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  In vivo evidence of remote neural degeneration in the lumbar enlargement after cervical injury

David, G., Seif, M., Huber, E., Hupp, M., Rosner, J., Dietz, V., et al. (2019). In vivo evidence of remote neural degeneration in the lumbar enlargement after cervical injury. Neurology, 92(12), e1367-e1377. doi:10.1212/WNL.0000000000007137.

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David, Gergely1, Author
Seif, Maryam1, 2, Author
Huber, Eveline1, Author
Hupp, Markus 1, Author
Rosner, Jan 1, Author
Dietz, Volker 1, Author
Weiskopf, Nikolaus2, 3, Author           
Mohammadi, Siawoosh3, 4, Author
Freund, Patrick1, 2, 3, Author           
1Balgrist Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland, ou_persistent22              
2Department Neurophysics (Weiskopf), MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_2205649              
3Wellcome Trust Centre for Neuroimaging, University College London, United Kingdom, ou_persistent22              
4Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany, ou_persistent22              


Free keywords: MRI; Spinal cord trauma; DWI; Volumetric MRI
 Abstract: Objective To characterize remote secondary neurodegeneration of spinal tracts and neurons below a cervical spinal cord injury (SCI) and its relation to the severity of injury, the integrity of efferent and afferent pathways, and clinical impairment.

Methods A comprehensive high-resolution MRI protocol was acquired in 17 traumatic cervical SCI patients and 14 controls at 3T. At the cervical lesion, a sagittal T2-weighted scan provided information on the width of preserved midsagittal tissue bridges. In the lumbar enlargement, high-resolution T2*-weighted and diffusion-weighted scans were used to calculate tissue-specific cross-sectional areas and diffusion indices, respectively. Regression analyses determined associations between MRI readouts and the electrophysiologic and clinical measures.

Results At the cervical injury level, preserved midsagittal tissue bridges were present in the majority of patients. In the lumbar enlargement, neurodegeneration—in terms of macrostructural and microstructural MRI changes—was evident in the white matter and ventral and dorsal horns. Patients with thinner midsagittal tissue bridges had smaller ventral horn area, higher radial diffusivity in the gray matter, smaller motor evoked potential amplitude from the lower extremities, and lower motor score. In addition, smaller width of midsagittal tissue bridges was also associated with smaller tibialis sensory evoked potential amplitude and lower light-touch score.

Conclusions This study shows extensive tissue-specific cord pathology in infralesional spinal networks following cervical SCI, its magnitude relating to lesion severity, electrophysiologic integrity, and clinical impairment of the lower extremity. The clinical eloquence of remote neurodegenerative changes speaks to the application of neuroimaging biomarkers in diagnostic workup and planning of clinical trials.


Language(s): eng - English
 Dates: 2018-06-252018-11-072019-02-152019-03-19
 Publication Status: Published in print
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: Peer
 Identifiers: DOI: 10.1212/WNL.0000000000007137
PMID: 30770423
Other: Epub 2019
 Degree: -



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Project name : -
Grant ID : PCEFP3_181362/1
Funding program : SNF Eccellenza Professorial Fellowship Grant
Funding organization : Swiss National Science Foundation
Project name : -
Grant ID : IRP-158
Funding program : -
Funding organization : International Foundation for Research in Paraplegia
Project name : -
Grant ID : WFL-CH-007/14
Funding program : -
Funding organization : Wings for Life, Austria
Project name : Antibodies against Nogo-A to enhance plasticity, regeneration and functional recovery after acute spinal cord injury, a multicenter European clinical proof of concept trial / NISCI
Grant ID : 68094
Funding program : Horizon 2020 (H2020-PHC-2014-2014)
Funding organization : European Commission (EC)
Project name : NEURON-Verbund hMRTofSchl: Entschlüsselung der pathophysiologischen Prozesse induziert durch eine Querschnittlähmung: Anwendung von MRT basierter in vivo und ex vivo Histologie / ERA-NET NEURON
Grant ID : 01EW1711B
Funding program : ERA-NET NEURON Call "Entwicklungsstörungen im Nervensystem" (ERA-NET NEURON JTC2016)
Funding organization : German Federal Ministry of Education and Research (BMBF)
Project name : Marie Sklodowska-Curie Individual Fellowship
Grant ID : -
Funding program : Horizon 2020 (H2020-MSCA-IF-2015 )
Funding organization : European Commission (EC)
Project name : -
Grant ID : MO 2397/4-1
Funding program : -
Funding organization : Deutsche Forschungsgemeinschaft (DFG)
Project name : Non-invasive in vivo histology in health and disease using Magnetic Resonance Imaging (MRI) / HMRI
Grant ID : 616905
Funding program : Funding Programme 7 (ERC-2013-CoG)
Funding organization : European Commission (EC)
Project name : -
Grant ID : 0915/Z/10/Z
Funding program : -
Funding organization : Wellcome Trust
Project name : -
Grant ID : -
Funding program : -
Funding organization : Siemens Healthcare
Project name : -
Grant ID : 091593/Z/10/Z
Funding program : -
Funding organization : Wellcome Trust

Source 1

Title: Neurology
Source Genre: Journal
Publ. Info: Cleveland, Ohio [etc.] : Advanstar Communications [etc.]
Pages: - Volume / Issue: 92 (12) Sequence Number: - Start / End Page: e1367 - e1377 Identifier: ISSN: 0028-3878
CoNE: https://pure.mpg.de/cone/journals/resource/954925246073