title: Axonal integrity predicts cortical reorganisation following cervical injury.
abstract: BACKGROUND
  Traumatic spinal cord injury (SCI) leads to disruption of axonal architecture and macroscopic tissue loss with impaired information flow between the brain and spinal cord-the presumed basis of ensuing clinical impairment.
  
  
  OBJECTIVE
  The authors used a clinically viable, multimodal MRI protocol to quantify the axonal integrity of the cranial corticospinal tract (CST) and to establish how microstructural white matter changes in the CST are related to cross-sectional spinal cord area and cortical reorganisation of the sensorimotor system in subjects with traumatic SCI.
  
  
  METHODS
  Nine volunteers with cervical injuries resulting in bilateral motor impairment and 14 control subjects were studied. The authors used diffusion tensor imaging to assess white matter integrity in the CST, T1-weighted imaging to measure cross-sectional spinal cord area and functional MRI to compare motor task-related brain activations. The relationships among microstructural, macrostructural and functional measures were assessed using regression analyses. Results Diffusion tensor imaging revealed significant differences in the CST of SCI subjects-compared with controls-in the pyramids, the internal capsule, the cerebral peduncle and the hand area. The microstructural white matter changes observed in the left pyramid predicted increased task-related responses in the left M1 leg area, while changes in the cerebral peduncle were predicted by reduced cord area.
  
  
  CONCLUSIONS
  The observed microstructural changes suggest trauma-related axonal degeneration and demyelination, which are related to cortical motor reorganisation and macrostructure. The extent of these changes may reflect the plasticity of motor pathways associated with cortical reorganisation. This clinically viable multimodal imaging approach is therefore appropriate for monitoring degeneration of central pathways and the evaluation of treatments targeting axonal repair in SCI.
authors.affiliation: Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London WC1N 3BG, UK. p.freund@ucl.ac.uk
authors.forename: Patrick
authors.initials: P
authors.lastname: Freund
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Wheeler-Kingshott
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Nagy
authors.forename: Nikos
authors.initials: N
authors.lastname: Gorgoraptis
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Weiskopf
authors.forename: Karl
authors.initials: K
authors.lastname: Friston
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Thompson
authors.forename: Chloe
authors.initials: C
authors.lastname: Hutton
mesh_terms: D000328:Adult; D000368:Aged; D001369:Axons / Q000473:pathology / Q000502:physiology; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000503:physiopathology*; D002574:Cervical Vertebrae / Q000293:injuries; D003711:Demyelinating Diseases / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D056324:Diffusion Tensor Imaging / Q000379:methods / Q000523:psychology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009410:Nerve Degeneration / Q000473:pathology / Q000503:physiopathology; D009413:Nerve Fibers, Myelinated / Q000473:pathology* / Q000502:physiology*; D009434:Neural Pathways / Q000473:pathology / Q000503:physiopathology; D059906:Neuroimaging / Q000379:methods / Q000523:psychology*; D011597:Psychomotor Performance / Q000502:physiology; D011712:Pyramidal Tracts / Q000473:pathology / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000473:pathology* / Q000503:physiopathology*