3D MRI Tract-Specific Spinal Cord Lesion Pattern Improves Prediction of Distinct Neurological Recovery

Lynn Farner; Tim M Emmenegger; Simon Schading-Sassenhausen; Julia Berroth; Maryam Seif; Armin Curt; Patrick Freund; Nogo Inhibition in Spinal Cord Injury Study Group

doi:10.1002/acn3.70087

3D MRI Tract-Specific Spinal Cord Lesion Pattern Improves Prediction of Distinct Neurological Recovery

Ann Clin Transl Neurol. 2025 Jun 27. doi: 10.1002/acn3.70087. Online ahead of print.

Authors

Lynn Farner¹, Tim M Emmenegger^{1

2}, Simon Schading-Sassenhausen¹, Julia Berroth¹, Maryam Seif^{1

3}, Armin Curt¹, Patrick Freund^{1

3

4}; Nogo Inhibition in Spinal Cord Injury Study Group

Affiliations

¹ Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
² Department of Biomedical Imaging and Image-Guided Therapy, High Field MR Center, Medical University of Vienna, Vienna, Austria.
³ Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
⁴ Department of Imaging Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, UK.

PMID: 40574619
DOI: 10.1002/acn3.70087

Abstract

Objective: To distinguish lateralized motor- and sensory-tract damage after acute spinal cord injury (SCI) and explore its predictive power for motor and sensory recovery.

Methods: Thirty-five SCI patients (two female) from a multi-center data set (placebo-arm of the Nogo-A-Inhibition in SCI trial) underwent routine T2-weighted sagittal MRI scans at the lesion site at baseline (19.9 days, 95% confidence interval [CI]: 17.9-21.8), 1-month (54.2 days, 95% CI: 52.1-56.2), and 6-month (192.4 days, 95% CI: 181.3-203.6) post-injury. Concurrently with the MRI scans, clinical examinations were performed. Lesions were manually segmented across all slices, and 3D-tract damage was assessed by determining the overlap between segmented lesions and identified motor and sensory tracts in the axial plane. The relationship between lesion assessments and baseline-adjusted clinical outcomes at 6 months was explored.

Results: Over the 6-month, patients recovered by 4.95 motor points/month (95% CI: 3.89-5.89, p < 0.001) on the International Standards for the Neurological Classification of SCI scale, 2.28 light-touch points/month (95% CI: 1.43-3.12, p < 0.001), and 2.06 pinprick points/month (95% CI: 1.21-2.91, p < 0.001). Lesion volume decreased from 381.82mm ³ (95% CI: 295.78-467.87) by -14.04 mm³/month (95% CI: -25.39 to -1.56, p = 0.023). MRI visible changes in motor tract damage over the 6-month were marginal (0.02%/month, 95% CI: -0.81 to -1.02, p = 0.971). Changes in the sensory tracts were more pronounced, decreasing by -0.69%/month (95% CI: -1.29 to -0.09, p = 0.05). Left-and-right motor-tract damage at baseline significantly predicted left-and-right motor score recovery (R² = 0.75, p = 0.015), while baseline left-and-right sensory-tract damage significantly predicted improvements in left-and-right pin-prick scores (R² = 0.79, p = 0.024).

Interpretation: Revealing the extent of damage to spinal motor-and sensory-pathways early after SCI is a valuable predictor of related neurological recovery. Tracking 3D dynamics of major spinal pathways has the potential to enhance diagnostic accuracy and patient stratification for future clinical trials.

Keywords: MRI; lesion segmentation; recovery; spinal cord injury.