Quantifying neurodegeneration of the cervical cord and brain in degenerative cervical myelopathy: A multicentre study using quantitative magnetic resonance imaging

• DOI: 10.1111/ene.16297
• Publication Date: 2024-05-07T17:13:33Z
• Authors: Patrick Freund; Viveka Boller; Tim M. Emmenegger; Muhammad Akbar; Markus Hupp; Nikolai Pfender; Claudia Angela Mi...; Julien Cohen‐Adad; Michael G. Fehlings; Armin Curt; Maryam Seif
• Keywords: Male; Adult; Cervical Cord; Brain; 610 Medicine & health; Neurodegenerative Diseases; Middle Aged; Magnetic Resonance Imaging; Spinal Cord Diseases; 2728 Neurology (clinical); 2808 Neurology; Neurorehabilitation; Humans; 10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center; Female; Aged

AbstractBackground and purposeSimultaneous assessment of neurodegeneration in both the cervical cord and brain across multiple centres can enhance the effectiveness of clinical trials. Thus, this study aims to simultaneously assess microstructural changes in the cervical cord and brain above the stenosis in degenerative cervical myelopathy (DCM) using quantitative magnetic resonance imaging (MRI) in a multicentre study.MethodsWe applied voxelwise analysis with a probabilistic brain/spinal cord template embedded in statistical parametric mappin (SPM‐BSC) to process multi parametric mapping (MPM) including effective transverse relaxation rate (R2*), longitudinal relaxation rate (R1), and magnetization transfer (MT), which are indirectly sensitive to iron and myelin content. Regression analysis was conducted to establish associations between neurodegeneration and clinical impairment. Thirty‐eight DCM patients (mean age ± SD = 58.45 ± 11.47 years) and 38 healthy controls (mean age ± SD = 41.18 ± 12.75 years) were recruited at University Hospital Balgrist, Switzerland and Toronto Western Hospital, Canada.ResultsRemote atrophy was observed in the cervical cord (p = 0.002) and in the left thalamus (0.026) of the DCM group. R1 was decreased in the periaqueductal grey matter (p = 0.014), thalamus (p = 0.001), corpus callosum (p = 0.0001), and cranial corticospinal tract (p = 0.03). R2* was increased in the primary somatosensory cortices (p = 0.008). Sensory impairments were associated with increased iron‐sensitive R2* in the thalamus and periaqueductal grey matter in DCM.ConclusionsSimultaneous assessment of the spinal cord and brain revealed DCM‐induced demyelination, iron deposition, and atrophy. The extent of remote neurodegeneration was associated with sensory impairment, highlighting the intricate and expansive nature of microstructural neurodegeneration in DCM, reaching beyond the stenosis level.