Degenerative cervical myelopathy (DCM) is among the most common causes of spinal cord (SC) dysfunction, involving age-related degeneration of the discs, ligaments, and vertebrae leading to extrinsic compression and dynamic injury. Spinal MRI is often used for the diagnosis of DCM due to its high resolution and superior soft tissue contrast. Several studies have evaluated the impact of DCM in some brain areas, confirming that the effect of chronic spinal cord compression affects other areas besides the anatomical area where the main impairment occurs. The aim of the study is to evaluate whether DCM patients show macroscopic and microscopic brain changes in sensorimotor-related area due to the cervical compression. A total of 43 subjects were recruited at the Neurosurgery Unit and scanned a 3T MRI scanner at the Neuroradiology Unit of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico. Eighteen patients with confirmed clinical and radiological degenerative cervical myelopathy who did not have any other neurological conditions (such as multiple sclerosis or pathological brain abnormalities) were prospectively recruited. During the same period, twenty-five subject with negative brain MRI were recruited in the control group. Two fully automatic pipelines were built to quantitatively evaluate the magnetic susceptibility and characterize the diffusivity of water molecules in vivo by Quantitative Susceptibility Mapping (QSM) and Diffusion MRI with both (Diffusion Tensor Imaging) DTI and (Neurite Orientation Dispersion and Density Imaging) NODDI algorithms. The first pipeline identifies as main phases: automatic brain segmentation through the FreeSurfer software and the obtaining of the QSM map, through the Matlab STI Suite toolbox, used to evaluate susceptibility changes in all subjects. The second pipeline identifies the following main phases: obtaining the DTI maps, through the use of TORTOISE toolbox, and the maps obtained from the NODDI, thanks to the use of the Matlab NODDI toolbox, in order to evaluate diffusive phenomena, in the patient group. i For the patient group correlations were made between QSM and diffusion MRI measurements. Neuroimaging measurements were subsequently correlated and stratified with respect to the mJOA and Nurick clinical data. The magnetic susceptibility in the pre and post-central WM showed to be statistically increased in the patient group compared to the control group. The correlations with the diffusion techniques and the investigations performed with respect to clinical data also show statistical significance in different brain areas, including the pre- and post-central WM and cortex. The automatic methods presented allows to highlight changes in the susceptibility in different cortical or subcortical regions of the brain and to related them to diffusion MRI parameters.
La mielopatia cervicale degenerativa (DCM) rappresenta una delle cause più comuni di disfunzione del midollo spinale (SC), che coinvolge la degenerazione legata all'età dei dischi, dei legamenti e delle vertebre che porta a compressione estrinseca e danno dinamico. Diversi studi hanno indagato l'impatto della DCM in alcune aree cerebrali, confermando che l'effetto della compressione cronica del midollo spinale colpisce ulteriori aree oltre a quella anatomica in cui si verifica il principale danno. Lo scopo dello studio è valutare se i pazienti con DCM mostrano alterazioni cerebrali macroscopiche e microscopiche nelle aree sensomotorie. Un totale di 43 soggetti è stato reclutato presso l’Unità di Neurochirurgia e sottoposto a risonanza magnetica 3T nell’Unità di Neuroradiologia della Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico. Sono stati reclutati prospetticamente diciotto pazienti con confermata mielopatia cervicale degenerativa, sia clinica che radiologica, e che non presentavano altre condizioni neurologiche (come sclerosi multipla o anomalie cerebrali patologiche). Nello stesso periodo, venticinque soggetti con risonanza magnetica cerebrale negativa, sono stati reclutati nel gruppo di controllo. Due pipelines completamente automatiche sono state implementate per valutare quantitativamente la suscettibilità magnetica e caratterizzare la diffusività delle molecole d'acqua in vivo. Le tecniche utilizzate sono state rispettivamente Quantitative Susceptibility Mapping (QSM) e Diffusion MRI attraverso algoritmi di (Diffusion Tensor Imaging) DTI e (Neurite Orientation