BACKGROUND: Degenerative cervical spinal cord compression is becoming increasingly prevalent, yet the MRI criteria that define compression are vague, and vary between studies. This contribution addresses the detection of compression by means of the Spinal Cord Toolbox (SCT) and assesses the variability of the morphometric parameters extracted with it. METHODS: Prospective cross-sectional study. Two types of MRI examination, 3 and 1.5 T, were performed on 66 healthy controls and 118 participants with cervical spinal cord compression. Morphometric parameters from 3T MRI obtained by Spinal Cord Toolbox (cross-sectional area, solidity, compressive ratio, torsion) were combined in multivariate logistic regression models with the outcome (binary dependent variable) being the presence of compression determined by two radiologists. Inter-trial (between 3 and 1.5 T) and inter-rater (three expert raters and SCT) variability of morphometric parameters were assessed in a subset of 35 controls and 30 participants with compression. RESULTS: The logistic model combining compressive ratio, cross-sectional area, solidity, torsion and one binary indicator, whether or not the compression was set at level C6/7, demonstrated outstanding compression detection (area under curve =0.947). The single best cut-off for predicted probability calculated using a multiple regression equation was 0.451, with a sensitivity of 87.3% and a specificity of 90.2%. The inter-trial variability was better in Spinal Cord Toolbox (intraclass correlation coefficient was 0.858 for compressive ratio and 0.735 for cross-sectional area) compared to expert raters (mean coefficient for three expert raters was 0.722 for compressive ratio and 0.486 for cross-sectional area). The analysis of inter-rater variability demonstrated general agreement between SCT and three expert raters, as the correlations between SCT and raters were generally similar to those of the raters between one another. CONCLUSIONS: This study demonstrates successful semi-automated compression detection based on four parameters. The inter-trial variability of parameters established through two MRI examinations was conclusively better for Spinal Cord Toolbox compared with that of three experts' manual ratings.

Central European Institute of Technology Multimodal and Functional Imaging Laboratory Brno Czech Republic

Danish Research Centre for Magnetic Resonance Centre for Functional and Diagnostic Imaging and Research Copenhagen University Hospital Amager and Hvidovre Hvidovre Denmark

Department of Biomedical Engineering University Hospital Olomouc Olomouc Czech Republic

Department of Imaging Methods Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Neurology Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic

Department of Neurology University Hospital Brno Brno Czech Republic

Department of Neurology University Hospital Olomouc Olomouc Czech Republic

Department of Radiology and Nuclear Medicine University Hospital Brno Brno Czech Republic

Department of Radiology Centre for Functional and Diagnostic Imaging and Research Copenhagen University Hospital Amager and Hvidovre Hvidovre Denmark

Faculty of Medicine Masaryk University Brno Czech Republic

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

Medical University of Vienna Department of Biomedical Imaging and Image guided Therapy High Field MR Centre Vienna Austria

Medical University of Vienna Department of Medicine 3 Clinical Division of Endocrinology and Metabolism Vienna Austria

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Reproducible Spinal Cord Quantitative MRI Analysis with the Spinal Cord Toolbox

Evidence-based commentary on the diagnosis, management, and further research of degenerative cervical spinal cord compression in the absence of clinical symptoms of myelopathy

Quantitative MR Markers in Non-Myelopathic Spinal Cord Compression: A Narrative Review