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<meta name="DC.Title" content="Considerations for Mean Upper Cervical Cord Area Implementation in a Longitudinal MRI Setting: Methods, Interrater Reliability, and MRI Quality Control" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6394" />
<meta name="DC.Date" content="2020-02-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2020 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Spinal cord atrophy is commonly measured from cerebral MRIs, including the upper cervical cord. However, rescan intraparticipant measures have not been investigated in healthy cohorts. This study investigated technical and rescan variability in the mean upper cervical cord area calculated from T1-weighted cerebral MRIs.

MATERIALS AND METHODS: In this retrospective study, 8 healthy participants were scanned and rescanned with non-distortion- and distortion-corrected MPRAGE sequences (11–50 sessions in 6–8 months), and 50 participants were scanned once with distortion-corrected MPRAGE sequences in the Day2day daily variability study. From another real-world observational cohort, we collected non-distortion-corrected MPRAGE scans from 27 healthy participants (annually for 2–4 years) and cross-sectionally from 77 participants. Statistical analyses included coefficient of variation, smallest real difference, intraclass correlation coefficient, Bland-Altman limits of agreement, and paired t tests.

RESULTS: Distortion- versus non-distortion-corrected MPRAGE-derived mean upper cervical cord areas were similar; however, a paired t test showed incomparability ( t = 11.0, P = &lt;.001). Higher variability was found in the mean upper cervical cord areas calculated from an automatic segmentation method. Interrater analysis yielded incomparable measures in the same participant scans ( t = 4.5, P = &lt;. 001). Non-distortion-corrected mean upper cervical cord area measures were shown to be robust in real-world data ( t = −1.04, P = .31). The main sources of variability were found to be artifacts from movement, head/neck positioning, and/or metal implants.

CONCLUSIONS: Technical variability in cord measures decreased using non-distortion-corrected MRIs, a semiautomatic segmentation approach, and 1 rater. Rescan variability was within ±4.4% for group mean upper cervical cord area when MR imaging quality criteria were met.

