Lynn Farner, Tim M. Emmenegger, Simon Schading-Sassenhausen, Julia Berroth, Maryam Seif, Armin Curt, Patrick Freund, The Nogo Inhibition in Spinal Cord Injury Study Group
{"title":"3D MRI特定脊髓损伤模式提高了对神经系统恢复的预测。","authors":"Lynn Farner, Tim M. Emmenegger, Simon Schading-Sassenhausen, Julia Berroth, Maryam Seif, Armin Curt, Patrick Freund, The Nogo Inhibition in Spinal Cord Injury Study Group","doi":"10.1002/acn3.70087","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>To distinguish lateralized motor- and sensory-tract damage after acute spinal cord injury (SCI) and explore its predictive power for motor and sensory recovery.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Thirty-five SCI patients (two female) from a multi-center data set (placebo-arm of the Nogo-A-Inhibition in SCI trial) underwent routine T2-weighted sagittal MRI scans at the lesion site at baseline (19.9 days, 95% confidence interval [CI]: 17.9–21.8), 1-month (54.2 days, 95% CI: 52.1–56.2), and 6-month (192.4 days, 95% CI: 181.3–203.6) post-injury. Concurrently with the MRI scans, clinical examinations were performed. Lesions were manually segmented across all slices, and 3D-tract damage was assessed by determining the overlap between segmented lesions and identified motor and sensory tracts in the axial plane. The relationship between lesion assessments and baseline-adjusted clinical outcomes at 6 months was explored.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Over the 6-month, patients recovered by 4.95 motor points/month (95% CI: 3.89–5.89, <i>p</i> < 0.001) on the International Standards for the Neurological Classification of SCI scale, 2.28 light-touch points/month (95% CI: 1.43–3.12, <i>p</i> < 0.001), and 2.06 pinprick points/month (95% CI: 1.21–2.91, <i>p</i> < 0.001). Lesion volume decreased from 381.82mm <sup>3</sup> (95% CI: 295.78–467.87) by −14.04 mm<sup>3</sup>/month (95% CI: −25.39 to −1.56, <i>p</i> = 0.023). MRI visible changes in motor tract damage over the 6-month were marginal (0.02%/month, 95% CI: −0.81 to −1.02, <i>p</i> = 0.971). Changes in the sensory tracts were more pronounced, decreasing by −0.69%/month (95% CI: −1.29 to −0.09, <i>p</i> = 0.05). Left-and-right motor-tract damage at baseline significantly predicted left-and-right motor score recovery (<i>R</i><sup>2</sup> = 0.75, <i>p</i> = 0.015), while baseline left-and-right sensory-tract damage significantly predicted improvements in left-and-right pin-prick scores (<i>R</i><sup>2</sup> = 0.79, <i>p</i> = 0.024).</p>\n </section>\n \n <section>\n \n <h3> Interpretation</h3>\n \n <p>Revealing the extent of damage to spinal motor-and sensory-pathways early after SCI is a valuable predictor of related neurological recovery. Tracking 3D dynamics of major spinal pathways has the potential to enhance diagnostic accuracy and patient stratification for future clinical trials.</p>\n </section>\n </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"12 9","pages":"1762-1770"},"PeriodicalIF":3.9000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.70087","citationCount":"0","resultStr":"{\"title\":\"3D MRI Tract-Specific Spinal Cord Lesion Pattern Improves Prediction of Distinct Neurological Recovery\",\"authors\":\"Lynn Farner, Tim M. 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Lesions were manually segmented across all slices, and 3D-tract damage was assessed by determining the overlap between segmented lesions and identified motor and sensory tracts in the axial plane. The relationship between lesion assessments and baseline-adjusted clinical outcomes at 6 months was explored.