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Research ArticleSPINE
Open Access

Automatic Spinal Cord Gray Matter Quantification: A Novel Approach

C. Tsagkas, A. Horvath, A. Altermatt, S. Pezold, M. Weigel, T. Haas, M. Amann, L. Kappos, T. Sprenger, O. Bieri, P. Cattin and K. Parmar
American Journal of Neuroradiology August 2019, DOI: https://doi.org/10.3174/ajnr.A6157
C. Tsagkas
aFrom the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical EngineeringbTranslational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical EngineeringeMedical Image Analysis Center (C.T., A.A., M.A.), Basel, Switzerland
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A. Horvath
fDepartment of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
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A. Altermatt
bTranslational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical EngineeringeMedical Image Analysis Center (C.T., A.A., M.A.), Basel, SwitzerlandfDepartment of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
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S. Pezold
fDepartment of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
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M. Weigel
bTranslational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical EngineeringcDivision of Radiological Physics (M.W., T.H., O.B.), Department of RadiologyfDepartment of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
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T. Haas
cDivision of Radiological Physics (M.W., T.H., O.B.), Department of Radiology
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M. Amann
aFrom the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical EngineeringbTranslational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical EngineeringdDivision of Diagnostic and Interventional Neuroradiology (M.A.), Department of Radiology, University Hospital Basel, University of Basel, Basel, SwitzerlandeMedical Image Analysis Center (C.T., A.A., M.A.), Basel, Switzerland
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L. Kappos
aFrom the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical EngineeringbTranslational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering
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T. Sprenger
aFrom the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical EngineeringgDepartment of Neurology (T.S.), DKD HELIOS Klinik, Wiesbaden, Germany.
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O. Bieri
cDivision of Radiological Physics (M.W., T.H., O.B.), Department of RadiologyfDepartment of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
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P. Cattin
fDepartment of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
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K. Parmar
aFrom the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical EngineeringbTranslational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering
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Abstract

BACKGROUND AND PURPOSE: Currently, accurate and reproducible spinal cord GM segmentation remains challenging and a noninvasive broadly accepted reference standard for spinal cord GM measurements is still a matter of ongoing discussion. Our aim was to assess the reproducibility and accuracy of cervical spinal cord GM and WM cross-sectional area measurements using averaged magnetization inversion recovery acquisitions images and a fully-automatic postprocessing segmentation algorithm.

MATERIALS AND METHODS: The cervical spinal cord of 24 healthy subjects (14 women; mean age, 40 ± 11 years) was scanned in a test-retest fashion on a 3T MR imaging system. Twelve axial averaged magnetization inversion recovery acquisitions slices were acquired over a 48-mm cord segment. GM and WM were both manually segmented by 2 experienced readers and compared with an automatic variational segmentation algorithm with a shape prior modified for 3D data with a slice similarity prior. Precision and accuracy of the automatic method were evaluated using coefficients of variation and Dice similarity coefficients.

RESULTS: The mean GM area was 17.20 ± 2.28 mm2 and the mean WM area was 72.71 ± 7.55 mm2 using the automatic method. Reproducibility was high for both methods, while being better for the automatic approach (all mean automatic coefficients of variation, ≤4.77%; all differences, P < .001). The accuracy of the automatic method compared with the manual reference standard was excellent (mean Dice similarity coefficients: 0.86 ± 0.04 for GM and 0.90 ± 0.03 for WM). The automatic approach demonstrated similar coefficients of variation between intra- and intersession reproducibility as well as among all acquired spinal cord slices.

CONCLUSIONS: Our novel approach including the averaged magnetization inversion recovery acquisitions sequence and a fully-automated postprocessing segmentation algorithm demonstrated an accurate and reproducible spinal cord GM and WM segmentation. This pipeline is promising for both the exploration of longitudinal structural GM changes and application in clinical settings in disorders affecting the spinal cord.

ABBREVIATIONS:

AMIRA
averaged magnetization inversion recovery acquisitions
CV
coefficient of variation
DSC
Dice similarity coefficient
HD
Hausdorff distance
SC
spinal cord

Footnotes

  • C. Tsagkas and A. Horvath contributed equally as first authors.

