Charting Cervical Spinal Cord Morphometry Across the Lifespan
Kurt G. Schilling, Michael E. Kim, Matthew Amandola, Chenyu Gao, Karthik Ramadass, Praitayini Kanakaraj, Sam Bogdanov, Gaurav Rudravaram, Nancy R. Newlin, Derek Archer, Timothy J. Hohman, Angela L. Jefferson, Victoria L. Morgan, Alexandra Roche, Dario J. Englot, Murat Bilgel, Lori L. Beason Held, Luigi Ferrucci, Laurie E. Cutting, Laura A. Barquero, Micah A. D'archangel, Tin Q. Nguyen, Kathryn L. Humphreys, Yanbin Niu, Sophia Vinci‐Booher, Carissa J. Cascio, , , , Zhiyuan Li, Daniel Moyer, Simon N. Vandekar, Panpan Zhang, Samuelle St‐Onge, Sandrine Bédard, Jan Valošek, Benjamin De Leener, Julien Cohen‐Adad, John C. Gore, Seth Smith, Bennett A. LandmanABSTRACT
Spinal cord morphometry provides essential biomarkers of neurological health, but clinical interpretations are confounded by inter‐subject variability and a lack of normative references across the full human lifespan. We address this gap by generating the first comprehensive lifespan charts for cervical spinal cord morphometry. From 78,269 T1‐weighted brain MRI sessions, we identified a final cross‐sectional cohort of 24,251 healthy or cognitively normal controls from 33 datasets (ages 0–100 years) with cervical cord coverage. To overcome contrast variability, we employed a state‐of‐the‐art contrast‐agnostic deep learning segmentation method, extracting cross‐sectional area (CSA), anteroposterior (AP) and right–left (RL/transverse), and shape indices (AP/RL ratio, eccentricity, and solidity) from C1 to C7. Normative trajectories were modeled using Generalized Additive Models for Location, Scale, and Shape (GAMLSS). The resulting charts reveal distinct non‐linear lifespan changes: rapid growth through childhood and adolescence, peak maturation occurring in early‐to‐mid adulthood (e.g., mid‐30s for CSA), followed by gradual decreases. Significant regional variations along the cervical cord and consistent sex differences (males > females for size metrics) were quantified. Spinal cord trajectories showed strong temporal coupling with brain white matter and brainstem volumes, suggesting integrated CNS development and aging. These lifespan charts provide a robust normative framework, enabling age‐ and sex‐specific centile scoring of individual spinal cord morphometry. This resource offers a critical tool for differentiating typical variation from pathological changes, enhancing the clinical utility of spinal cord MRI in studies of development and neurodegeneration.