Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

Spinal Cord, 2021 · DOI: 10.1038/s41393-020-00561-w · Published: October 6, 2020

Spinal Cord Injury Neurology Medical Imaging

Simple Explanation

This study investigates whether MRI scans taken early after a spinal cord injury (SCI) can predict a person's ability to walk one year later. Specifically, it looks at the relationship between the amount of damage seen on the MRI and walking ability. The researchers measured the 'axial damage ratio' on MRI scans, which represents the proportion of the spinal cord that is damaged at the point of greatest damage. They also assessed the amount of healthy tissue remaining in specific areas of the spinal cord. The study found that a smaller axial damage ratio was associated with a greater likelihood of being able to walk. However, this MRI measure did not provide additional predictive power when combined with standard clinical assessments of neurological function.

Study Duration

Not specified

Participants

145 participants status post cervical SCI

Evidence Level

Level 3: Retrospective study

Key Findings

1
Axial damage ratios from MRIs taken early after injury were significant predictors of walking ability one year post-SCI; smaller ratios correlated with a higher likelihood of walking.
2
The axial damage ratio had fair discriminative ability for determining walking, with an AUC value of 0.75.
3
The percentage of spared tissue in the lateral spinal cord region was correlated with the motor scores of the same-side lower extremity.

Research Summary

This retrospective study assessed whether axial damage ratios from MRIs could predict walking ability one year after spinal cord injury (SCI). The study found that axial damage ratios were significant predictors of walking ability, but did not add predictive value over initial neurological grades. Lateral cord regions correlated with same-side lower extremity motor scores (LEMS). The axial damage ratio biomarker may be a useful tool in predicting future walking ability after SCI, but initial AIS grades remain the optimal predictor if clinically available.

Practical Implications

Prognostic Tool

Axial damage ratios could be a useful tool for predicting walking ability after SCI, particularly when initial neurological grades are unavailable.

Treatment planning

The findings could help clinicians to set realistic expectations for patients and to tailor rehabilitation programs accordingly.

Future Research

Future prospective research is needed to validate these findings and to explore the potential of other MRI biomarkers for predicting outcomes after SCI.

Study Limitations

1
The axial damage ratio cut-off score of 0.374 is specific to the study's cohort and needs validation in independent cohorts before generalization.
2
The earliest imaging available averaged 3.7 ± 2.8 weeks post-SCI, which is a possible confounder because SCI imaging characteristics are dynamic, especially within the first 3 weeks of injury.
3
The study used self-reported walking ability, which may be subject to recall bias.

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