TY - JOUR
T1 - Quantification of Cervical Cord Cross-Sectional Area: Which Acquisition, Vertebra Level, and Analysis Software? A Multicenter Repeatability Study on a Traveling Healthy Volunteer
AU - Lukas, Carsten
AU - Bellenberg, Barbara
AU - Prados, Ferran
AU - Valsasina, Paola
AU - Parmar, Katrin
AU - Brouwer, Iman
AU - Pareto, Deborah
AU - Rovira, Àlex
AU - Sastre-Garriga, Jaume
AU - Gandini Wheeler-Kingshott, Claudia A. M.
AU - Kappos, Ludwig
AU - Rocca, Maria A.
AU - the MAGNIMS Study Group
AU - Filippi, Massimo
AU - Yiannakas, Marios
AU - Barkhof, Frederik
AU - Vrenken, Hugo
N1 - Funding Information: We acknowledge support by the Open Access Publication Funds of the Ruhr-Universität Bochum. Funding Information: Parts of this work were funded by the German Federal Ministry for Education and Research, BMBF, German Competence Network Multiple Sclerosis KKNMS (Grant Nos. 01GI1601I and 01GI0914) and by grants from the UK MS Society. FP, CG, and MY were supported by the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Center. The funding institutions did not interfere with the study design, the collection, analysis and Funding Information: 35. Kearney H, Yiannakas MC, Abdel-Aziz K, Wheeler-Kingshott C, a.M., Altmann DR, et al. Improved MRI quantification of spinal cord atrophy in multiple sclerosis. J Magnet Reson Imaging. (2013) 39:617–23. doi: 10.1002/jmri.24194 Conflict of Interest: CL received a research grant by the German Federal Ministry for Education and Research, BMBF, German Competence Network Multiple Sclerosis (KKNMS), grant no. 01GI1601I, has received consulting and speaker’s honoraria from Biogen, Bayer, Daiichi Sanykyo, Merck Serono, Novartis, Sanofi, Genzyme and TEVA. BB reports financial support by the German Federal Ministry for Education and Research, BMBF, German Competence Network Multiple Sclerosis (KKNMS), grant no. 01GI1601I. FP has received grants from MRC and the NIHR biomedical research center at UCLH, outside the submitted work. PV reports speaker honoraria from Biogen and ExceMed, outside the submitted work. IB is supported by research grants from Teva Pharmaceuticals, Merck Serono, Novartis Pharma and the Dutch MS Foundation (grants to HV and FB), outside the submitted work. DP has received honoraria as speaker from Novartis and Genzyme, and a grant by Biogen, outside the submitted work. ÀR reports personal fees from Novartis, Sanofi-Genzyme, Bayer, Roche, Biogen, Neurodiem, Bracco, Merck Serono, Teva Pharmaceuticals, and Icometrix; and non-financial support from SyntheticMR, outside the submitted work. JS-G reports grants and personal fees from Sanofi Genzyme; and personal fees from Almirall, Biogen, Celgene, Merck Serono, Novartis, Roche, and Orchid Pharma and Biopass, outside the submitted work; and is member of the Editorial Committee of Multiple Sclerosis Journal and director of the Scientifi Committee of Revista de Neurologia. CG receives research grants outside the submitted work from ISRT, EPSRC, Wings for Life, UK MS Society, Horizon2020, Biogen and Novartis; is editorial board member of Functional Neurology. LK reports personal fees from Actelion, Addex, Biotica, Celgene Receptos, Sanof Genzyme, Eli Lilly, Mitsubishi, Ono Pharmaceutical, Pfier, Sanofi Santhera Pharmaceuticals, Siemens, Teva Pharmaceuticals, UCB, and XenoPort; grants and personal fees from Bayer HealthCare Pharmaceuticals, Biogen, Merck Serono, and Novartis; and grants from F Hoffann-La Roche, EU, Innoswiss, Roche Research Foundation, Swiss Multiple Sclerosis Society, and Swiss National Research Foundation, outside the submitted work. MR reports personal fees from Biogen, Novartis, Sanofi Genzyme, Teva Pharmaceuticals, Merck Serono, and Roche, outside the submitted work; and receives research support from the Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla. MF reports personal fees from Biogen, Merck Serono, Novartis, and Teva Pharmaceuticals, outside the submitted work; receives research support from Biogen, Merck Serono, Novartis, Teva Pharmaceuticals, Roche, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and Fondazione Italiana di Ricerca per la SLA; and is editor-in-chief of the Journal of Neurology. FB received, outside the submitted work, compensation for consulting services by Bayer, Biogen; receives research support from Biogen, GE Healthcare, IMI-EU IXICO Ltd., Merck-Serono, Roche, The Dutch Foundation MS Reserach; he is Editor in chief of “Clinical Neuroradiology - The ESNR textbook”. HV reports grants and consulting fees paid directly to their institution from Merck Serono and Novartis, and grants from Teva Pharmaceuticals, outside the submitted work. Publisher Copyright: © Copyright © 2021 Lukas, Bellenberg, Prados, Valsasina, Parmar, Brouwer, Pareto, Rovira, Sastre-Garriga, Gandini Wheeler-Kingshott, Kappos, Rocca, Filippi, Yiannakas, Barkhof and Vrenken. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/8/4