  • Disclosures: Charidimos Tsagkas—RELATED: Grant: Swiss National Science Foundation (grant No. 320030_156860) and the Foundation for Sponsorship of Gastroenterological and General Clinical Research as well as of Medical Imaging (application ID 02/2015); UNRELATED: Grants/Grants Pending: University of Basel, Forschungsfonds für exzellente Nachwuchsforschende, pending. Antal Horvath—RELATED: Support for Travel to Meetings for the Study or Other Purposes: Swiss National Science Foundation.* Simon Pezold—UNRELATED: Grants/Grants Pending: Novartis Research Foundation.* Matthias Weigel—RELATED: Grant: Swiss National Science Foundation, Comments: grant No. 320030_156860, Method Development for MRI of Spinal Cord*; UNRELATED: Employment: Department of Biomedical Engineering, University of Basel, Switzerland, Comments: postdocterate; Patents (Planned, Pending or Issued): University Hospital Freiburg, Freiburg, Germany, Comments: patent for Optical Motion Correction, neither relevant nor used in the present work; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: International Society for Magnetic Resonance in Medicine, European Society for Magnetic Resonance in Medicine and Biology, MR Compact, Comments: travel reimbursement and accommodation for invited, scientific talks about MRI physics. Ludwig Kappos—UNRELATED: Board Membership: Actelion, Almirall, Bayer AG, Biogen, Celgene/Receptos, df-mp, Excemed, Genzyme, Japan Tobacco, Merck, Minoryx, Mitsubishi Tanabe Pharma, Novartis, Roche, Sanofi-Aventis, Santhera, Teva Pharmaceutical Industries, Vianex*; Consultancy: Actelion, Almirall, Bayer AG, Biogen, Celgene/Receptos, df-mp, Excemed, Genzyme, Japan Tobacco, Merck, Minoryx, Mitsubishi Tanabe Pharma, Novartis, Roche, Sanofi-Aventis, Santhera, Teva Pharmaceutical Industries, Vianex*; Grants/Grants Pending: Bayer AG, Biogen, Novartis, Roche, the Swiss MS Society, the Swiss National Research Foundation*; Payment for Lectures Including Service on Speakers Bureaus: Allergan, Almirall, Baxalta, Bayer AG, Biogen, CSL Behring, Desitin, Excemed, Genzyme, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva Pharmaceutical Industries*; Payment for Development of Educational Presentations: Allergan, Almirall, Baxalta, Bayer AG, Biogen, CSL Behring, Desitin, Excemed, Genzyme, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva Pharmaceutical Industries.* Till Sprenger—RELATED: Grant: Swiss National Science Foundation*; UNRELATED: Consultancy: Actelion, ATI, Biogen, Desitin, electroCore, Sanofi Genzyme, Novartis, and Mitsubishi Tanabe Pharma Europe*; Grants/Grants Pending: EFIC-Grünenthal, Novartis Switzerland, the Swiss Multiple Sclerosis Society*; Payment for Lectures Including Service on Speakers Bureaus: Sanofi Genzyme, Biogen, Novartis, Teva Pharmaceutical Industries.* Oliver Bieri—RELATED: Grant: Swiss National Science Foundation*; UNRELATED: Grants/Grants Pending: Swiss National Science Foundation.* Katrin Parmar—RELATED: Grant: Swiss National Science Foundation*; UNRELATED: Grants/Grants Pending: Baasch Medicus Foundation; Payment for Lectures Including Service on Speakers Bureaus: Excemed, Novartis Switzerland*; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: Novartis Switzerland. *Money paid to the institution.

  • This work was supported by the Swiss National Science Foundation (grant No. 320030_156860) and the Foundation for Sponsorship of Gastroenterological and General Clinical Research as well as of Medical Imaging (application ID 02/2015).

  • © 2019 by American Journal of Neuroradiology

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Automatic Spinal Cord Gray Matter Quantification: A Novel Approach
C. Tsagkas, A. Horvath, A. Altermatt, S. Pezold, M. Weigel, T. Haas, M. Amann, L. Kappos, T. Sprenger, O. Bieri, P. Cattin, K. Parmar
American Journal of Neuroradiology Aug 2019, DOI: 10.3174/ajnr.A6157

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Automatic Spinal Cord Gray Matter Quantification: A Novel Approach
C. Tsagkas, A. Horvath, A. Altermatt, S. Pezold, M. Weigel, T. Haas, M. Amann, L. Kappos, T. Sprenger, O. Bieri, P. Cattin, K. Parmar
American Journal of Neuroradiology Aug 2019, DOI: 10.3174/ajnr.A6157
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