CoV
:   coefficient of variation
HP
:   healthy participants
ICC
:   intraclass correlation coefficient
MUCCA
:   mean upper cervical cord area
SC
:   spinal cord
SCT
:   Spinal Cord Toolbox
SRD
:   smallest real difference
UCC
:   upper cervical cord
DND
:   Day2day non-distortion corrected
DDC
:   Day2day distortion corrected cross-sectional
CNDC
:   clinical non-distortion corrected cross-sectional
D’AD
:   asymptotic test of equality
LoA
:   Bland-Altman limits of agreement
SEM
:   standard error of measurement" />
<meta name="DC.Contributor" content="C. Chien" />
<meta name="DC.Contributor" content="V. Juenger" />
<meta name="DC.Contributor" content="M. Scheel" />
<meta name="DC.Contributor" content="A.U. Brandt" />
<meta name="DC.Contributor" content="F. Paul" />
<meta name="article:published_time" content="2020-02-01" />
<meta name="article:section" content="Spine" />
<meta name="citation_title" content="Considerations for Mean Upper Cervical Cord Area Implementation in a Longitudinal MRI Setting: Methods, Interrater Reliability, and MRI Quality Control" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Spinal cord atrophy is commonly measured from cerebral MRIs, including the upper cervical cord. However, rescan intraparticipant measures have not been investigated in healthy cohorts. This study investigated technical and rescan variability in the mean upper cervical cord area calculated from T1-weighted cerebral MRIs.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;In this retrospective study, 8 healthy participants were scanned and rescanned with non-distortion- and distortion-corrected MPRAGE sequences (11–50 sessions in 6–8 months), and 50 participants were scanned once with distortion-corrected MPRAGE sequences in the Day2day daily variability study. From another real-world observational cohort, we collected non-distortion-corrected MPRAGE scans from 27 healthy participants (annually for 2–4 years) and cross-sectionally from 77 participants. Statistical analyses included coefficient of variation, smallest real difference, intraclass correlation coefficient, Bland-Altman limits of agreement, and paired &lt;i&gt;t&lt;/i&gt; tests.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Distortion- versus non-distortion-corrected MPRAGE-derived mean upper cervical cord areas were similar; however, a paired &lt;i&gt;t&lt;/i&gt; test showed incomparability (&lt;i&gt;t&lt;/i&gt; = 11.0, &lt;i&gt;P&lt;/i&gt; = &amp;lt;.001). Higher variability was found in the mean upper cervical cord areas calculated from an automatic segmentation method. Interrater analysis yielded incomparable measures in the same participant scans (&lt;i&gt;t&lt;/i&gt; = 4.5, &lt;i&gt;P = &amp;lt;.&lt;/i&gt;001). Non-distortion-corrected mean upper cervical cord area measures were shown to be robust in real-world data (&lt;i&gt;t&lt;/i&gt; = −1.04, &lt;i&gt;P&lt;/i&gt; = .31). The main sources of variability were found to be artifacts from movement, head/neck positioning, and/or metal implants.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Technical variability in cord measures decreased using non-distortion-corrected MRIs, a semiautomatic segmentation approach, and 1 rater. Rescan variability was within ±4.4% for group mean upper cervical cord area when MR imaging quality criteria were met.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2020/02/01" />
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<meta name="citation_issn" content="0195-6108" />
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<meta name="citation_author" content="C. Chien" />
<meta name="citation_author_institution" content="aFrom the Experimental and Clinical Research Center (C.C., V.J., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine &amp; Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany" />
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<meta name="citation_author_institution" content="bNeuroCure Clinical Research Center (C.C., V.J., M.S., A.U.B., F.P.)" />
<meta name="citation_author_institution" content="cDepartments of Neuroradiology (V.J., M.S.)" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-8098-178X" />
<meta name="citation_author" content="M. Scheel" />
<meta name="citation_author_institution" content="cDepartments of Neuroradiology (V.J., M.S.)" />
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<meta name="citation_author" content="A.U. Brandt" />
<meta name="citation_author_institution" content="aFrom the Experimental and Clinical Research Center (C.C., V.J., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine &amp; Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany" />
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<meta name="citation_author_institution" content="eDepartment of Neurology (A.U.B.), University of California, Irvine, Irvine, California." />
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<meta name="citation_author" content="F. Paul" />
<meta name="citation_author_institution" content="aFrom the Experimental and Clinical Research Center (C.C., V.J., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine &amp; Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany" />
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<meta name="citation_reference" content="citation_journal_title=Neurology;citation_author=F. Prados;citation_author=F. Barkhof;citation_title=Spinal cord atrophy rates: ready for prime time in multiple sclerosis clinical trials?;citation_volume=91;citation_year=2018;citation_pmid=29950433;citation_doi=10.1212/WNL.0000000000005873" />
<meta name="citation_reference" content="citation_journal_title=The journal of spinal cord medicine;citation_journal_abbrev=J Spinal Cord Med;citation_author=National Institute on Disability and Rehabilitation;citation_title=Neuroimaging in traumatic spinal cord injury: an evidence-based review for clinical practice and research.;citation_pages=205-214;citation_volume=30;citation_year=2007;citation_issue=3;citation_pmid=17684886;citation_doi=10.1080/10790268.2007.11753928" />
