Quantitative MRI of the Spinal Cord (eBook)

Julien Cohen-Adad, Claudia Wheeler-Kingshott (Herausgeber)

eBook Download: PDF | EPUB

2014 | 1. Auflage
330 Seiten
Elsevier Science (Verlag)
978-0-12-397282-8 (ISBN)

Quantitative MRI of the Spinal Cord is the first book focused on quantitative MRI techniques with specific application to the human spinal cord. This work includes coverage of diffusion-weighted imaging, magnetization transfer imaging, relaxometry, functional MRI, and spectroscopy. Although these methods have been successfully used in the brain for the past 20 years, their application in the spinal cord remains problematic due to important acquisition challenges (such as small cross-sectional size, motion, and susceptibility artifacts). To date, there is no consensus on how to apply these techniques; this book reviews and synthesizes state-of-the-art methods so users can successfully apply them to the spinal cord.

Quantitative MRI of the Spinal Cord introduces the theory behind each quantitative technique, reviews each theory's applications in the human spinal cord and describes its pros and cons, and suggests a simple protocol for applying each quantitative technique to the spinal cord.

Chapters authored by international experts in the field of MRI of the spinal cord
Contains 'cooking recipes”-examples of imaging parameters for each quantitative technique-designed to aid researchers and clinicians in using them in practice
Ideal for clinical settings

Quantitative MRI of the Spinal Cord is the first book focused on quantitative MRI techniques with specific application to the human spinal cord. This work includes coverage of diffusion-weighted imaging, magnetization transfer imaging, relaxometry, functional MRI, and spectroscopy. Although these methods have been successfully used in the brain for the past 20 years, their application in the spinal cord remains problematic due to important acquisition challenges (such as small cross-sectional size, motion, and susceptibility artifacts). To date, there is no consensus on how to apply these techniques; this book reviews and synthesizes state-of-the-art methods so users can successfully apply them to the spinal cord. Quantitative MRI of the Spinal Cord introduces the theory behind each quantitative technique, reviews each theory's applications in the human spinal cord and describes its pros and cons, and suggests a simple protocol for applying each quantitative technique to the spinal cord. Chapters authored by international experts in the field of MRI of the spinal cord Contains "e;cooking recipes?-examples of imaging parameters for each quantitative technique-designed to aid researchers and clinicians in using them in practice Ideal for clinical settings

Chapter 1.2

Inflammatory Demyelinating Diseases

IstvanPirko1Charles R.G.Guttmann2 1Department of Neurology, Mayo Clinic, College of Medicine, Rochester, MN, USA 2Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

Abstract

The spinal cord is commonly affected in inflammatory demyelinating diseases (IDD) of the central nervous system. In the most common IDD, multiple sclerosis (MS), the importance of spinal cord involvement is highlighted by the inclusion of characteristic cord lesions in its current diagnostic criteria. In neuromyelitis optica, longitudinally extensive spinal cord lesions over three or more segments are considered almost pathognomonic for the disease. In general, spinal cord lesion load shows a strong correlation with disability, and spinal cord-derived magnetic resonance imaging (MRI) measures are some of the strongest biomarkers of a disabling disease course. In progressive forms of MS, the clinical phenotype is consistent with a progressive myelopathy in most cases. These forms of MS, especially primary progressive MS, represent a major challenge for disease activity monitoring. Novel quantitative MRI metrics characterizing spinal cord involvement in MS are expected to find their way into routine clinical monitoring as they provide unique insight into tissue abnormalities, allowing for monitoring of disease progression and assessment of response to treatment. These techniques include magnetization transfer MRI, diffusion-weighted imaging, atrophy measurement techniques, T1 and T2 relaxometry, and magnetic resonance spectroscopy.

Keywords

Inflammatory myelopathyMultiple sclerosisNeuromyelitis opticaParaneoplastic myelopathyTransverse myelitis

Introduction

The spinal cord is a common site of involvement in inflammatory demyelinating diseases of the central nervous system (CNS). The most common such disease, multiple sclerosis, is the leading cause of nontraumatic disability in young adults, with an enormous socioeconomic impact.1 Neuromyelitis optica (NMO), an increasingly recognized and recently redefined condition, also has prominent and very characteristic spinal cord involvement, which is typically much more severe than MS-related transverse myelitis. The critical importance of spinal cord imaging in these conditions is also highlighted by the inclusion of spinal cord magnetic resonance imaging (MRI)-derived metrics in the internationally utilized diagnostic criteria of MS and NMO. However, with the constant evolution of the MS diagnostic criteria, new discoveries pertaining to the pathogenesis and biomarkers of NMO, and the evolving definitions of transverse myelitis, acute disseminated encephalomyelitis (ADEM), pediatric MS, and systemic autoimmune disease-associated and paraneoplastic myelopathies, one might feel overwhelmed when attempting to classify, characterize, diagnose, and manage these conditions. Neuroimaging, specifically MRI, plays a key role in the correct diagnosis of these conditions, and it provides a critically important aid for treatment monitoring. With the advent of advanced MRI techniques enabling quantitative analysis methods, MRI provides a reliable tool in monitoring and characterizing disease progression, and it also enables a unique insight into the generally poorly understood pathogenesis of these disorders.