Dispersion and Density Imaging) NODDI. La prima pipeline è composta dalla segmentazione automatica del cervello attraverso il software FreeSurfer e l’ottenimento della mappa di QSM, attraverso con il Matlab toolbox STI Suite, al fine di valutare i cambiamenti di suscettibilità in tutti i soggetti. Nella seconda pipeline, invece, avviene l’ottenimento delle mappe di DTI, attraverso l’uso del toolbox TORTOISE, e le mappe ottenute dal NODDI, grazie all’uso del NODDI toolbox di Matlab, al fine di valutare i fenomeni diffusivi nel gruppo di pazienti. Per il gruppo di pazienti, sono state effettuate correlazioni tra le misure QSM e di MRI di diffusione. Le misurazioni di neuroimaging sono state successivamente correlate e stratificate rispetto ai dati clinici mJOA e Nurick. La suscettibilità magnetica nella WM pre e post-centrale ha mostrato un aumento statisticamente significativo nel gruppo di pazienti rispetto al gruppo di controllo. Le correlazioni con le tecniche di diffusione e le indagini eseguite rispetto ai dati clinici, mostrano significatività statistica in diverse aree cerebrali, tra cui la WM pre- e post-centrale e la corteccia. I metodi automatici presentati consentono di evidenziare i cambiamenti nella suscettibilità in diverse regioni corticali o sottocorticali del cervello e di correlarli ai parametri della MRI di diffusione.
Prospective multi parametric study of cerebral alterations in degenerative cervical myelopathy
Aruanno, Anouk Maodan
2021/2022
Abstract
Degenerative cervical myelopathy (DCM) is among the most common causes of spinal cord (SC) dysfunction, involving age-related degeneration of the discs, ligaments, and vertebrae leading to extrinsic compression and dynamic injury. Spinal MRI is often used for the diagnosis of DCM due to its high resolution and superior soft tissue contrast. Several studies have evaluated the impact of DCM in some brain areas, confirming that the effect of chronic spinal cord compression affects other areas besides the anatomical area where the main impairment occurs. The aim of the study is to evaluate whether DCM patients show macroscopic and microscopic brain changes in sensorimotor-related area due to the cervical compression. A total of 43 subjects were recruited at the Neurosurgery Unit and scanned a 3T MRI scanner at the Neuroradiology Unit of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico. Eighteen patients with confirmed clinical and radiological degenerative cervical myelopathy who did not have any other neurological conditions (such as multiple sclerosis or pathological brain abnormalities) were prospectively recruited. During the same period, twenty-five subject with negative brain MRI were recruited in the control group. Two fully automatic pipelines were built to quantitatively evaluate the magnetic susceptibility and characterize the diffusivity of water molecules in vivo by Quantitative Susceptibility Mapping (QSM) and Diffusion MRI with both (Diffusion Tensor Imaging) DTI and (Neurite Orientation Dispersion and Density Imaging) NODDI algorithms. The first pipeline identifies as main phases: automatic brain segmentation through the FreeSurfer software and the obtaining of the QSM map, through the Matlab STI Suite toolbox, used to evaluate susceptibility changes in all subjects. The second pipeline identifies the following main phases: obtaining the DTI maps, through the use of TORTOISE toolbox, and the maps obtained from the NODDI, thanks to the use of the Matlab NODDI toolbox, in order to evaluate diffusive phenomena, in the patient group. i For the patient group correlations were made between QSM and diffusion MRI measurements. Neuroimaging measurements were subsequently correlated and stratified with respect to the mJOA and Nurick clinical data. The magnetic susceptibility in the pre and post-central WM showed to be statistically increased in the patient group compared to the control group. The correlations with the diffusion techniques and the investigations performed with respect to clinical data also show statistical significance in different brain areas, including the pre- and post-central WM and cortex. The automatic methods presented allows to highlight changes in the susceptibility in different cortical or subcortical regions of the brain and to related them to diffusion MRI parameters.File | Dimensione | Formato | |
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https://hdl.handle.net/10589/192403