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

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. 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.