European Radiology

, Volume 28, Issue 11, pp 4488–4495 | Cite as

Reliable and fast volumetry of the lumbar spinal cord using cord image analyser (Cordial)

  • Charidimos Tsagkas
  • Anna Altermatt
  • Ulrike Bonati
  • Simon Pezold
  • Julia Reinhard
  • Michael Amann
  • Philippe Cattin
  • Jens Wuerfel
  • Dirk Fischer
  • Katrin ParmarEmail author
  • Arne Fischmann
Magnetic Resonance



To validate the precision and accuracy of the semi-automated cord image analyser (Cordial) for lumbar spinal cord (SC) volumetry in 3D T1w MRI data of healthy controls (HC).

Materials and methods

40 3D T1w images of 10 HC (w/m: 6/4; age range: 18–41 years) were acquired at one 3T-scanner in two MRI sessions (time interval 14.9±6.1 days). Each subject was scanned twice per session, allowing determination of test-retest reliability both in back-to-back (intra-session) and scan-rescan images (inter-session). Cordial was applied for lumbar cord segmentation twice per image by two raters, allowing for assessment of intra- and inter-rater reliability, and compared to a manual gold standard.


While manually segmented volumes were larger (mean: 2028±245 mm3 vs. Cordial: 1636±300 mm3, p<0.001), accuracy assessments between manually and semi-automatically segmented images showed a mean Dice-coefficient of 0.88±0.05. Calculation of within-subject coefficients of variation (COV) demonstrated high intra-session (1.22–1.86%), inter-session (1.26–1.84%), as well as intra-rater (1.73–1.83%) reproducibility. No significant difference was shown between intra- and inter-session reproducibility or between intra-rater reliabilities. Although inter-rater reproducibility (COV: 2.87%) was slightly lower compared to all other reproducibility measures, between rater consistency was very strong (intraclass correlation coefficient: 0.974).


While under-estimating the lumbar SCV, Cordial still provides excellent inter- and intra-session reproducibility showing high potential for application in longitudinal trials.

Key Points

Lumbar spinal cord segmentation using the semi-automated cord image analyser (Cordial) is feasible.

Lumbar spinal cord is 40-mm cord segment 60 mm above conus medullaris.

Cordial provides excellent inter- and intra-session reproducibility in lumbar spinal cord region.

Cordial shows high potential for application in longitudinal trials.


Spinal cord Volumetry Semi-automated segmentation Magnetic resonance imaging Imaging biomarker 



Central nervous system


Coefficient of variation


Cerebrospinal fluid




Healthy controls


Intra-class correlation coefficient


Magnetisation-prepared rapid gradient-echo


Spinal cord


Spinal cord volume


Standard deviation


Echo time


Repetition time


Volumetric interpolated breath-hold examination



We would like to thank Tanja Haas and Pascal Kuster for MRI data acquisition and data management. Most of all, we are grateful to the healthy controls for participating in the study. Data acquisition was funded by F. Hoffman La Roche. F. Hoffman La Roche did not have any additional role in the study design, data collection, analysis, interpretation of data, writing of the report and decision to submit the paper for publication.


Data acquisition was funded by F. Hoffman La Roche. F. Hoffman La Roche did not have any additional role in the study design, data collection, analysis, interpretation of data, writing of the report and decision to submit the paper for publication.

KP holds a personal grant of the Baasch Medicus Foundation Switzerland.

Compliance with ethical standards


The scientific guarantor of this publication is PD Dr. Katrin Parmar.

Conflict of interest

C.T., A.A., U.B., S.P., J.R., M.A., P.C. and D.F. declare no relationships with any companies whose products or services may be related to the subject matter of the article.

J.W. is CEO of MIAC AG Basel. Unrelated to this work he received grants from the German Ministry of Science (BMBF), the German Ministery of Economy (BMWI), the EU (Horizon2020) and compensation for talks and advisory boards from Actelion, Bayer, Biogen, Genzyme, Novartis, Roche.

K.P. received travel support from Novartis Switzerland unrelated to this work.

A.F. reports travel support from Bracco Switzerland unrelated to this work.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• method validation

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Charidimos Tsagkas
    • 1
    • 2
  • Anna Altermatt
    • 2
    • 3
  • Ulrike Bonati
    • 4
  • Simon Pezold
    • 3
  • Julia Reinhard
    • 5
  • Michael Amann
    • 1
    • 2
    • 5
  • Philippe Cattin
    • 3
  • Jens Wuerfel
    • 2
    • 3
  • Dirk Fischer
    • 4
  • Katrin Parmar
    • 1
    Email author
  • Arne Fischmann
    • 5
    • 6
  1. 1.Department of NeurologyUniversity Hospital BaselBaselSwitzerland
  2. 2.Medical Image Analysis Center (MIAC AG), BaselBaselSwitzerland
  3. 3.Center for medical Image Analysis & Navigation (CIAN), Department of BioengineeringUniversity BaselAllschwilSwitzerland
  4. 4.Division of NeuropediatricsUniversity of Basel Children’s HospitalBaselSwitzerland
  5. 5.Division of Diagnostic and Interventional Neuroradiology, Department of RadiologyUniversity Hospital BaselBaselSwitzerland
  6. 6.Division of NeuroradiologyHirslanden Klinik St. AnnaLuzernSwitzerland

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