title: Reliable volumetry of the cervical spinal cord in MS patient follow-up data with cord image analyzer (Cordial).
abstract: Spinal cord (SC) atrophy is an important contributor to the development of disability in many neurological disorders including multiple sclerosis (MS). To assess the spinal cord atrophy in clinical trials and clinical practice, largely automated methods are needed due to the sheer amount of data. Moreover, using these methods in longitudinal trials requires them to deliver highly reliable measurements, enabling comparisons of multiple data sets of the same subject over time. We present a method for SC volumetry using 3D MRI data providing volume measurements for SC sections of fixed length and location. The segmentation combines a continuous max flow approach with SC surface reconstruction that locates the SC boundary based on image voxel intensities. Two cutting planes perpendicular to the SC centerline are determined based on predefined distances to an anatomical landmark, and the cervical SC volume (CSCV) is then calculated in-between these boundaries. The development of the method focused on its application in MRI follow-up studies; the method provides a high scan-rescan reliability, which was tested on healthy subject data. Scan-rescan reliability coefficients of variation (COV) were below 1 %, intra- and interrater COV were even lower (0.1-0.2 %). To show the applicability in longitudinal trials, 3-year follow-up data of 48 patients with a progressive course of MS were assessed. In this cohort, CSCV loss was the only significant predictor of disability progression (p = 0.02). We are, therefore, confident that our method provides a reliable tool for SC volumetry in longitudinal clinical trials.
authors.affiliation: Medical Image Analysis Center (MIAC) AG, Mittlere Strasse 83, 4054, Basel, Switzerland. Michael.Amann@usb.ch.|Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. Michael.Amann@usb.ch.|Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. Michael.Amann@usb.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Amann
authors.affiliation: Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123, Allschwil, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Pezold
authors.affiliation: Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Naegelin
authors.affiliation: Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123, Allschwil, Switzerland.
authors.forename: Ketut
authors.initials: K
authors.lastname: Fundana
authors.affiliation: Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Michaela
authors.initials: M
authors.lastname: Andělová
authors.affiliation: Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Katrin
authors.initials: K
authors.lastname: Weier
authors.affiliation: Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Stippich
authors.affiliation: Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kappos
authors.affiliation: Medical Image Analysis Center (MIAC) AG, Mittlere Strasse 83, 4054, Basel, Switzerland.
authors.forename: Ernst-Wilhelm
authors.initials: EW
authors.lastname: Radue
authors.affiliation: Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123, Allschwil, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cattin
authors.affiliation: Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.|Department of Neurology, DKD Helios Klinik Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Sprenger
mesh_terms: D000328:Adult; D000368:Aged; D066193:Cervical Cord / Q000000981:diagnostic imaging / Q000473:pathology*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging / Q000473:pathology*; D015203:Reproducibility of Results; D055815:Young Adult
keywords: Atrophy; Continuous max flow; Multiple sclerosis; Progression; Reliability; Segmentation; Spinal cord; Volumetry