<meta name="citation_reference" content="citation_journal_title=Spinal Cord;citation_author=M. Seif;citation_author=CA. Wheeler-Kingshott;citation_author=J. Cohen-Adad;citation_title=Guidelines for the conduct of clinical trials in spinal cord injury: neuroimaging biomarkers;citation_pages=717-28;citation_volume=57;citation_year=2019;citation_pmid=31267015;citation_doi=10.1038/s41393-019-0309-x" />
<meta name="citation_reference" content="citation_journal_title=Neurosurg Focus;citation_author=A. Nouri;citation_author=AR. Martin;citation_author=D. Mikulis;citation_title=Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques;citation_pages=E5;citation_volume=40;citation_year=2016;citation_pmid=27246488;citation_doi=10.3171/2016.3.FOCUS1667" />
<meta name="citation_reference" content="citation_journal_title=J Neuroimaging;citation_author=C. Casserly;citation_author=EE. Seyman;citation_author=. Alcaide;citation_author=P. Leon;citation_title=Spinal cord atrophy in multiple sclerosis: a systematic review and meta-analysis;citation_pages=556-86;citation_volume=28;citation_year=2018;citation_pmid=30102003;citation_doi=10.1111/jon.12553" />
<meta name="citation_reference" content="citation_journal_title=Magn Reson Med;citation_author=North American Imaging in Multiple Sclerosis Cooperative (NAIMS);citation_title=Gradient nonlinearity effects on upper cervical spinal cord area measurement from 3D T1-weighted brain MRI acquisitions;citation_pages=1595-601;citation_volume=79;citation_year=2018;citation_pmid=28617996;citation_doi=10.1002/mrm.26776" />
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<meta name="citation_reference" content="citation_journal_abbrev=NeuroImage;citation_author=MA. Horsfield;citation_author=S. Sala;citation_author=M. Neema;citation_title=Rapid semi-automatic segmentation of the spinal cord from magnetic resonance images: application in multiple sclerosis.;citation_pages=446-455;citation_volume=50;citation_year=2010;citation_issue=2;citation_pmid=20060481;citation_doi=10.1016/j.neuroimage.2009.12.121" />
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<meta name="citation_reference" content="citation_journal_title=NeuroImage;citation_author=B. De Leener;citation_author=S. Kadoury;citation_author=J. Cohen-Adad;citation_title=Robust, accurate and fast automatic segmentation of the spinal cord;citation_pages=528-36;citation_volume=98;citation_year=2014;citation_pmid=24780696;citation_doi=10.1016/j.neuroimage.2014.04.051" />
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<meta name="citation_reference" content="citation_journal_title=Neuroimage Clin;citation_author=MC. Yiannakas;citation_author=AM. Mustafa;citation_author=B. De Leener;citation_title=Fully automated segmentation of the cervical cord from T1-weighted MRI using PropSeg: application to multiple sclerosis;citation_pages=71-77;citation_volume=10;citation_year=2016;citation_pmid=26793433;citation_doi=10.1016/j.nicl.2015.11.001" />
<meta name="citation_reference" content="citation_journal_title=Neuroimage;citation_author=C. Gros;citation_author=B. De Leener;citation_author=A. Badji;citation_title=Automatic segmentation of the spinal cord and intramedullary multiple sclerosis lesions with convolutional neural networks;citation_pages=901-15;citation_volume=184;citation_year=2019;citation_pmid=30300751;citation_doi=10.1016/j.neuroimage.2018.09.081" />
<meta name="citation_reference" content="citation_journal_title=AJNR Am J Neuroradiol;citation_author=Y. Liu;citation_author=C. Lukas;citation_author=MD. Steenwijk;citation_title=Multicenter validation of mean upper cervical cord area measurements from head 3D T1-weighted MR imaging in patients with multiple sclerosis;citation_volume=37;citation_year=2016;citation_pmid=26659338;citation_doi=10.3174/ajnr.A4635" />
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<meta name="citation_reference" content="citation_journal_title=Journal of spinal disorders &amp; techniques;citation_journal_abbrev=J Spinal Disord Tech;citation_author=M. Yanase;citation_author=Y. Matsuyama;citation_author=K. Hirose;citation_title=Measurement of the cervical spinal cord volume on MRI.;citation_pages=125-129;citation_volume=19;citation_year=2006;citation_issue=2;citation_pmid=16760787;citation_doi=10.1097/01.bsd.0000181294.67212.79" />
<meta name="citation_reference" content="citation_journal_title=Neuroimage;citation_author=A. Trefler;citation_author=N. Sadeghi;citation_author=AG. Thomas;citation_title=Impact of time-of-day on brain morphometric measures derived from T1-weighted magnetic resonance imaging;citation_pages=41-52;citation_volume=133;citation_year=2016;citation_pmid=26921714;citation_doi=10.1016/j.neuroimage.2016.02.034" />
<meta name="citation_reference" content="citation_journal_title=Spinal Cord;citation_author=C. Wang;citation_author=RC. Tam;citation_author=E. Mackie;citation_title=Dehydration affects spinal cord cross-sectional area measurement on MRI in healthy subjects;citation_pages=616-20;citation_volume=52;citation_year=2014;citation_pmid=24777158;citation_doi=10.1038/sc.2014.66" />
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<meta name="twitter:title" content="Considerations for Mean Upper Cervical Cord Area Implementation in a Longitudinal MRI Setting: Methods, Interrater Reliability, and MRI Quality Control" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Spinal cord atrophy is commonly measured from cerebral MRIs, including the upper cervical cord. However, rescan intraparticipant measures have not been investigated in healthy cohorts. This study investigated technical and rescan variability in the mean upper cervical cord area calculated from T1-weighted cerebral MRIs.

