A multicenter assessment of cervical cord atrophy among MS clinical phenotypes

Rocca, Maria A.; Horsfield, Mark A.; Sala, Stefania; Copetti, Massimiliano; Valsasina, Paola; Mesaroš, Šarlota; Martinelli, Vittorio; Caputo, Domenico; Stošić-Opinćal, Tatjana; Drulović, Jelena; Comı, Gıancarlo; Filippi, Massimo

doi:10.1212/wnl.0b013e31821f46b8

Cited by 126 publications

(157 citation statements)

References 33 publications

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“…We compute the volume of the segmented cord (vol) and use leave-out-one cross-validation to train our model and test on the omitted volume. As expected from the existing literature [1,7,8,12,16], we detect a moderate yet statistically significant correlation between volume and clinical score (vol: r=0.473, p=0.00824). The predictive ability for a linear regression model using volume as the explanatory variable is reported in Table 1 (row 1) and shown in Fig.…”

Section: Simple Linear Regression With Spinal Cord Volumesupporting

confidence: 87%

“…Multiple sclerosis (MS) studies have found that a patient's physical disability correlates with spinal cord atrophy [1,7,8,12,16]. Measuring spinal cord atrophy is potentially useful for monitoring the progression of diseases or the effectiveness of therapies [12].…”

Section: Introductionmentioning

confidence: 99%

“…Measuring spinal cord atrophy is potentially useful for monitoring the progression of diseases or the effectiveness of therapies [12]. Spinal cord atrophy is defined as a loss of tissue and commonly measured by cross-sectional area (CSA) or spinal cord volume [7,8,12].…”

Section: Introductionmentioning

confidence: 99%

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Novel Morphological and Appearance Features for Predicting Physical Disability from MR Images in Multiple Sclerosis Patients

Kawahara

McIntosh

Tam

et al. 2014

Lecture Notes in Computational Vision and Biomechanics

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Physical disability in patients with multiple sclerosis is determined by functional ability and quantified with numerical scores. In vivo studies using magnetic resonance imaging (MRI) have found that these scores correlate with spinal cord atrophy (loss of tissue), where atrophy is commonly measured by spinal cord volume or cross-sectional area. However, this correlation is generally weak to moderate, and improved measures would strengthen the utility of imaging biomarkers. We propose novel spinal cord morphological and MRI-based appearance features. Select features are used to train regression models to predict patients' physical disability scores. We validate our models using 30 MRI scans of different patients with varying levels of disability. Our results suggest that regression models trained with multiple spinal cord features predict clinical disability better than a model based on the volume of the spinal cord alone.

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Section: Simple Linear Regression With Spinal Cord Volumesupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Novel Morphological and Appearance Features for Predicting Physical Disability from MR Images in Multiple Sclerosis Patients

Kawahara

McIntosh

Tam

et al. 2014

Lecture Notes in Computational Vision and Biomechanics

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“…1 Differences in cervical cord volume and area among patients with different phenotypes of MS and healthy controls (HCs) measured by MR imaging have been identified in many studies. [2][3][4] Furthermore, a modest or strong correlation between spinal cord atrophy and disability has been demonstrated in numerous studies, suggesting that spinal cord atrophy is an essential determinant of clinical disability and a potential outcome measure to monitor MS disease progression. [5][6][7] The measurement of the upper cervical cord area is a well-established method for the assessment of spinal cord atrophy and has been applied in most studies so far.…”

mentioning

confidence: 99%

“…3,4 The MUCCA also has been measured recently on 3D T1-weighted MR images of the head covering the upper cervical cord, which has yielded promising results showing associations between MUCCA and clinical disability and disease progression. 2,5 Measuring the MUCCA from head MR images offers the opportunity to analyze MUCCA retrospectively in datasets without dedicated cervical 3D T1-weighted images, and it can reduce costs and patient burden in prospective studies by eliminating the need for separate cervical cord image acquisitions if these are only acquired to measure the MUCCA.…”

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confidence: 99%

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

Lukas

Steenwijk²,

Daams³

et al. 2015

AJNR Am J Neuroradiol

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Association Between Thoracic Spinal Cord Gray Matter Atrophy and Disability in Multiple Sclerosis

et al. 2015

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IMPORTANCE In multiple sclerosis (MS), upper cervical cord gray matter (GM) atrophy correlates more strongly with disability than does brain or cord white matter (WM) atrophy. The corresponding relationships in the thoracic cord are unknown owing to technical difficulties in assessing GM and WM compartments by conventional magnetic resonance imaging techniques.OBJECTIVES To investigate the associations between MS disability and disease type with lower thoracic cord GM and WM areas using phase-sensitive inversion recovery magnetic resonance imaging at 3T, as well as to compare these relationships with those obtained at upper cervical levels. DESIGN, SETTING, AND PARTICIPANTSBetween July 2013 and March 2014, a total of 142 patients with MS (aged 25-75 years; 86 women) and 20 healthy control individuals were included in this cross-sectional observational study conducted at an academic university hospital. MAIN OUTCOMES AND MEASURESTotal cord areas (TCAs), GM areas, and WM areas at the disc levels C2/C3, C3/C4, T8/9, and T9/10. Area differences between groups were assessed, with age and sex as covariates.RESULTS Patients with relapsing MS (RMS) had smaller thoracic cord GM areas than did ageand sex-matched control individuals (mean differences [coefficient of variation (COV)]: 0.98 mm 2 [9.2%]; P = .003 at T8/T9 and 0.93 mm 2 [8.0%]; P = .01 at T9/T10); however, there were no significant differences in either the WM area or TCA. Patients with progressive MS showed smaller GM areas (mean differences [COV]: 1.02 mm 2 [10.6%]; P < .001 at T8/T9 and 1.37 mm 2 [13.2%]; P < .001 at T9/T10) and TCAs (mean differences [COV]: 3.66 mm 2 [9.0%]; P < .001 at T8/T9 and 3.04 mm 2 [7.2%]; P = .004 at T9/T10) compared with patients with RMS. All measurements (GM, WM, and TCA) were inversely correlated with Expanded Disability Status Scale score. Thoracic cord GM areas were correlated with lower limb function. In multivariable models (which also included cord WM areas and T2 lesion number, brain WM volumes, brain T1 and fluid-attenuated inversion recovery lesion loads, age, sex, and disease duration), cervical cord GM areas had the strongest correlation with Expanded Disability Status Scale score followed by thoracic cord GM area and brain GM volume.CONCLUSIONS AND RELEVANCE Thoracic cord GM atrophy can be detected in vivo in the absence of WM atrophy in RMS. This atrophy is more pronounced in progressive MS than RMS and correlates with disability and lower limb function. Our results indicate that remarkable cord GM atrophy is present at multiple cervical and lower thoracic levels and, therefore, may reflect widespread cord GM degeneration.

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A multicenter assessment of cervical cord atrophy among MS clinical phenotypes

Abstract: Cervical cord atrophy provides a relevant and useful marker for the characterization of clinical heterogeneity of patients with MS. The stability of this measure among different centers supports its use as potential outcome measure to monitor disease progression in multicenter trials.

Cited by 126 publications

References 33 publications

Novel Morphological and Appearance Features for Predicting Physical Disability from MR Images in Multiple Sclerosis Patients

Novel Morphological and Appearance Features for Predicting Physical Disability from MR Images in Multiple Sclerosis Patients

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

Association Between Thoracic Spinal Cord Gray Matter Atrophy and Disability in Multiple Sclerosis

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