Y1 - 2021/8/4
N2 - Background: Considerable spinal cord (SC) atrophy occurs in multiple sclerosis (MS). While MRI-based techniques for SC cross-sectional area (CSA) quantification have improved over time, there is no common agreement on whether to measure at single vertebral levels or across larger regions and whether upper SC CSA can be reliably measured from brain images. Aim: To compare in a multicenter setting three CSA measurement methods in terms of repeatability at different anatomical levels. To analyze the agreement between measurements performed on the cervical cord and on brain MRI. Method: One healthy volunteer was scanned three times on the same day in six sites (three scanner vendors) using a 3T MRI protocol including sagittal 3D T1-weighted imaging of the brain (covering the upper cervical cord) and of the SC. Images were analyzed using two semiautomated methods [NeuroQLab (NQL) and the Active Surface Model (ASM)] and the fully automated Spinal Cord Toolbox (SCT) on different vertebral levels (C1–C2; C2/3) on SC and brain images and the entire cervical cord (C1–C7) on SC images only. Results: CSA estimates were significantly smaller using SCT compared to NQL and ASM (p < 0.001), regardless of the cord level. Inter-scanner repeatability was best in C1–C7: coefficients of variation for NQL, ASM, and SCT: 0.4, 0.6, and 1.0%, respectively. CSAs estimated in brain MRI were slightly lower than in SC MRI (all p ≤ 0.006 at the C1–C2 level). Despite protocol harmonization between the centers with regard to image resolution and use of high-contrast 3D T1-weighted sequences, the variability of CSA was partly scanner dependent probably due to differences in scanner geometry, coil design, and details of the MRI parameter settings. Conclusion: For CSA quantification, dedicated isotropic SC MRI should be acquired, which yielded best repeatability in the entire cervical cord. In the upper part of the cervical cord, use of brain MRI scans entailed only a minor loss of CSA repeatability compared to SC MRI. Due to systematic differences between scanners and the CSA quantification software, both should be kept constant within a study. The MRI dataset of this study is available publicly to test new analysis approaches.
AB - Background: Considerable spinal cord (SC) atrophy occurs in multiple sclerosis (MS). While MRI-based techniques for SC cross-sectional area (CSA) quantification have improved over time, there is no common agreement on whether to measure at single vertebral levels or across larger regions and whether upper SC CSA can be reliably measured from brain images. Aim: To compare in a multicenter setting three CSA measurement methods in terms of repeatability at different anatomical levels. To analyze the agreement between measurements performed on the cervical cord and on brain MRI. Method: One healthy volunteer was scanned three times on the same day in six sites (three scanner vendors) using a 3T MRI protocol including sagittal 3D T1-weighted imaging of the brain (covering the upper cervical cord) and of the SC. Images were analyzed using two semiautomated methods [NeuroQLab (NQL) and the Active Surface Model (ASM)] and the fully automated Spinal Cord Toolbox (SCT) on different vertebral levels (C1–C2; C2/3) on SC and brain images and the entire cervical cord (C1–C7) on SC images only. Results: CSA estimates were significantly smaller using SCT compared to NQL and ASM (p < 0.001), regardless of the cord level. Inter-scanner repeatability was best in C1–C7: coefficients of variation for NQL, ASM, and SCT: 0.4, 0.6, and 1.0%, respectively. CSAs estimated in brain MRI were slightly lower than in SC MRI (all p ≤ 0.006 at the C1–C2 level). Despite protocol harmonization between the centers with regard to image resolution and use of high-contrast 3D T1-weighted sequences, the variability of CSA was partly scanner dependent probably due to differences in scanner geometry, coil design, and details of the MRI parameter settings. Conclusion: For CSA quantification, dedicated isotropic SC MRI should be acquired, which yielded best repeatability in the entire cervical cord. In the upper part of the cervical cord, use of brain MRI scans entailed only a minor loss of CSA repeatability compared to SC MRI. Due to systematic differences between scanners and the CSA quantification software, both should be kept constant within a study. The MRI dataset of this study is available publicly to test new analysis approaches.
KW - CSA
KW - MRI
KW - atrophy
KW - cervical cord
KW - cord segmentation software
KW - cross-sectional area
KW - multiple sclerosis
KW - spinal cord
UR - http://www.scopus.com/inward/record.url?scp=85113132836&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fneur.2021.693333
DO - https://doi.org/10.3389/fneur.2021.693333
M3 - Article
C2 - 34421797
SN - 1664-2295
VL - 12
JO - Frontiers in Neurology
JF - Frontiers in Neurology
M1 - 693333
ER -