MATERIALS AND METHODS: In this retrospective study, 8 healthy participants were scanned and rescanned with non-distortion- and distortion-corrected MPRAGE sequences (11–50 sessions in 6–8 months), and 50 participants were scanned once with distortion-corrected MPRAGE sequences in the Day2day daily variability study. From another real-world observational cohort, we collected non-distortion-corrected MPRAGE scans from 27 healthy participants (annually for 2–4 years) and cross-sectionally from 77 participants. Statistical analyses included coefficient of variation, smallest real difference, intraclass correlation coefficient, Bland-Altman limits of agreement, and paired t tests.

RESULTS: Distortion- versus non-distortion-corrected MPRAGE-derived mean upper cervical cord areas were similar; however, a paired t test showed incomparability ( t = 11.0, P = &lt;.001). Higher variability was found in the mean upper cervical cord areas calculated from an automatic segmentation method. Interrater analysis yielded incomparable measures in the same participant scans ( t = 4.5, P = &lt;. 001). Non-distortion-corrected mean upper cervical cord area measures were shown to be robust in real-world data ( t = −1.04, P = .31). The main sources of variability were found to be artifacts from movement, head/neck positioning, and/or metal implants.

CONCLUSIONS: Technical variability in cord measures decreased using non-distortion-corrected MRIs, a semiautomatic segmentation approach, and 1 rater. Rescan variability was within ±4.4% for group mean upper cervical cord area when MR imaging quality criteria were met.

CoV
:   coefficient of variation
HP
:   healthy participants
ICC
:   intraclass correlation coefficient
MUCCA
:   mean upper cervical cord area
SC
:   spinal cord
SCT
:   Spinal Cord Toolbox
SRD
:   smallest real difference
UCC
:   upper cervical cord
DND
:   Day2day non-distortion corrected
DDC
:   Day2day distortion corrected cross-sectional
CNDC
:   clinical non-distortion corrected cross-sectional
D’AD
:   asymptotic test of equality
LoA
:   Bland-Altman limits of agreement
SEM
:   standard error of measurement" />
<meta name="og-title" property="og:title" content="Considerations for Mean Upper Cervical Cord Area Implementation in a Longitudinal MRI Setting: Methods, Interrater Reliability, and MRI Quality Control" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/41/2/343" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Spinal cord atrophy is commonly measured from cerebral MRIs, including the upper cervical cord. However, rescan intraparticipant measures have not been investigated in healthy cohorts. This study investigated technical and rescan variability in the mean upper cervical cord area calculated from T1-weighted cerebral MRIs.

MATERIALS AND METHODS: In this retrospective study, 8 healthy participants were scanned and rescanned with non-distortion- and distortion-corrected MPRAGE sequences (11–50 sessions in 6–8 months), and 50 participants were scanned once with distortion-corrected MPRAGE sequences in the Day2day daily variability study. From another real-world observational cohort, we collected non-distortion-corrected MPRAGE scans from 27 healthy participants (annually for 2–4 years) and cross-sectionally from 77 participants. Statistical analyses included coefficient of variation, smallest real difference, intraclass correlation coefficient, Bland-Altman limits of agreement, and paired t tests.

