Abstract
Histopathological studies have demonstrated the involvement of spinal cord grey matter (GM) and white matter (WM) in several diseases and recent research has suggested the use of magnetic resonance imaging (MRI) as a promising tool for in vivo assessment of the upper spinal cord. However, many neurological conditions would benefit from quantitative assessment of tissue integrity at different levels and relatively little work has been done, mainly due to technical challenges associated with imaging the lower spinal cord. In this study, the value of the lumbosacral enlargement (LSE) as an intrinsic imaging biomarker was determined by exploring the feasibility of obtaining within it reliable GM and WM cross-sectional area (CSA) measurements by means of a commercially available MRI system at 3 tesla (T). 10 healthy volunteers (mean age 27.5 years, 6 female) gave written informed consent and high resolution images of the LSE were acquired and analysed using an optimised MRI acquisition and analysis protocol. GM and WM mean CSA measurements were obtained from a 15 mm section at the level of the LSE and the reproducibility of the measurements was determined by means of scan-rescan, intra- and inter-observer assessments. Mean (±SD) LSE cross-sectional area (LSE-CSA) was 62.3 (±4.1) mm2 and mean (±SD) LSE grey matter cross-sectional area (LSE-GM-CSA) was 19.8 (±3.3) mm2. The mean scan-rescan, intra- and inter-observer % coefficient of variation (COV) for measuring the LSE-CSA were 2%, 2% and 2.5%, respectively and for measuring the LSE-GM-CSA were 7.8%, 8% and 8.6%, respectively. This study has shown that the LSE can be used reliably as an intrinsic imaging biomarker. The method presented here can be potentially extended to study the LSE in the diseased state and could provide a solid foundation for subsequent multi-parametric MRI investigations.
Highlights
Many neurological conditions cause intrinsic pathological changes in the spinal cord (SC) [1]
The segmentation of the lumbosacral enlargement (LSE)-grey matter (GM)-cross-sectional area (CSA) required manual editing in all cases
In this study we have successfully presented a clinically feasible magnetic resonance imaging (MRI) protocol for obtaining tissue-specific (i.e. GM and white matter (WM)) CSA measurements in the lumbar SC in healthy subjects using commercially available hardware and software, which has the potential for immediate clinical utility
Summary
Many neurological conditions cause intrinsic pathological changes in the spinal cord (SC) [1]. Previous research has used cross-sectional area (CSA) measurements of the upper cervical cord, obtained by means of magnetic resonance imaging (MRI), to assess the degree of atrophy (i.e. tissue loss, which implies neurodegeneration). This measure has been significantly correlated with measures of locomotor disability in people with MS [9,10,11], while a decline of spinal cord CSA over time of between 11% and 30% has been observed in cases of chronic spinal cord injury (SCI) using similar methodologies [12,13,14]. The use of MRI to assess tissue-specific changes within the SC has been limited due to a number of technical factors relating to resolution, signal-to-noise ratio (SNR) and motion artefacts, which make it technically difficult to assess the integrity of the SC in detail [15]
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