Brain and spinal cord abnormalities in multiple sclerosis. Correlation between MRI parameters, clinical subtypes and symptoms

Abstract

We investigated various magnetic resonance MRI parameters for both brain and spinal cord to see if any improved the clinicoradiological correlation in multiple sclerosis. Ninety-one multiple sclerosis patients (28 relapsing-remitting, 32 secondary progressive and 31 primary progressive) were imaged using conventional T1, proton density- and T2-weighted MRI of the brain and spinal cord. Focal brain and spinal cord lesion load was scored, as were diffuse signal abnormalities, brain ventricular volume and spinal cord cross-sectional area. Clinical measures included the expanded disability status scale (EDSS), the functional systems score and a dedicated urology complaint questionnaire. Secondary progressive patients differed from relapsing-remitting and primary progressive patients by a larger number of hypointense T1 lesions in the brain, ventricular enlargement and spinal cord atrophy. Primary progressive patients more often had diffuse abnormalities in the brain and/or spinal cord than did relapsing-remitting and secondary progressive patients. In the entire study population, EDSS correlated with both brain and spinal cord MRI parameters, which were independent. The urological complaint score correlated only with spinal cord MRI parameters. In relapsing-remitting and secondary progressive multiple sclerosis, the correlation between MRI and clinical parameters was better than in the entire population. In this subgroup EDSS variance could be explained best by T1 brain lesion load, ventricle volume and spinal cord cross-sectional area. In the primary progressive subgroup the clinicoradiological correlation was weak for brain parameters but was present between spinal cord symptoms and spinal cord MRI parameters. In conclusion, the different brain and spinal cord MRI parameters currently available revealed considerable heterogeneity between clinical subtypes of multiple sclerosis. In relapsing-remitting and secondary progressive multiple sclerosis both brain and spinal cord MRI may provide a tool for monitoring patients, while in primary progressive multiple sclerosis the clinicoradiological correlation is weak for brain imaging.

A diffusion tensor imaging group study of the spinal cord in multiple sclerosis patients with and without T2 spinal cord lesions

“…However, it has been demonstrated that findings on conventional MR scans do not always correlate well with the clinical status of the MS patients (41,42). In addition, previous studies did not find a correlation between the clinical disability of MS patients and the number and extent of the spinal cord lesions that were detected on MR (43)(44)(45)(46). Because DTI provides information about the microstructural WM organization, the resulting diffusion metrics are potentially more sensitive to detect spinal cord involvement in MS patients than conventional MR is.…”

Thoracic spinal cord lesions are influenced by the degree of cervical spine involvement in multiple sclerosis

“…Importantly, this observation was found to be independent of the number of brain lesions, treatment exposure, clinical symptoms and disease duration from first symptom onset. Despite shortcomings of T2 techniques in identifying spinal involvement, cervical spinal cord involvement has been demonstrated to be related to disability outcomes in MS, 2,15,16 specifically driven by diffuse rather than focal involvement. 17 Little is known about the impact of thoracic spinal cord involvement; however, one study showed modest correlations with thoracic spine T2 lesions and disability measures of EDSS and timed 25 foot walk in a small cohort of patients.…”

“…Involvement of the spinal cord parenchyma is correlated with disability outcomes in MS, [1][2][3] as well as higher conversion rates to clinically definite MS and risk for a first clinical event related to central nervous system demyelination in clinically and radiologically isolated syndromes, respectively. [4][5][6][7] To improve visualization of the spinal cord, cervical and thoracic segments are acquired separately.…”

Quantitative Cervical Spinal Cord 3T Proton MR Spectroscopy in Multiple Sclerosis

“…Spinal cord atrophy is sometimes estimated with MR imaging, 44,45 but some authors 22 observed that atrophy and NAA decrease are not correlated and that atrophy is not a complete marker of disease progression and axonal damage in the spine. Again, the addition of MR spectroscopy metabolic information can enhance the evaluation of pathologic cord involvement.…”