RESULTS: Distortion- versus non-distortion-corrected MPRAGE-derived mean upper cervical cord areas were similar; however, a paired t test showed incomparability ( t = 11.0, P = &lt;.001). Higher variability was found in the mean upper cervical cord areas calculated from an automatic segmentation method. Interrater analysis yielded incomparable measures in the same participant scans ( t = 4.5, P = &lt;. 001). Non-distortion-corrected mean upper cervical cord area measures were shown to be robust in real-world data ( t = −1.04, P = .31). The main sources of variability were found to be artifacts from movement, head/neck positioning, and/or metal implants.

CONCLUSIONS: Technical variability in cord measures decreased using non-distortion-corrected MRIs, a semiautomatic segmentation approach, and 1 rater. Rescan variability was within ±4.4% for group mean upper cervical cord area when MR imaging quality criteria were met.

CoV
:   coefficient of variation
HP
:   healthy participants
ICC
:   intraclass correlation coefficient
MUCCA
:   mean upper cervical cord area
SC
:   spinal cord
SCT
:   Spinal Cord Toolbox
SRD
:   smallest real difference
UCC
:   upper cervical cord
DND
:   Day2day non-distortion corrected
DDC
:   Day2day distortion corrected cross-sectional
CNDC
:   clinical non-distortion corrected cross-sectional
D’AD
:   asymptotic test of equality
LoA
:   Bland-Altman limits of agreement
SEM
:   standard error of measurement" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node73069--5" data-node-nid="73069" id="top-node-73069--6344687710" data-pisa="ajnr;41/2/343" data-pisa-master="ajnr;ajnr.A6394" data-apath="/ajnr/41/2/343.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <h1 class="highwire-cite-title" id="page-title">Considerations for Mean Upper Cervical Cord Area Implementation in a Longitudinal MRI Setting: Methods, Interrater Reliability, and MRI Quality Control</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">C. Chien</span>, <span class="highwire-citation-author" data-delta="1">V. Juenger</span>, <span class="highwire-citation-author" data-delta="2">M. Scheel</span>, <span class="highwire-citation-author" data-delta="3">A.U. Brandt</span> and <span class="highwire-citation-author" data-delta="4">F. Paul</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">February 2020,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">343-350; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6394 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-73069--6344687710" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">C. Chien </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Experimental and Clinical Research Center (C.C., V.J., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine & Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany</div><div class='author-affiliation'><span class='nlm-sup'>b</span>NeuroCure Clinical Research Center (C.C., V.J., M.S., A.U.B., F.P.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BChien%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chien%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BChien%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8280-9513" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Chien</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">V. Juenger </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Experimental and Clinical Research Center (C.C., V.J., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine & Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany</div><div class='author-affiliation'><span class='nlm-sup'>b</span>NeuroCure Clinical Research Center (C.C., V.J., M.S., A.U.B., F.P.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Neuroradiology (V.J., M.S.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=V.%2BJuenger%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Juenger%20V&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AV.%2BJuenger%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8098-178X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for V. Juenger</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">M. Scheel </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Neuroradiology (V.J., M.S.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BScheel%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Scheel%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BScheel%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3505-2914" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Scheel</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">A.U. Brandt </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Experimental and Clinical Research Center (C.C., V.J., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine & Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany</div><div class='author-affiliation'><span class='nlm-sup'>b</span>NeuroCure Clinical Research Center (C.C., V.J., M.S., A.U.B., F.P.)</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Neurology (A.U.B.), University of California, Irvine, Irvine, California.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.U.%2BBrandt%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Brandt%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.U.%2BBrandt%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9768-014X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.U. Brandt</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">F. Paul </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Experimental and Clinical Research Center (C.C., V.J., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine & Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany</div><div class='author-affiliation'><span class='nlm-sup'>b</span>NeuroCure Clinical Research Center (C.C., V.J., M.S., A.U.B., F.P.