In this chapter, we will discuss the currently available and constantly evolving MRI-based quantitative tools. These will be discussed in the context of the most common forms of acute and subacute inflammatory myelopathies, including MS-related transverse myelitis, longitudinally extensive transverse myelitis (LETM) related to NMO and NMO spectrum disorder, and idiopathic inflammatory transverse myelitis in the context of MS and as a stand-alone condition. The vast majority of the published quantitative MRI literature clearly has focused on MS, with a smaller but growing proportion of studies related to NMO; for that reason, these two diseases are the main focus when we discuss quantitative methods. Finally, we will outline future perspectives and challenges in the evolving field of quantitative MRI in inflammatory myelopathies.

Classification of Inflammatory Myelopathies

While there is currently no single universally accepted and utilized classification of inflammatory myelopathies, one can consider several features of these conditions to establish clinically useful classifications. One such feature is the lesion location or “lesion type” (Table 1.2.1).2 In addition, an important classification strategy also followed in the recently published American Academy of Neurology guidelines is whether the TM episode is complete or partial,3 which is an especially helpful distinguishing feature at first presentation with transverse myelitis.

SPINAL CORD INVOLVEMENT IN INFLAMMATORY MYELOPATHIES: KEY POINTS AND FEATURES

• Multiple sclerosis (MS): Patch-like lesions abutting the surface of the cord; in contact with cerebral spinal fluid (CSF); up to one-half of the axial crosscut surface is involved, but more commonly one-fourth to one-third

• Neuromyelitis optica (NMO): Longitudinally extensive transverse myelitis—three or more segments long, “center of the cord” appearance on axial cuts, often involves more than 50% on axial cuts

• Idiopathic transverse myelitis (TM): May be similar to MS or NMO-like lesions, without meeting the criteria for either; can be a clinically isolated syndrome (CIS) leading to MS, the first manifestation of NMO, or a stand-alone disease

• Paraneoplastic myelopathies: Most commonly present as tractopathy

Transverse Myelitis: A Practical Definition Based on MRI

Transverse myelitis is a collective term for segmental inflammatory disorders of the spinal cord. While TM can be seen in the context of infections, which are typically easily recognized given the associated systemic features and/or CSF findings, most cases represent idiopathic inflammatory diseases, including MS, NMO, and less commonly ADEM, paraneoplastic disorders, or sarcoidosis. Metabolic diseases such as vitamin B12 or copper deficiency also may look like TM on conventional MRI, but even with conventional imaging usually there are clear clues regarding their noninflammatory nature.

The most important classifying feature of idiopathic TM is based on its MRI appearance on axial and sagittal scans: lesions that encompass one-fourth to one-third of the cord crosscut surface area, typically abut the CSF, have a wedge-like appearance, and on sagittal images rarely extend beyond one or two segments are typical MS lesions. By contrast, lesions that are mostly gray matter centered, encompass one-half or more of the crosscut surface area, are longitudinally extensive usually beyond three segments, and during their acute stage are associated with mass effect are typical NMO lesions. TM lesions with NMO-like characteristics are often labeled as LETM.

TABLE 1.2.1

Classification of Inflammatory Myelopathies Based on Lesion Location

Complete

All tracts

Pyramidal, sensory, and autonomic dysfunction below lesion

Trauma or acute necrotizing viral myelitis

Bown–Séquard hemicord syndrome

Ipsilateral corticospinal, posterior columns; contralateral spinothalamic

Ipsilateral pyramidal weakness and loss of posterior column function; contralateral spinothalamic loss

Multiple sclerosis, compression

Anterior cord syndrome

Bilateral anterior horn cells corticospinal tracts, spinothalamic and autonomic

Acute bilateral flaccid weakness, loss of pain temperature, and sphincter and autonomic dysfunction; preservation of dorsal column modalities such as joint position sense

Anterior spinal artery occlusion

Posterior cord

Bilateral posterior columns

Bilateral loss of light touch, vibration, and joint position

Vitamin B12 or copper deficiency (usually chronic)

Central

Crossing spinothalamic, corticospinal, and autonomic fibers

Dissociated sensory loss (loss of pain and temperature with preserved vibration and joint position); pyramidal distribution weakness below lesion; autonomic dysfunction below the lesion

Syrinx, neuromyelitis optica

Conus medullaris

Autonomic outflow and sacral spinal cord segments

Early sphincter dysfunction, sacral sensory loss, and relatively mild motor dysfunction

Postviral myelitis

Cauda equina

Spinal nerve roots of the cauda equina

Early, often asymmetric flaccid weakness of the lower limbs; sensory loss in root distribution followed by autonomic dysfunction

Acute...

Erscheint lt. Verlag	16.1.2014
Sprache	englisch
Themenwelt	Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie
Themenwelt	Medizinische Fachgebiete ► Radiologie / Bildgebende Verfahren ► Kernspintomographie (MRT)
ISBN-10	0-12-397282-5 / 0123972825
ISBN-13	978-0-12-397282-8 / 9780123972828

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