Magnetisation transfer ratio measurement in the cervical spinal cord: a preliminary study in multiple sclerosis

Abstract

MRI readily detects the lesions of multiple sclerosis (MS) in the brain and spinal cord. Conventional MRI sequences do not, however, permit distinction between the various pathological characteristics (oedema, demyelination, axonal loss and gliosis) of lesions in MS. Magnetisation transfer (MT) imaging may be more specific in distinguishing the pathologies responsible for disability in MS, namely demyelination and axonal loss, and therefore may have a potential role in monitoring treatment. We have applied MT imaging to the cervical spinal cord to see if it is feasible to measure MT ratios (MTR) in this region where pathological changes may result in considerable disability. We studied 12 patients with MS and 12 age- and sex-matched normal controls using a sagittal T2-weighted fast spin-echo sequence with and without an MT pulse. The median value for cervical cord mean MTR measurement in normal controls was 19.30% units (interquartile range 19.05-19.55), whereas values were significantly lower in MS patients (median = 17.95% units, interquartile range 17.25-19.00, P = 0.0004). There was a low intrarater variability for repeated mean MTR measurements. We conclude that it is possible to measure MTR in the cervical spinal cord, that a significant reduction occurs in patients with MS, and that there may be a role for this measure in future MS treatment trials.

Cervical spinal cord MTR histogram analysis in multiple sclerosis using a 3D acquisition and a B-spline active surface segmentation technique

“…Silver et al performed the first MTR study in MS using ROIs manually placed on sagittal images of the cervical spinal cord. They demonstrated significantly lower MTR values at the C2/3 level of 12 MS patients compared with 12 age-and sex-matched controls (p ϭ 0.0004), however there was no linear correlation between the MTR and disability [10]. MTR histograms reflect the global disease burden.…”

Magnetization Transfer Magnetic Resonance Imaging of the Brain, Spinal Cord, and Optic Nerve

“…94 -99 ROI analysis has revealed reduced MTR values in the cervical cord of MS patients, compared with healthy volunteers. 90 Histogram analysis has demonstrated the absence of abnormalities in cord MTR histogram metrics of patients with RRMS, 92 early-onset MS, 52 and CIS. 99 By contrast, cord MTR metrics are markedly reduced in patients with SPMS and PPMS.…”

Benefit of repetitive intrathecal triamcinolone acetonide therapy in predominantly spinal multiple sclerosis: prediction by upper spinal cord atrophy

“…Amount and severity of MS pathology in the cervical cord are greater in the progressive forms of the disease [Filippi et al 2000]. It is assumed that axonal loss in MS is an important factor for the occurrence of atrophy and that atrophy in general represents the endpoint of tissue destruction [Lin and Blumhardt 2001;Matthews 1999;Silber and Sharief 1999;Rovaris et al 1997;Silver et al 1997]. Since spinal cord atrophy already develops in the early phases of MS, the quantification of spinal cord volume by MRI is a potential marker to quantitatively monitor the course of the disease and furthermore to monitor treatment efficacy.…”