The Relationships among MRI-Defined Spinal Cord Involvement, Brain Involvement, and Disability in Multiple Sclerosis

Departments of Neurology and Radiology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA.
Journal of neuroimaging: official journal of the American Society of Neuroimaging (Impact Factor: 1.82). 03/2011; 22(2):122-8. DOI: 10.1111/j.1552-6569.2011.00589.x
Source: PubMed

ABSTRACT To determine the interrelationships between MRI-defined lesion and atrophy measures of spinal cord involvement and brain involvement and their relationships to disability in a small cohort of patients with multiple sclerosis (MS).
Although it is known that cervical spinal cord atrophy correlates with disability in MS, it is unknown whether it is the most important determinant when compared to other regions of the central nervous system (CNS). Furthermore, it is not clear to what extent brain and cord lesions and atrophy are related.
3T MRI of the whole brain and whole spinal cord was obtained in 21 patients with MS, including 18 with relapsing-remitting, one with secondary progressive, one with primary progressive, and one with a clinically isolated syndrome. Brain global gray and white matter volumes were segmented with Statistical Parametric Mapping 8. Spinal cord contour volume was segmented in whole by a semi-automated method with bins assigned to either the cervical or thoracic regions. All CNS volumes were normalized by the intracranial volume. Brain and cord T2 hyperintense lesions were segmented using a semi-automated edge finding tool.
Among all MRI measures, only upper cervical spinal cord volume significantly correlated with Expanded Disability Status Scale score (r =-.515, P = .020). The brain cord relationships between whole or regional spinal cord volume or lesions and gray matter, white matter, or whole brain volume or whole brain lesions were generally weak and all nonsignificant.
In this preliminary study of mildly disabled, treated MS patients, cervical spinal cord atrophy most strongly correlates with physical disability in MS when accounting for a wide range of other CNS measures of lesions and atrophy, including thoracic or whole spinal cord volume, and cerebral gray, white or whole brain volume. The weak relationship between spinal cord and brain lesions and atrophy may suggest that they progress rather independently in patients with MS.

Download full-text


Available from: Guy J Buckle, Jun 30, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: In multiple sclerosis (MS), recent work suggests that cervical cord atrophy is more consistently correlated with physical disability than brain white matter lesion load and atrophy. Although spinal cord imaging has not been routinely obtained in many clinical trial and research studies, brain volumetric imaging usually has and includes the upper cervical cord. Objectives: Using volumetric T1-weighted brain images, we investigated cross-sectional area measures in the uppermost cervical cord and compared them with areas at the standard C2/3 level. Methods: Using T1-weighted brain scans from 13 controls and 37 people with MS, and an active surface technique, cross-sectional area was measured over 5 mm and 1 mm cord segments at C2/3, below the level of odontoid peg, and 2 cm and 2.5 cm below the pons. Brain volume was also measured. Results: Cord area measurements were most reliable in a 5 mm segment 2.5 cm below the pons (inter-rater coefficient of variation 1.5%, intraclass correlation coefficient 0.99). Cord area at this level correlated more with that at C2/3 area than with brain volume (r=0.811 with C2/3, r=0.502 with brain volume). Conclusion: Whereas the standard C2/3 level is often not within the field of view on brain images, the level 2.5 cm below the pons usually is, and measurement at this level may be a good way to investigate upper cervical cord atrophy when only brain images are available.
    01/2015; 4(1-1):52-57. DOI:10.1016/j.msard.2014.11.004
  • [Show abstract] [Hide abstract]
    ABSTRACT: This review summarizes the recent data pertaining to the use of magnetic resonance imaging (MRI) in assessing brain and spinal cord involvement in multiple sclerosis (MS). Using MRI as a tool, investigators have made progress recently in understanding the substrate and mechanisms underlying the development and evolution of focal lesions and diffuse damage in MS. The application of refined MRI sequences has markedly improved the characterization of focal lesions, in particular cortical lesions. Promising improvements have been made to clarify the pathological specificity and sensitivity of MRI techniques by performing combined histopathologic-MRI correlation studies. The use of high-field (3 T) and ultra-high-field (UHF; >3 T) MRI has further facilitated the detection of both gray matter and white matter microstructural damage, and elucidated the topographic relationship of overt damage to venous blood vessels. The development of advanced MRI postprocessing tools has led to additional progress in detecting clinically relevant regional gray matter and white matter damage. MRI continues to play a pivotal role in the investigation of MS. Ongoing advances in MRI technology should further expand the current understanding of pathologic disease mechanisms and improve diagnostic, prognostic, and monitoring ability in patients with MS.
    Current opinion in neurology 06/2012; 25(4):402-9. DOI:10.1097/WCO.0b013e328354f63f · 5.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To (a) apply an active surface method to map the regional distribution of cord atrophy across levels and sectors in a relatively large group of patients with multiple sclerosis (MS), (b) compare the anatomic location of cord atrophy between patients with relapsing-remitting (RR) MS and those with secondary progressive (SP) MS, and (c) assess correlations between atrophy and disability. Materials and Methods: This study was approved by the local ethical committee, and written informed consent was obtained from each participant. High-spatial-resolution magnetic resonance (MR) images of the cervical cord were acquired from 45 patients with RR MS, 26 patients with SP MS, and 67 age-matched healthy control subjects. The active surface method segmented the cord surface from C1 to C7 and created output images reformatted in planes perpendicular to the estimated cord center line. These unfolded cervical cord images were coregistered into a common standard space, and smoothed cord binary masks were used as input images for spatial statistics. Voxel-wise between-group comparisons and the correlation between regional cord atrophy versus clinical and conventional MR imaging variables were assessed with software. Results: Compared with control subjects, patients with RR MS showed localized clusters of atrophy in the posterior cord. Conversely, patients with SP MS showed a widespread pattern of cord atrophy, predominantly in the posterior and lateral cord columns. In patients with MS, cervical cord atrophy was correlated with clinical disability, disease duration, and, to a lesser extent, conventional MR imaging measures of brain injury. No correlation was found between cord atrophy and the presence of focal cord lesions. Conclusion: Voxel-wise assessment of the regional distribution of damage in the cervical cord is feasible and might improve our understanding of the mechanisms related to the development of irreversible clinical disability in MS. (C) RSNA, 2012
    Radiology 11/2012; 266(3). DOI:10.1148/radiol.12120813 · 6.21 Impact Factor