Claudia Wheeler-Kingshott, Julien Cohen-Adad, Armin Curt, Michael G. Fehlings, University College London, London, UK

ImagiNg SPInal cord injury and assessing its pREDictive Value - the INSPIRED study

Funded in: 2016, 2017, 2018

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Problem: Imaging the spinal cord is very challenging

Target: Modeling and image analysis methods for MRI scans

Goal: Advanced MRI imaging methods for monitoring the effects of treatment in clinical trials in SCI


A quantifiable multicenter spinal cord neuro-imaging project funded jointly by three NGOs CHNF, ISRT and WFL 

Traumatic spinal cord injury and other conditions of the spinal cord have potentially life changing consequences for affected people. Developing techniques to increase understanding of what happens in both the brain and spinal cord is essential because imaging can help deciding on the treatment strategy, can improve monitoring how the patient responds to a proposed therapy and may also indicate new areas for drug development.

Imaging the spinal cord, though, is very challenging. The spinal cord is about 10 times smaller than the brain, it moves a lot with breathing and with the heart pulsation. The fact that the spinal cord is surrounded by the osseous spine further diminishes the quality of the images.

This study aims to advance research in SCI using measurements made with MRI techniques that not only acquire images of the brain and spinal cord, but that can give parameters linked to properties of the tissue.

In this joint project three state-of-the-art 3T MRI scanners from three different vendors will be used to perform a multi-centre study focussing on some specific aspects of tissue damage, in particular demyelination, and axonal damage, which are key in the processes of damage and repair. Quantitative MRI techniques performed in the spinal cord will help to identify the best MR measures for showing demyelination and remyelination (repair), axonal damage, oedema and measurements of iron content in tissue (associated with micro haemorrhages).


Description of the study

Initially novel approaches, modeling and image analysis methods for the MRI scans will be developed and optimized on scanners from three different manufacturers. Following protocol development the study will recruit CSM patients (cervical spondylotic myelopathy), acute traumatic SCI patients and healthy volunteers (age and gender matched) for an MRI scan. Using the newly developed protocols at the two clinical sites, with three different scanners, the spinal cord area and size of lesion at the level of the injury will be analyzed and measurements related to myelin and axonal damage in the cord at that level will be performed. In the whole brain (covering to cervical cord level C3), myelin and water content, axonal damage and also iron content will be measured.

Additionally, the test persons will be clinically assessed using neurological scores and neurophysiological testing. Clinical measures related to both CSM and SCI, as well as neurophysiological testing (nerve conduction tests) of specific motor and sensory nerve fibre tracts will be compared with MRI measurements to assess the sensitivity and specificity of the markers to disease processes.  

There is evidence that measures obtained from quantitative imaging in the spinal cord provide novel, sensitive markers for clinical outcomes in spinal cord conditions including SCI. This will enable selecting appropriate methods for monitoring the effects of treatment in clinical trials as well as potentially identifying new targets for treatment therapies.