Imaging of the Spinal Cord in Multiple Sclerosis: Past, Present, Future

Chen, Yongsheng; Haacke, E. Mark; Bernitsas, Evanthia

doi:10.3390/brainsci10110857

Cited by 10 publications

(18 citation statements)

References 125 publications

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“…Multiple sclerosis (MS) is an inflammatory demyelinating disease affecting both the brain and the spinal cord [1,2]. MS is the most frequent cause of disability in the young and middle-aged population in developed countries [3].…”

Section: Introductionmentioning

confidence: 99%

MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

et al. 2021

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Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

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Section: Introductionmentioning

confidence: 99%

MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

et al. 2021

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“…Also, T2 lesion detection in the spinal cord can be challenging, especially for small and lateral cord lesions due to partial volume effects. 17 , 18 …”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of gadolinium contrast administration for spinal cord magnetic resonance imaging in multiple sclerosis patients and correlative markers of lesion enhancement

Neuberger

Schregel

Brugnara

et al. 2021

Multiple Sclerosis Journal - Experimental, Translational and Cl

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Background Magnetic resonance imaging is essential for monitoring people with multiple sclerosis, but the diagnostic value of gadolinium contrast administration in spine magnetic resonance imaging is unclear. Objective To assess the diagnostic value of gadolinium contrast administration in spine magnetic resonance imaging follow-up examinations and identify imaging markers correlating with lesion enhancement. Methods A total of 65 multiple sclerosis patients with at least 2 spinal magnetic resonance imaging follow-up examinations were included. Spine magnetic resonance imaging was performed at 3 Tesla with a standardized protocol (sagittal and axial T2-weighted turbo spin echo and T1-weighted post-contrast sequences). T2 lesion load and enhancing lesions were assessed by two independent neuroradiologists for lesion size, localization, and T2 signal ratio (T2 signallesion/T2 signalnormal appearing spinal cord). Results A total of 68 new spinal T2 lesions and 20 new contrast-enhancing lesions developed during follow-up. All enhancing lesions had a discernable correlate as a new T2 lesion. Lesion enhancement correlated with a higher T2 signal ratio compared to non-enhancing lesions (T2 signal ratio: 2.0 ± 0.4 vs. 1.4 ± 0.2, **** p < 0.001). Receiver operating characteristics analysis showed an optimal cutoff value of signal ratio 1.78 to predict lesion enhancement (82% sensitivity and 97% specificity). Conclusion Gadolinium contrast administration is dispensable in follow-up spine magnetic resonance imaging if no new T2 lesions are present. Probability of enhancement correlates with the T2 signal ratio.

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“…1 Demyelination, axonal loss, and gliosis contribute to damage of this region, resulting in chronic motor, sensory, and autonomic dysfunction. 1,2 Spinal cord atrophy, especially in the cervical segment, occurs to a variable extent in both relapsing-remitting (RR) and progressive (P) MS, 1,3,4 and is often associated with clinical disability. 1,[3][4][5] Longitudinal studies have consistently demonstrated that spinal cord atrophy progresses over time in all disease phenotypes.…”

mentioning

confidence: 99%

“…1,2 Spinal cord atrophy, especially in the cervical segment, occurs to a variable extent in both relapsing-remitting (RR) and progressive (P) MS, 1,3,4 and is often associated with clinical disability. 1,[3][4][5] Longitudinal studies have consistently demonstrated that spinal cord atrophy progresses over time in all disease phenotypes. [6][7][8][9][10][11][12] Because of its strong correlation with clinical disability and short-term disease worsening, 8,9 cervical cord atrophy progression appears to be a good candidate biomarker for monitoring disease evolution, and may be included as an outcome measure for clinical trials.…”

mentioning

confidence: 99%

Improved Assessment of Longitudinal Spinal Cord Atrophy in Multiple Sclerosis Using a Registration‐Based Approach: Relevance for Clinical Studies

Valsasina

Horsfield²,

Meani

et al. 2021

Magnetic Resonance Imaging

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Background Reliable measurements of cervical cord atrophy progression may be useful for monitoring neurodegeneration in multiple sclerosis (MS). Purpose To compare a new, registration‐based (Reg) method with two existing methods (active surface [AS] and propagation segmentation [PropSeg]) to measure cord atrophy changes over time in MS. Study Type Retrospective. Subjects Cohort I: Eight healthy controls (HC) and 28 MS patients enrolled at a single institution, and cohort II: 25 HC and 63 MS patients enrolled at three European sites. Field Strength/Sequence 3D T1‐weighted gradient echo sequence, acquired at 1.5 T (cohort I) and 3.0 T (cohort II). Assessment Percentage cord area changes (PCACs) between baseline and follow‐up (cohort I: 2.34 years [interquartile range = 2.00–2.55 years], cohort II: 1.05 years [interquartile range = 1.01–1.18 years]) were evaluated for all subjects using Reg, AS, and PropSeg. Reg included an accurate registration of baseline and follow‐up straightened cord images, followed by AS‐based optimized cord segmentation. A subset of studies was analyzed twice by two observers. Statistical Tests Linear regression models were used to estimate annualized PCAC, and effect sizes expressed as the ratio between the estimated differences and HC error term (P < 0.05). Reproducibility was assessed by linear mixed‐effect models. Annualized PCACs were used for sample size calculations (significance: α = 0.05, power: 1 − β = 0.80). Results Annualized PCACs and related standard errors (SEs) were lower with Reg than with other methods: PCAC in MS patients at 1.5 T was −1.12% (SE = 0.22) with Reg, −1.32% (SE = 0.30) with AS, and −1.40% (SE = 0.33) with PropSeg, while at 3.0 T PCAC was −0.83% (SE = 0.25) with Reg, −0.92% (SE = 0.32) with AS, and −1.18 (SE = 0.53) with PropSeg. This was reflected in larger effect sizes and lower sample sizes. Intra‐ and inter‐observer agreement range was 0.72–0.91 with AS, and it was >0.96 with Reg. Data Conclusion The results support the use of the registration method to measure cervical cord atrophy progression in future MS clinical studies. Level of Evidence 3 Technical Efficacy Stage 2

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Imaging of the Spinal Cord in Multiple Sclerosis: Past, Present, Future

Cited by 10 publications

References 125 publications

MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

Diagnostic value of gadolinium contrast administration for spinal cord magnetic resonance imaging in multiple sclerosis patients and correlative markers of lesion enhancement

Improved Assessment of Longitudinal Spinal Cord Atrophy in Multiple Sclerosis Using a Registration‐Based Approach: Relevance for Clinical Studies

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