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Traumatic and nontraumatic spinal cord injury: pathological insights from neuroimaging
Gergely David1,2, Siawoosh Mohammadi2,3, Allan R Martin4
1Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Abstract:
Pathophysiological changes in the spinal cord white and grey matter resulting from injury can be observed with MRI techniques. These techniques provide sensitive markers of macrostructural and microstructural tissue integrity, which correlate with histological findings. Spinal cord MRI findings in traumatic spinal cord injury (tSCI) and nontraumatic spinal cord injury - the most common form of which is degenerative cervical myelopathy (DCM) - have provided important insights into the pathophysiological processes taking place not just at the focal injury site but also rostral and caudal to the spinal injury. Although tSCI and DCM have different aetiologies, they show similar degrees of spinal cord pathology remote from the injury site, suggesting the involvement of similar secondary degenerative mechanisms. Advanced quantitative MRI protocols that are sensitive to spinal cord pathology have the potential to improve diagnosis and, more importantly, predict outcomes in patients with tSCI or nontraumatic spinal cord injury. This Review describes the insights into tSCI and DCM that have been revealed by neuroimaging and outlines current activities and future directions for the field.
Insights
Magnetic resonance imaging (MRI) reveals spinal cord changes after injury. Advanced MRI techniques can improve diagnosis and predict outcomes for traumatic spinal cord injury (tSCI) and degenerative cervical myelopathy (DCM).
Area of Science:
- Neuroimaging
- Spinal Cord Pathology
- Quantitative MRI
Background:
- Spinal cord injuries (SCI) cause pathophysiological changes in white and grey matter, observable via MRI.
- MRI provides sensitive markers of tissue integrity, correlating with histological findings.
- Traumatic spinal cord injury (tSCI) and degenerative cervical myelopathy (DCM) exhibit similar remote spinal cord pathology, suggesting shared secondary degenerative mechanisms.
Purpose of the Study:
- To review neuroimaging insights into tSCI and DCM.
- To outline current activities and future directions in spinal cord MRI.
- To highlight the potential of advanced quantitative MRI for diagnosis and outcome prediction in SCI patients.
Main Methods:
- Review of current literature on spinal cord MRI in tSCI and DCM.
- Focus on advanced quantitative MRI protocols sensitive to spinal cord pathology.
- Correlation of MRI findings with macrostructural and microstructural tissue integrity.
Main Results:
- Spinal cord MRI reveals insights into pathophysiological processes at and remote from the injury site.
- Similar remote spinal cord pathology in tSCI and DCM suggests common secondary degenerative mechanisms.
- Advanced quantitative MRI protocols show promise for improved diagnosis and outcome prediction.
Conclusions:
- Neuroimaging, particularly advanced quantitative MRI, offers valuable insights into spinal cord injury.
- MRI can detect subtle changes and predict patient outcomes in tSCI and DCM.
- Further research in advanced MRI techniques is crucial for advancing spinal cord injury management.
