Spinal cord gray matter atrophy correlates with multiple sclerosis disability

Abstract

Objective In multiple sclerosis (MS) cerebral gray matter (GM) atrophy correlates more strongly than white matter (WM) atrophy with disability. The corresponding relationships in the spinal cord (SC) are unknown due to technical limitations in assessing SCGM atrophy. Using phase sensitive inversion recovery (PSIR) MRI, we determined the association of the SCGM and SCWM areas with MS disability and disease type. Methods 113 MS patients and 20 healthy controls were examined at 3T with a PSIR sequence acquired at the C2/C3 disc level. Two independent, clinically-masked readers measured the cord WM and GM areas. Correlations between cord areas and Expanded Disability Status Score (EDSS) were determined. Differences in areas between groups were assessed with age and sex as covariates. Results Relapsing (R) MS patients showed smaller SCGM areas than age and sex matched controls (p=0.008) without significant differences in SCWM areas. Progressive MS patients showed smaller SCGM and SCWM areas compared to RMS patients (all p≤0.004). SCGM, SCWM, and whole cord areas inversely correlated with EDSS (rho: −0.60, −0.32, −0.42, respectively; all p≤0.001). SCGM area was the strongest correlate of disability in multivariate models including brain GM and WM volumes, FLAIR lesion load, T1-lesion load, SCWM area, number of spinal cord T2 lesions, age, sex, disease duration. Brain and spinal GM independently contributed to EDSS. Interpretation SCGM atrophy is detectable in-vivo in absence of WM atrophy in RMS. It is more pronounced in progressive than RMS and contributes more to patient disability than spinal cord WM or brain GM atrophy.

Long‐term evolution of multiple sclerosis disability in the treatment era

“…For example, cross-sectional data demonstrated that EDSS is highly correlated with grey matter volume in the cervical and thoracic cord, independent of brain volume. 53,54 …”

A reliable spatially normalized template of the human spinal cord — Applications to automated white matter/gray matter segmentation and tensor-based morphometry (TBM) mapping of gray matter alterations occurring with age

“…GM atrophy linked to multiple sclerosis (MS), as demonstrated recently based on volumetric measurements (Kearney et al, 2014;Schlaeger et al, 2014), to ALS (Cohen-Adad et al, 2013), or aging as recently studied in vivo through relative and absolute gray matter area and measurements (Fradet et al, 2014).…”

Cervical cord area is associated with infratentorial grey and white matter volume predominantly in relapsing–remitting multiple sclerosis: A study using semi-automated cord volumetry and voxel-based morphometry

“…Atrophy of the cerebellum on the other hand, driven by volume loss of the cerebellar cortex, has been shown to be a landmark for conversion to the secondary progressive disease state (Calabrese et al, 2013). The clinical relevance of cervical cord atrophy is related to its high anatomicalfunctional vulnerability, which has been emphasized in several recent studies (Bonati et al, 2011;Kearney et al, 2014;Lukas et al, 2015;Oh et al, 2013;Schlaeger et al, 2014;Valsasina et al, 2013).…”