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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleSpine Imaging and Spine Image-Guided Interventions
Open Access

A Novel MRI Biomarker of Spinal Cord White Matter Injury: T2*-Weighted White Matter to Gray Matter Signal Intensity Ratio

A.R. Martin, B. De Leener, J. Cohen-Adad, D.W. Cadotte, S. Kalsi-Ryan, S.F. Lange, L. Tetreault, A. Nouri, A. Crawley, D.J. Mikulis, H. Ginsberg and M.G. Fehlings
American Journal of Neuroradiology June 2017, 38 (6) 1266-1273; DOI: https://doi.org/10.3174/ajnr.A5162
A.R. Martin
aFrom the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
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  • ORCID record for A.R. Martin
B. De Leener
cPolytechnique Montreal (B.D.L., J.C.-A.), Montreal, Quebec, Canada
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J. Cohen-Adad
cPolytechnique Montreal (B.D.L., J.C.-A.), Montreal, Quebec, Canada
dFunctional Neuroimaging Unit (J.C.-A.), Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Université de Montréal, Montreal, Quebec, Canada
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D.W. Cadotte
aFrom the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
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S. Kalsi-Ryan
aFrom the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
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S.F. Lange
eUniversity of Groningen (S.F.L.), Groningen, the Netherlands.
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L. Tetreault
aFrom the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
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A. Nouri
aFrom the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
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A. Crawley
bDepartment of Medical Imaging (A.C., D.J.M.), University of Toronto and the University Health Network, Toronto, Ontario, Canada
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D.J. Mikulis
bDepartment of Medical Imaging (A.C., D.J.M.), University of Toronto and the University Health Network, Toronto, Ontario, Canada
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H. Ginsberg
aFrom the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
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M.G. Fehlings
aFrom the Division of Neurosurgery, Department of Surgery (A.R.M., D.W.C., S.K.-R., L.T., A.N., H.G., M.G.F.)
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Abstract

BACKGROUND AND PURPOSE: T2*-weighted imaging provides sharp contrast between spinal cord GM and WM, allowing their segmentation and cross-sectional area measurement. Injured WM demonstrates T2*WI hyperintensity but requires normalization for quantitative use. We introduce T2*WI WM/GM signal-intensity ratio and compare it against cross-sectional area, the DTI metric fractional anisotropy, and magnetization transfer ratio in degenerative cervical myelopathy.

MATERIALS AND METHODS: Fifty-eight patients with degenerative cervical myelopathy and 40 healthy subjects underwent 3T MR imaging, covering C1–C7. Metrics were automatically extracted at maximally compressed and uncompressed rostral/caudal levels. Normalized metrics were compared with t tests, area under the curve, and logistic regression. Relationships with clinical measures were analyzed by using Pearson correlation and multiple linear regression.

RESULTS: The maximally compressed level cross-sectional area demonstrated superior differences (P = 1 × 10−13), diagnostic accuracy (area under the curve = 0.890), and univariate correlation with the modified Japanese Orthopedic Association score (0.66). T2*WI WM/GM showed strong differences (rostral: P = 8 × 10−7; maximally compressed level: P = 1 × 10−11; caudal: P = 1 × 10−4), correlations (modified Japanese Orthopedic Association score; rostral: −0.52; maximally compressed level: −0.59; caudal: −0.36), and diagnostic accuracy (rostral: 0.775; maximally compressed level: 0.860; caudal: 0.721), outperforming fractional anisotropy and magnetization transfer ratio in most comparisons and cross-sectional area at rostral/caudal levels. Rostral T2*WI WM/GM showed the strongest correlations with focal motor (−0.45) and sensory (−0.49) deficits and was the strongest independent predictor of the modified Japanese Orthopedic Association score (P = .01) and diagnosis (P = .02) in multivariate models (R2 = 0.59, P = 8 × 10−13; area under the curve = 0.954, respectively).

CONCLUSIONS: T2*WI WM/GM shows promise as a novel biomarker of WM injury. It detects damage in compressed and uncompressed regions and contributes substantially to multivariate models for diagnosis and correlation with impairment. Our multiparametric approach overcomes limitations of individual measures, having the potential to improve diagnostics, monitor progression, and predict outcomes.

ABBREVIATIONS:

AUC
area under the curve
CSA
cross-sectional area
DCM
degenerative cervical myelopathy
FA
fractional anisotropy
MCL
maximally compressed level
mJOA
modified Japanese Orthopedic Association
MT
magnetization transfer
MTR
magnetization transfer ratio
qMRI
quantitative MRI
SC
spinal cord
SCI
spinal cord injury
UE
upper extremity
  • © 2017 by American Journal of Neuroradiology

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American Journal of Neuroradiology: 38 (6)
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A.R. Martin, B. De Leener, J. Cohen-Adad, D.W. Cadotte, S. Kalsi-Ryan, S.F. Lange, L. Tetreault, A. Nouri, A. Crawley, D.J. Mikulis, H. Ginsberg, M.G. Fehlings
A Novel MRI Biomarker of Spinal Cord White Matter Injury: T2*-Weighted White Matter to Gray Matter Signal Intensity Ratio
American Journal of Neuroradiology Jun 2017, 38 (6) 1266-1273; DOI: 10.3174/ajnr.A5162

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A Novel MRI Biomarker of Spinal Cord White Matter Injury: T2*-Weighted White Matter to Gray Matter Signal Intensity Ratio
A.R. Martin, B. De Leener, J. Cohen-Adad, D.W. Cadotte, S. Kalsi-Ryan, S.F. Lange, L. Tetreault, A. Nouri, A. Crawley, D.J. Mikulis, H. Ginsberg, M.G. Fehlings
American Journal of Neuroradiology Jun 2017, 38 (6) 1266-1273; DOI: 10.3174/ajnr.A5162
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