title: Multivariate Analysis of MRI Biomarkers for Predicting Neurologic Impairment in Cervical Spinal Cord Injury.
abstract: Acute markers of spinal cord injury are essential for both diagnostic and prognostic purposes. The goal of this study was to assess the relationship between early MR imaging biomarkers after acute cervical spinal cord injury and to evaluate their predictive validity of neurologic impairment.
  
  
  
  We performed a retrospective cohort study of 95 patients with acute spinal cord injury and preoperative MR imaging within 24 hours of injury. The American Spinal Injury Association Impairment Scale was used as our primary outcome measure to define neurologic impairment. We assessed several MR imaging features of injury, including axial grade (Brain and Spinal Injury Center score), sagittal grade, length of injury, maximum canal compromise, and maximum spinal cord compression. Data-driven nonlinear principal component analysis was followed by correlation and optimal-scaled multiple variable regression to predict neurologic impairment.
  
  
  
  Nonlinear principal component analysis identified 2 clusters of MR imaging variables related to 1) measures of intrinsic cord signal abnormality and 2) measures of extrinsic cord compression. Neurologic impairment was best accounted for by MR imaging measures of intrinsic cord signal abnormality, with axial grade representing the most accurate predictor of short-term impairment, even when correcting for surgical decompression and degree of cord compression.
  
  
  
  This study demonstrates the utility of applying nonlinear principal component analysis for defining the relationship between MR imaging biomarkers in a complex clinical syndrome of cervical spinal cord injury. Of the assessed imaging biomarkers, the intrinsic measures of cord signal abnormality were most predictive of neurologic impairment in acute spinal cord injury, highlighting the value of axial T2 MR imaging.
authors.affiliation: From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).|Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).
authors.forename: J
authors.identifier: 0000-0002-3546-728X
authors.initials: J
authors.lastname: Haefeli
authors.affiliation: Radiology and Biomedical Imaging (M.C.M., J.F.T.).
authors.forename: M C
authors.identifier: 0000-0002-4538-0823
authors.initials: MC
authors.lastname: Mabray
authors.affiliation: Emergency Medicine (W.D.W.).|Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).
authors.forename: W D
authors.identifier: 0000-0002-8568-6640
authors.initials: WD
authors.lastname: Whetstone
authors.affiliation: From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).|Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).
authors.forename: S S
authors.identifier: 0000-0002-6891-2722
authors.initials: SS
authors.lastname: Dhall
authors.affiliation: Anesthesia and Perioperative Care (J.Z.P.), University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California.|Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).
authors.forename: J Z
authors.identifier: 0000-0001-5814-3707
authors.initials: JZ
authors.lastname: Pan
authors.affiliation: From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).|Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).
authors.forename: P
authors.identifier: 0000-0003-2071-6965
authors.initials: P
authors.lastname: Upadhyayula
authors.affiliation: From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).|Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).
authors.forename: G T
authors.identifier: 0000-0002-0926-3128
authors.initials: GT
authors.lastname: Manley
authors.affiliation: From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).|Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).
authors.forename: J C
authors.identifier: 0000-0003-2243-7054
authors.initials: JC
authors.lastname: Bresnahan
authors.affiliation: From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).|Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).
authors.forename: M S
authors.identifier: 0000-0001-9463-3631
authors.initials: MS
authors.lastname: Beattie
authors.affiliation: From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.) adam.ferguson@ucsf.edu.|Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).|San Francisco VA Medical Center (A.R.F.), San Francisco, California.
authors.forename: A R
authors.identifier: 0000-0001-7102-1608
authors.initials: AR
authors.lastname: Ferguson
authors.affiliation: Radiology and Biomedical Imaging (M.C.M., J.F.T.).|Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).
authors.forename: J F
authors.identifier: 0000-0003-3943-5530
authors.initials: JF
authors.lastname: Talbott
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D002574:Cervical Vertebrae / Q000293:injuries; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D015415:Biomarkers