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Over the 6-month, patients recovered by 4.95 motor points/month (95% CI: 3.89–5.89, <i>p</i> < 0.001) on the International Standards for the Neurological Classification of SCI scale, 2.28 light-touch points/month (95% CI: 1.43–3.12, <i>p</i> < 0.001), and 2.06 pinprick points/month (95% CI: 1.21–2.91, <i>p</i> < 0.001). Lesion volume decreased from 381.82mm <sup>3</sup> (95% CI: 295.78–467.87) by −14.04 mm<sup>3</sup>/month (95% CI: −25.39 to −1.56, <i>p</i> = 0.023). MRI visible changes in motor tract damage over the 6-month were marginal (0.02%/month, 95% CI: −0.81 to −1.02, <i>p</i> = 0.971). Changes in the sensory tracts were more pronounced, decreasing by −0.69%/month (95% CI: −1.29 to −0.09, <i>p</i> = 0.05). Left-and-right motor-tract damage at baseline significantly predicted left-and-right motor score recovery (<i>R</i><sup>2</sup> = 0.75, <i>p</i> = 0.015), while baseline left-and-right sensory-tract damage significantly predicted improvements in left-and-right pin-prick scores (<i>R</i><sup>2</sup> = 0.79, <i>p</i> = 0.024).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Interpretation</h3>\\n \\n <p>Revealing the extent of damage to spinal motor-and sensory-pathways early after SCI is a valuable predictor of related neurological recovery. 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引用次数: 0
摘要
目的：区分急性脊髓损伤（SCI）后的运动和感觉束偏侧损伤，并探讨其对运动和感觉恢复的预测能力。方法：来自多中心数据集（Nogo-A-Inhibition in SCI试验的安慰剂组）的35例SCI患者（2名女性）在损伤后基线（19.9天，95%可信区间[CI]: 17.9-21.8）、1个月（54.2天，95% CI: 52.1-56.2）和6个月（192.4天，95% CI: 181.3-203.6）对病变部位进行常规t2加权矢状面MRI扫描。在MRI扫描的同时，进行了临床检查。在所有切片上手动分割病变，并通过确定分割病变与已识别的运动和感觉束在轴向平面上的重叠来评估3d束损伤。探讨病变评估与6个月基线调整临床结果之间的关系。结果：6个月后，患者恢复4.95运动点/月(95% CI: 3.89-5.89, 95% CI: 295.78-467.87) -14.04 mm3/月（95% CI: -25.39至-1.56,p = 0.023）。6个月内MRI可见的运动道损伤变化很小（0.02%/月，95% CI: -0.81 ~ -1.02, p = 0.971）。感觉束的变化更为明显，下降-0.69%/月（95% CI: -1.29 ~ -0.09, p = 0.05）。基线时左右运动道损伤可显著预测左右运动评分恢复（R2 = 0.75, p = 0.015），而基线时左右感觉道损伤可显著预测左右针刺评分改善（R2 = 0.79, p = 0.024）。结论：在脊髓损伤后早期揭示脊髓运动和感觉通路的损伤程度是相关神经恢复的一个有价值的预测指标。跟踪主要脊柱通路的3D动态有可能提高诊断准确性和患者分层，以用于未来的临床试验。
3D MRI Tract-Specific Spinal Cord Lesion Pattern Improves Prediction of Distinct Neurological Recovery
Objective
To distinguish lateralized motor- and sensory-tract damage after acute spinal cord injury (SCI) and explore its predictive power for motor and sensory recovery.
Methods
Thirty-five SCI patients (two female) from a multi-center data set (placebo-arm of the Nogo-A-Inhibition in SCI trial) underwent routine T2-weighted sagittal MRI scans at the lesion site at baseline (19.9 days, 95% confidence interval [CI]: 17.9–21.8), 1-month (54.2 days, 95% CI: 52.1–56.2), and 6-month (192.4 days, 95% CI: 181.3–203.6) post-injury. Concurrently with the MRI scans, clinical examinations were performed. Lesions were manually segmented across all slices, and 3D-tract damage was assessed by determining the overlap between segmented lesions and identified motor and sensory tracts in the axial plane. The relationship between lesion assessments and baseline-adjusted clinical outcomes at 6 months was explored.
Results
Over the 6-month, patients recovered by 4.95 motor points/month (95% CI: 3.89–5.89, p < 0.001) on the International Standards for the Neurological Classification of SCI scale, 2.28 light-touch points/month (95% CI: 1.43–3.12, p < 0.001), and 2.06 pinprick points/month (95% CI: 1.21–2.91, p < 0.001). Lesion volume decreased from 381.82mm 3 (95% CI: 295.78–467.87) by −14.04 mm3/month (95% CI: −25.39 to −1.56, p = 0.023). MRI visible changes in motor tract damage over the 6-month were marginal (0.02%/month, 95% CI: −0.81 to −1.02, p = 0.971). Changes in the sensory tracts were more pronounced, decreasing by −0.69%/month (95% CI: −1.29 to −0.09, p = 0.05). Left-and-right motor-tract damage at baseline significantly predicted left-and-right motor score recovery (R2 = 0.75, p = 0.015), while baseline left-and-right sensory-tract damage significantly predicted improvements in left-and-right pin-prick scores (R2 = 0.79, p = 0.024).
Interpretation
Revealing the extent of damage to spinal motor-and sensory-pathways early after SCI is a valuable predictor of related neurological recovery. Tracking 3D dynamics of major spinal pathways has the potential to enhance diagnostic accuracy and patient stratification for future clinical trials.
期刊介绍：
Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.
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