title: MRI Atlas-Based Measurement of Spinal Cord Injury Predicts Outcome in Acute Flaccid Myelitis.
abstract: Recent advances in spinal cord imaging analysis have led to the development of a robust anatomic template and atlas incorporated into an open-source platform referred to as the Spinal Cord Toolbox. Using the Spinal Cord Toolbox, we sought to correlate measures of GM, WM, and cross-sectional area pathology on T2 MR imaging with motor disability in patients with acute flaccid myelitis.
  
  
  
  Spinal cord imaging for 9 patients with acute flaccid myelitis was analyzed by using the Spinal Cord Toolbox. A semiautomated pipeline using the Spinal Cord Toolbox measured lesion involvement in GM, WM, and total spinal cord cross-sectional area. Proportions of GM, WM, and cross-sectional area affected by T2 hyperintensity were calculated across 3 ROIs: 1) center axial section of lesion; 2) full lesion segment; and 3) full cord atlas volume. Spearman rank order correlation was calculated to compare MR metrics with clinical measures of disability.
  
  
  
  Proportion of GM metrics at the center axial section significantly correlated with measures of motor impairment upon admission (r[9] = -0.78;P= .014) and at 3-month follow-up (r[9] = -0.66;P= .05). Further, proportion of GM extracted across the full lesion segment significantly correlated with initial motor impairment (r[9] = -0.74,P= .024). No significant correlation was found for proportion of WM or proportion of cross-sectional area with clinical disability.
  
  
  
  Atlas-based measures of proportion of GM T2 signal abnormality measured on a single axial MR imaging section and across the full lesion segment correlate with motor impairment and outcome in patients with acute flaccid myelitis. This is the first atlas-based study to correlate clinical outcomes with segmented measures of T2 signal abnormality in the spinal cord.
authors.affiliation: From the Department of Radiology and Biomedical Imaging (D.B.M., J.F.T., M.D.M., Mark Wilson, J.N.), University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
authors.forename: D B
authors.identifier: 0000-0003-2425-1923
authors.initials: DB
authors.lastname: McCoy
authors.affiliation: From the Department of Radiology and Biomedical Imaging (D.B.M., J.F.T., M.D.M., Mark Wilson, J.N.), University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.|Brain and Spinal Injury Center (J.F.T.), Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
authors.forename: J F
authors.identifier: 0000-0003-3943-5530
authors.initials: JF
authors.lastname: Talbott
authors.affiliation: Department of Neurology (Michael Wilson), University of California, San Francisco.
authors.forename: Michael
authors.identifier: 0000-0002-8705-5084
authors.initials: M
authors.lastname: Wilson
authors.affiliation: From the Department of Radiology and Biomedical Imaging (D.B.M., J.F.T., M.D.M., Mark Wilson, J.N.), University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
authors.forename: M D
authors.identifier: 0000-0002-6689-8912
authors.initials: MD
authors.lastname: Mamlouk
authors.affiliation: Institute of Biomedical Engineering (J.C.-A.), Ecole Polytechnique Montreal, Montreal, Quebec, Canada.|Functional Neuroimaging Unit (J.C.-A.), CRIUGM, University of Montreal, Montreal, Quebec, Canada.
authors.forename: J
authors.identifier: 0000-0003-3662-9532
authors.initials: J
authors.lastname: Cohen-Adad
authors.affiliation: From the Department of Radiology and Biomedical Imaging (D.B.M., J.F.T., M.D.M., Mark Wilson, J.N.), University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
authors.forename: Mark
authors.identifier: 0000-0002-0802-3958
authors.initials: M
authors.lastname: Wilson
authors.affiliation: From the Department of Radiology and Biomedical Imaging (D.B.M., J.F.T., M.D.M., Mark Wilson, J.N.), University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California jared.narvid@ucsf.edu.
authors.forename: J
authors.identifier: 0000-0002-2887-4231
authors.initials: J
authors.lastname: Narvid
mesh_terms: D000328:Adult; D019412:Anatomy, Cross-Sectional; D001271:Atlases as Topic; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009187:Myelitis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D013116:Spinal Cord / Q000000981:diagnostic imaging; D013119:Spinal Cord Injuries / Q000150:complications / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D055815:Young Adult