract

Since its development, spinal cord functional magnetic resonance imaging (fMRI) has utilized various methodologies and stimulation protocols to develop a deeper understanding of a healthy human spinal cord that lays a foundation for its use in clinical research and practice. In this review, we conducted a comprehensive literature search on spinal cord fMRI studies and summarized the recent advancements and resulting scientific achievements of spinal cord fMRI in the following three aspects: the current state of spinal cord fMRI methodologies and stimulation protocols, knowledge about the healthy spinal cord's functions obtained via spinal cord fMRI, and fMRI's exemplary usage in spinal cord diseases and injuries. We conclude with a discussion that, while technical challenges exist, novel fMRI technologies for and new knowledge about the healthy human spinal cord have been established. Empowered by these developments, investigations of pathological and injury states within the spinal cord have become the next important direction of spinal cord fMRI. Recent clinical investigations into spinal cord pathologies, for example, fibromyalgia, multiple sclerosis, spinal cord injury, and cervical spondylotic myelopathy, have already provided deep insights into spinal cord impairments and the time course of impairment‐caused changes. We expect that future spinal cord fMRI advancement and research development will further enhance our understanding of various spinal cord diseases and provide the foundation for evaluating existing and developing new treatment plans.

Cervical Spondylotic Myelopathy—Diagnostics and Clinimetrics

“…Moreover, it is worth adding that examination of the spinal cord, especially when diagnosing CSM, may contribute to shortening the time of diagnosis and treatment. The authors emphasize that innovative research in the field of fMRI may contribute to the creation of new forms of patient treatment and the implementation of innovative diagnostic protocols [ 37 ]. In October 2023, Khan’s team and co-inventors presented a review on functional changes in the human brain in CSM patients using fMRI.…”

“…Additionally, there is promise in research and advanced techniques in the field of MRI, which may improve the standards of care for people with CSM [ 43 ]. According to a review article by Haynes and co-authors, it can be concluded that further research in the field of fMRI of the spinal cord will contribute to the development of treatment for people with diseases in this area and will constitute the basis for implementing new assessment methods and developing treatment strategies [ 37 ]. However, the article by Khan and co-authors on the same topic gives great hope that the implementation of fMRI may facilitate the diagnosis of CSM.…”

Recent developments and future avenues for human corticospinal neuroimaging

“…This leaves room for interpretation of higher cortical regions connected to the spinal cord and involved in descending pain modulation. For more reviews on spinal and corticospinal imaging of pain, see Tinnermann et al (2021a) , Kinany et al (2022) , and Haynes et al (2023) .…”

“…Recently, the findings of this study were replicated using an innovative data-driven multivariate approach ( Kinany et al, 2023 ) which shows great promise to probe CNS signatures of human sensorimotor behavior in health and disease. For more reviews on spinal and corticospinal imaging of motor task activity, see Landelle et al (2021) , Kinany et al (2022) , and Haynes et al (2023) .…”

Functional magnetic resonance imaging of the lumbosacral cord during a lower extremity motor task

“…Functional MRI (fMRI) has been increasingly applied in the spinal cord to non-invasively map spinal cord neuronal function (Cohen-Adad, 2017; Haynes et al, 2023; Landelle et al, 2021; Powers et al, 2018). Spinal cord fMRI conducted in healthy volunteers have investigated neuronal activation induced by a wide range of tasks and stimuli, including upper extremity motor task (Govers et al, 2007; Kinany et al, 2019; Stroman et al, 1999; Weber et al, 2016b), thermal stimulation (Bosma & Stroman, 2015; Rempe et al, 2015; Weber et al, 2016a, 2018), tactile stimulation (Brooks et al, 2012; Kornelsen et al, 2013; Summers et al, 2010; Weber et al, 2020), noxious stimuli (Brooks et al, 2012; Summers et al, 2010; Tinnermann et al, 2021), and sexual arousal (Alexander et al, 2016; Kozyrev et al, 2012).…”