Cervical spinal cord atrophy

Abstract

ObjectiveTo assess whether cervical spinal cord atrophy heralds the onset of progressive MS.MethodsWe studied 34 individuals with radiologically isolated syndrome (RIS) and 31 patients with relapsing-remitting MS (RRMS) age matched to 25 patients within a year of onset of secondary progressive MS (SPMS). Two raters independently measured (twice per rater) the cervical spinal cord average segmental area (CASA) (mm2) of axial T2-weighted images between C2 and C7 landmarks. The midsagittal T2-weighted image from the end of C2 to the end of C7 vertebra was used to measure the cervical spine (c-spine) length (mm). Sex, age at cervical MRI, number and location of cervical spinal cord lesions, c-spine length, and diagnoses were analyzed against the outcome measures of CASA and C2 and C7 slice segmental areas.ResultsIntrarater and interrater agreement was excellent (intraclass correlation coefficient >0.97). The CASA area (p = 0.03) and C7 area (p = 0.002) were smaller in SPMS compared with RRMS. The C2 area (p = 0.027), CASA (p = 0.004), and C7 area (p = 0.003) were smaller in SPMS compared with RIS. The C2 area did not differ between SPMS and RRMS (p = 0.09). The C2 area (p = 0.349), CASA (p = 0.136), and C7 area (p = 0.228) did not differ between RIS and MS (SPMS and RRMS combined). In the multivariable model, ≥2 cervical spinal cord lesions were associated with the C2 area (p = 0.008), CASA (p = 0.009), and C7 area independent of disease course (p = 0.017). Progressive disease course was associated with the C7 area independent of the cervical spinal cord lesion number (p = 0.004).ConclusionCervical spinal cord atrophy is evident at the onset of progressive MS and seems partially independent of the number of cervical spinal cord lesions.Classification of evidenceThis study provides Class III evidence that MRI cervical spinal cord atrophy distinguishes patients at the onset of progressive MS from those with RIS and RRMS.

Sensitivity of the Inhomogeneous Magnetization Transfer Imaging Technique to Spinal Cord Damage in Multiple Sclerosis

“…MS-related morphologic changes have been largely reported with evidence of cervical SC and GM atrophy in patients with MS relative to HC, with a strong correlation with clinical disability. [37][38][39] In our study, SC, WM, and GM semiautomated measurements of CSA were performed along the cervical cord from C1 to C6 and results suggested atrophy of both SC GM and WM in patients with MS (5%/14% decrease on average, respectively), consistent with the literature, with more important and more significant atrophy in WM.…”

Monitoring Progressive Multiple Sclerosis with Novel Imaging Techniques

“…In two studies, patients with PMS presented a higher lesion load and atrophy at both the cervical and thoracic levels than did patients with RR-MS [ 100 , 111 ]; additionally, the spinal cord area at both levels, in particular that of the GM, was found to correlate with clinical disability [ 111 ]. Although the area of the upper cervical segments is the preferred area of study, Zeydan and colleagues observed that the C7 area presented the greatest difference between patients with RR-MS and those with SP-MS at the early disease stages [ 112 ]. In their study involving 26 PP-MS patients, Ruggieri et al found a smaller cervical spinal cord volume (at both the C2–C3 and C2–C5 levels) in their patients compared to the healthy controls, but spinal cord atrophy did not correlate with brain lesion load or volume [ 16 ].…”

“… Not a good correlation between lesion aspects and pathological findings Present Spinal cord: PMS : cervical spinal cord lesion load was higher compared to RR-MS, and related to clinical disability [ 100 ] PP-MS : the presence of spinal cord lesions predicted conversion from RIS to PP-MS [ 102 ] Post-contrast FLAIR Cortex: SP-MS : leptomengingeal infiltrates were more frequent compared to RR-MS and tended to remain stable over time [ 58 – 60 ] Absent T1W sequences Cortex: PMS : global cortical atrophy was more prominent compared to other ClPh and was related to motor and cognitive impairment [ 20 , 57 , 84 ] SP-MS : temporal cortical atrophy was accelerated [ 85 ] Need of standardized protocols including high resolution images. The need of a reproducible and reliable method to quantify atrophy Present Whole brain, GM and spinal cord atrophy have been used in clinical trials [ 30 , 87 – 89 , 116 , 117 ] Spinal cord: PMS : higher cervical and thoracic spinal cord atrophy compared to RR-MS and it correlated to clinical disability [ 100 , 111 ] PP-MS : cervical spinal cord atrophy did not correlate with brain lesion or volume [ 16 ] SP-MS : cross-sectional area at the level of C7 presented the greatest difference compared to RR-MS [ 112 ] Results of longitudinal studies were discordant (see text) Cerebellum: PP-MS : higher rate of atrophy compared to HC over 5 years, with greater volume loss in patients with disease progression [ 125 , 126 ] SP-MS: GM volume was reduced compared to HC and atrophy of specific lobules correlate with clinical disability [ 123 , 124 ] DGM: PP-MS : atrophy of the thalami was detected since the early years and ...…”

Considerations for Mean Upper Cervical Cord Area Implementation in a Longitudinal MRI Setting: Methods, Interrater Reliability, and MRI Quality Control

“…[1][2][3] Several studies have identified cervical SC atrophy as predictive of disease progression and/or disability in patients with multiple sclerosis and related diseases; thus, it is of great interest to measure SC atrophy longitudinally. 1,4,5 One of the most common SC atrophy measurement methods is the mean upper cervical cord area (MUCCA). [6][7][8] MUCCA has been found to be robust at the C1-C2 and C2-C3 intervertebral levels.…”