Viola Biberacher1, Christine C Boucard2, Paul Schmidt3, Christina Engl2, Dorothea Buck4, Achim Berthele4, Muna-Miriam Hoshi4, Claus Zimmer5, Bernhard Hemmer6, Mark Mühlau7. 1. Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany biberacher@lrz.tum.de. 2. Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany. 3. Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany/Ludwig-Maximilians-University München, Germany. 4. Department of Neurology, Technische Universität München, Germany. 5. Technische Universität München, Germany. 6. Technische Universität München, Germany/Munich Cluster for Systems Neurology (SyNergy), Germany. 7. Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany/Munich Cluster for Systems Neurology (SyNergy), Germany.
Abstract
BACKGROUND: Despite agreement about spinal cord atrophy in progressive forms of multiple sclerosis (MS), data on clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS) are conflicting. OBJECTIVE: To determine the onset of spinal cord atrophy in the disease course of MS. METHODS: Structural brain magnetic resonance imaging (MRI) was acquired from 267 patients with CIS (85) or RRMS (182) and 64 healthy controls (HCs). The upper cervical cord cross-sectional area (UCCA) was determined at the level of C2/C3 by a segmentation tool and adjusted for focal MS lesions. The coefficient of variation (CV) was calculated from all measurements between C2/C3 and 13 mm above as a measure of structural variability. RESULTS: Compared to HCs (76.1±6.9 mm(2)), UCCA was significantly reduced in CIS patients (73.5±5.8 mm(2), p=0.018) and RRMS patients (72.4±7.0 mm(2), p<0.001). Structural variability was higher in patients than in HCs, particularly but not exclusively in case of focal lesions (mean CV HCs/patients without/with lesions: 2.13%/2.55%/3.32%, all p-values<0.007). UCCA and CV correlated with Expanded Disability Status Scale (EDSS) scores (r =-0.131/0.192, p=0.044/<0.001) and disease duration (r=-0.134/0.300, p=0.039/< 0.001). CV additionally correlated with hand and arm function (r=0.180, p=0.014). CONCLUSION: In MS, cervical cord atrophy already occurs in CIS. In early stages, structural variability may be a more meaningful marker of spinal cord pathology than atrophy.
BACKGROUND: Despite agreement about spinal cord atrophy in progressive forms of multiple sclerosis (MS), data on clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS) are conflicting. OBJECTIVE: To determine the onset of spinal cord atrophy in the disease course of MS. METHODS: Structural brain magnetic resonance imaging (MRI) was acquired from 267 patients with CIS (85) or RRMS (182) and 64 healthy controls (HCs). The upper cervical cord cross-sectional area (UCCA) was determined at the level of C2/C3 by a segmentation tool and adjusted for focal MS lesions. The coefficient of variation (CV) was calculated from all measurements between C2/C3 and 13 mm above as a measure of structural variability. RESULTS: Compared to HCs (76.1±6.9 mm(2)), UCCA was significantly reduced in CIS patients (73.5±5.8 mm(2), p=0.018) and RRMS patients (72.4±7.0 mm(2), p<0.001). Structural variability was higher in patients than in HCs, particularly but not exclusively in case of focal lesions (mean CV HCs/patients without/with lesions: 2.13%/2.55%/3.32%, all p-values<0.007). UCCA and CV correlated with Expanded Disability Status Scale (EDSS) scores (r =-0.131/0.192, p=0.044/<0.001) and disease duration (r=-0.134/0.300, p=0.039/< 0.001). CV additionally correlated with hand and arm function (r=0.180, p=0.014). CONCLUSION: In MS, cervical cord atrophy already occurs in CIS. In early stages, structural variability may be a more meaningful marker of spinal cord pathology than atrophy.
Authors: Hanna G Zimmermann; Benjamin Knier; Timm Oberwahrenbrock; Janina Behrens; Catherina Pfuhl; Lilian Aly; Miriam Kaminski; Muna-Miriam Hoshi; Svenja Specovius; René M Giess; Michael Scheel; Mark Mühlau; Judith Bellmann-Strobl; Klemens Ruprecht; Bernhard Hemmer; Thomas Korn; Friedemann Paul; Alexander U Brandt Journal: JAMA Neurol Date: 2018-09-01 Impact factor: 18.302
Authors: Burcu Zeydan; Xinyi Gu; Elizabeth J Atkinson; B Mark Keegan; Brian G Weinshenker; Jan-Mendelt Tillema; Daniel Pelletier; Christina J Azevedo; Christine Lebrun-Frenay; Aksel Siva; Darin T Okuda; Kejal Kantarci; Orhun H Kantarci Journal: Neurol Neuroimmunol Neuroinflamm Date: 2018-01-22