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Neurology (F.P.), Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BPaul%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Paul%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.%2BPaul%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6378-0070" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. Paul</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> Spinal cord atrophy is commonly measured from cerebral MRIs, including the upper cervical cord. However, rescan intraparticipant measures have not been investigated in healthy cohorts. This study investigated technical and rescan variability in the mean upper cervical cord area calculated from T1-weighted cerebral MRIs.</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>MATERIALS AND METHODS:</strong> In this retrospective study, 8 healthy participants were scanned and rescanned with non-distortion- and distortion-corrected MPRAGE sequences (11–50 sessions in 6–8 months), and 50 participants were scanned once with distortion-corrected MPRAGE sequences in the Day2day daily variability study. From another real-world observational cohort, we collected non-distortion-corrected MPRAGE scans from 27 healthy participants (annually for 2–4 years) and cross-sectionally from 77 participants. Statistical analyses included coefficient of variation, smallest real difference, intraclass correlation coefficient, Bland-Altman limits of agreement, and paired <em>t</em> tests.</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>RESULTS:</strong> Distortion- versus non-distortion-corrected MPRAGE-derived mean upper cervical cord areas were similar; however, a paired <em>t</em> test showed incomparability (<em>t</em> = 11.0, <em>P</em> = &lt;.001). Higher variability was found in the mean upper cervical cord areas calculated from an automatic segmentation method. Interrater analysis yielded incomparable measures in the same participant scans (<em>t</em> = 4.5, <em>P = &lt;.</em>001). Non-distortion-corrected mean upper cervical cord area measures were shown to be robust in real-world data (<em>t</em> = −1.04, <em>P</em> = .31). The main sources of variability were found to be artifacts from movement, head/neck positioning, and/or metal implants.</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>CONCLUSIONS:</strong> Technical variability in cord measures decreased using non-distortion-corrected MRIs, a semiautomatic segmentation approach, and 1 rater. Rescan variability was within ±4.4% for group mean upper cervical cord area when MR imaging quality criteria were met.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">CoV<span class="def-item-dt-sep"></span></dt><dd>coefficient of variation<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">HP<span class="def-item-dt-sep"></span></dt><dd>healthy participants<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">ICC<span class="def-item-dt-sep"></span></dt><dd>intraclass correlation coefficient<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">MUCCA<span class="def-item-dt-sep"></span></dt><dd>mean upper cervical cord area<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">SC<span class="def-item-dt-sep"></span></dt><dd>spinal cord<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">SCT<span class="def-item-dt-sep"></span></dt><dd>Spinal Cord Toolbox<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">SRD<span class="def-item-dt-sep"></span></dt><dd>smallest real difference<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">UCC<span class="def-item-dt-sep"></span></dt><dd>upper cervical cord<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">DND<span class="def-item-dt-sep"></span></dt><dd>Day2day non-distortion corrected<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">DDC<span class="def-item-dt-sep"></span></dt><dd>Day2day distortion corrected cross-sectional<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">CNDC<span class="def-item-dt-sep"></span></dt><dd>clinical non-distortion corrected cross-sectional<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">D’AD<span class="def-item-dt-sep"></span></dt><dd>asymptotic test of equality<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">LoA<span class="def-item-dt-sep"></span></dt><dd>Bland-Altman limits of agreement<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">SEM<span class="def-item-dt-sep"></span></dt><dd>standard error of measurement</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2020 by American Journal of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-1">Indicates open access to non-subscribers at <a href="http://www.ajnr.org" rel="license">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/41/2/343.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Chien</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Juenger</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Scheel</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.U.</span> <span class="nlm-surname">Brandt</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Paul</span></span></span></div>
  
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      <div class="highwire-cite-title">Considerations for Mean Upper Cervical Cord Area Implementation in a Longitudinal MRI Setting: Methods, Interrater Reliability, and MRI Quality Control</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Chien</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Juenger</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Scheel</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.U.</span> <span class="nlm-surname">Brandt</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Paul</span></span></span></div>
  
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