Citation

Dalkilic T, Fallah N, Noonan VK, Salimi Elizei S, Dong K, Belanger LM, Ritchie L, Tsang A, Bourassa-Moreau E, Heran MKS, Paquette SJ, Ailon T, Dea N, Street J, Fisher CG, Dvorak MF, Kwon BK. J. Neurotrauma 2018; 35(3): 435-445.

Affiliation

University of British Columbia, ICORD, Vancouver, British Columbia, Canada ; brian.kwon@ubc.ca.

Copyright

(Copyright © 2018, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2017.5357

PMID

29037121

Abstract

Biomarkers of acute human spinal cord injury (SCI) could provide a more objective measure of spinal cord damage and a better predictor of neurologic outcome than the current functional neurologic assessments. There has been growing interest in establishing neurochemical biomarkers using cerebrospinal fluid (CSF) and also imaging biomarkers using measurable features on MRI. In this study, we took the opportunity to compare CSF biomarkers and MRI biomarkers in a cohort of acute cervical SCI patients who had undergone both CSF sampling and pre-operative MRI scanning. From our prospective clinical trial of acute SCI in which lumbar intrathecal catheters were implanted for CSF sampling, we identified 36 cervical SCI patients at our institution who had also undergone pre-operative MRIs. From the CSF samples at 24 hours post-injury, the concentrations of inflammatory cytokines (IL-6, IL-8, MCP-1) and structural proteins (tau, GFAP, S100) were measured. From the pre-operative MRI scans, we measured the vertical length of edema, hematoma length, hematoma extent, CSF effacement, and maximum cord expansion were measured, and maximum cord compression was calculated. Baseline and 6-month post-injury assessments of AIS grade and motor score were conducted. Both MRI measures and CSF biomarker levels were found to correlate with baseline injury grade. For predicting neurologic recovery, the inflammatory biomarker levels predicted AIS grade conversion, while structural biomarker levels predicted motor score improvement. The use of CSF biomarkers alone in a prediction model was found to have 91.2% accuracy. In a direct comparison of MRI biomarkers with CSF biomarkers, the CSF biomarkers discriminate better between different injury severities, and are stronger predictors of neurologic recovery in terms of AIS injury grade and motor score improvement. These findings demonstrate the utility of measuring the acute biologic responses to injury as biomarkers for distinguishing injury severity and predicting neurologic outcome.

Language: en

Keywords

BIOMARKERS; CEREBROSPINAL FLUID; MRI; TRAUMATIC SPINAL CORD INJURY