Relation between Neuroimaging and Clinical Progress after acute Spinal Cord Injury

Status:

completed 12/2021

Aims:

Biomarkers that are able to objectively quantify the extent of injury, measure a therapeutic effect, or to predict outcome are missing in the spinal cord injury (SCI) field. This relevant knowledge gap is hindering clinical decision-making, as well as clinical research. With this study, we aimed to study any potential association between standard as well as advanced magnetic resonance imaging (MRI) studies with clinical and electrophysiological examinations over time. We specifically tried to study the evolution of these parameters over time (i.e. 1 year).

Activities/Methods:

A prospective, longitudinal cohort study at the Trauma Center Murnau between 2016 and 2021 including patients with acute SCI was conducted. After adjusting the study protocol due to hardware related acquisition artifacts in 2017 (i.e. exclusion of thoracic SCI patients), we focused solely on patients with cervical SCI. We included 52 patients throughout the study period. All included patients received at least three study related MRI investigations with predefined periods that were coordinated with a standard clinical exam (i.e. ISNCSCI – International Standard for Neurological Classification of Spinal Cord Injury) and an electrophysiological exam. The recruitment as well as the follow-up phase are finished. We have completed data entry, analysis, and the overall statistical evaluation.

We assessed a combination of parameters obtained via routine and advanced MRI imaging. With routine investigations, we scanned for the presence of intramedullary hemorrhage and analyzed multiple variables including lesion length, presence of edema, Sagittal Grade and Basic Score. Via DTI (diffusion tensor imaging), we assessed FA (fractional anisotropy), MD (mean diffusivity) and AD (axial diffusivity) at the lesion level as well as in the reference area, i.e. C0-C4.

Results:

52 patients were included in the final analysis (46 male, 6 female). Thirteen suffered from a motor complete SCI syndrome (AIS A and B) and the remaining 39 individuals had a motor incomplete injury (i.e. 9 AIS C and 30 AIS D patients). We identified significant relations between both routine and advanced imaging sequences, and clinical assessments. We outlined significant findings below:

• Sagittal Grade is significantly different among our patient cohort depending on their extent of neurological recovery.
• Patients with a pre-syrinx state (i.e. hyperintensities in the dorsal column) showed lower pinprick levels in their examination and have a trend towards worse neurological outcome.
• Intramedullary hemorrhage is a negative predictor for neurological recovery.
• FA is decreasing over time in all patients with SCI (clinical relevance needs to be assessed)
• FA at the lesion level correlates with motor recovery in our study cohort.
• MD is increasing over time (clinical relevance needs to be discussed in research articles)

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