Multicenter Validation of Mean Upper Cervical Cord Area Measurements from Head 3D T1-Weighted MR Imaging in Patients with Multiple Sclerosis

Lukas, Carsten; Steenwijk, Martijn D.; Daams, Marita; Versteeg, Adriaan; Li, K.; Weiler, Florian; Hahn, Horst K.; Wattjes, Mike P.; Barkhof, Frederik; Vrenken, Hugo

doi:10.3174/ajnr.a4635

Cited by 33 publications

(37 citation statements)

References 23 publications

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“…39 However, we have a priori set our study duration at 1 year to obtain estimates for clinical trials and short-term observational studies; of note, we obtained annualized atrophy rates in line with pooled estimates from 94 studies (1.78%/year), 13 and the number of participants per arm was consistent with that obtained by other similar studies. 7,19,25,42 A possible caveat of our study is that good quality images (eg, dedicated spinal cord 3DT1 images with 1mm isotropic voxel) are needed for spinal cord atrophy measurements. The PropSeg tool has already been demonstrated as a robust, accurate, and fast segmentation method of the spinal cord in both MS patients and controls, compared with other segmentation methods (eg, semimanual active surface method using JIM).…”

Section: Discussionmentioning

confidence: 99%

“…31,40,41 Also, the possibility of deriving spinal cord GBSI measurements from brain scans needs to be explored. 7,19,25,42 A possible caveat of our study is that good quality images (eg, dedicated spinal cord 3DT1 images with 1mm isotropic voxel) are needed for spinal cord atrophy measurements. We were only able to use 86% of the patients whose scans were originally collected at 8 experienced imaging centers, using slight variations in MRI protocols and field strength.…”

Section: Discussionmentioning

confidence: 99%

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Longitudinal spinal cord atrophy in multiple sclerosis using the generalized boundary shift integral

Moccia

Prados

Filippi

et al. 2019

Annals of Neurology

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Objective: Spinal cord atrophy is a clinically relevant feature of multiple sclerosis (MS), but longitudinal assessments on magnetic resonance imaging using segmentation-based methods suffer from measurement variability, especially in multicenter studies. We compared the generalized boundary shift integral (GBSI), a registration-based method, with a standard segmentation-based method. Methods: Baseline and 1-year spinal cord 3-dimensional T1-weighted images (1mm isotropic) were obtained from 282 patients (52 clinically isolated syndrome [CIS], 196 relapsing-remitting MS [RRMS], 34 progressive MS [PMS]), and 82 controls from 8 MAGNIMS (Magnetic Resonance Imaging in Multiple Sclerosis) sites on multimanufacturer and multi-field-strength scans. Spinal Cord Toolbox was used for C2-5 segmentation and cross-sectional area (CSA) calculation. After cord straightening and registration, GBSI measured atrophy based on the probabilistic boundary-shift region of interest. CSA and GBSI percentage annual volume change was calculated. Results: GBSI provided similar rates of atrophy, but reduced measurement variability compared to CSA in all MS subtypes (CIS: −0.95 AE 2.11% vs −1.19 AE 3.67%; RRMS: −1.74 AE 2.57% vs −1.74 AE 4.02%; PMS: −2.29 AE 2.40% vs −1.29 AE 3.20%) and healthy controls (0.02 AE 2.39% vs −0.56 AE 3.77%). GBSI performed better than CSA in differentiating healthy controls from CIS (area under the curve [AUC] = 0.66 vs 0.53; p = 0.03), RRMS (AUC = 0.73 vs 0.59; p < 0.001), PMS (AUC = 0.77 vs 0.53; p < 0.001), and patients with disability progression from patients without View this article online at wileyonlinelibrary.com.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Longitudinal spinal cord atrophy in multiple sclerosis using the generalized boundary shift integral

Moccia

Prados

Filippi

et al. 2019

Annals of Neurology

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“…Semiautomated and automated methods for quantifying cervical spinal cord atrophy in MS have previously been described for analysis of head MRI (only upper cervical cord) or dedicated cervical spinal cord MRI. 1 – 22 Cervical spinal cord atrophy occurs early in MS and even in those with clinically isolated syndrome (CIS), 4 , 15 , 23 but is most prominent in established progressive MS. 1 – 3 , 5 , 6 , 8 , 9 , 11 – 14 , 17 The cervical spinal cord area correlates inversely with disability in MS. 1 – 13 , 20 …”

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confidence: 99%

Cervical spinal cord atrophy

Zeydan

Atkinson

et al. 2018

Neurol Neuroimmunol Neuroinflamm

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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.

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“…Many studies have used Jim for MUCCA segmentation, but they had either 1 experienced rater for multiple centers 30 or no raters were mentioned. 31 We found only a moderate intraclass correlation between MUCCAs segmented by 2 raters.…”

Section: Discussionmentioning

confidence: 99%

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

Chien

Juenger

Scheel³

et al. 2020

AJNR Am J Neuroradiol

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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-distortionand 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.

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Multicenter Validation of Mean Upper Cervical Cord Area Measurements from Head 3D T1-Weighted MR Imaging in Patients with Multiple Sclerosis

Cited by 33 publications

References 23 publications

Longitudinal spinal cord atrophy in multiple sclerosis using the generalized boundary shift integral

Longitudinal spinal cord atrophy in multiple sclerosis using the generalized boundary shift integral

Cervical spinal cord atrophy

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

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