MR Diffusion Properties of Cervical Spinal Cord as a Predictor of Progression to Multiple Sclerosis in Patients with Clinically Isolated Syndrome

Abstract

BACKGROUND AND PURPOSE This study's aim was to investigate diffusion properties of the cervical spinal cord in patients with clinically isolated syndrome (CIS) through analysis of diffusion tensor imaging (DTI) data and thereby to assess the capacity of this technique for predicting the progression of CIS to clinically definite multiple sclerosis (CDMS). METHODS The study groups were comprised of 47 patients with CIS (15 of them with progression to CDMS within 2 years of follow‐up) and 57 asymptomatic controls. All patients and controls had undergone magnetic resonance imaging (MRI) of the cervical spine including DTI and brain MRI. Methodological approaches included histogram analysis of the cervical cord's diffusion parameters and evaluation of T2 hyperintense lesions of the spinal cord and brain. All parameters were compared between the study groups. Sensitivity and specificity calculations were then performed with a view to predicting conversion to CDMS. RESULTS The patient subgroups defined by progression to CDMS differed significantly in values of fractional anisotropy (FA) kurtosis measured within white matter (WM) and normal‐appearing WM (NAWM). The same parameters also differed significantly when patients with progression to CDMS were compared to healthy controls. Receiver operating characteristic (ROC) analysis revealed sensitivity and specificity of FA kurtosis of WM and NAWM of 93% and 72%, respectively, in terms of predicting CIS to CDMS progression. CONCLUSION This study presents evidence that histogram analysis of diffusion parameters of the cervical spinal cord in patients with CIS may be helpful in predicting conversion to CDMS.

Evaluating Magnetic Resonance Diffusion Properties Together with Brain Volumetry May Predict Progression to Multiple Sclerosis

“…Conversely, Kugler et al (24), in their study (and similarly to our study), proved alterations of FA in cerebellar tissues as a predictor of conversion to CDMS. Moreover, histogram analysis of cervical cord's diffusion parameters also has been used in a recent study to predict CIS to CDMS progression with sensitivity and specificity of FA kurtosis of both WM and NAWM of 93% and 72%, respectively (25). Conventional evaluation of structural MRI data according to McDonald DIS criteria revealed sensitivity of 81.8% in terms of prediction to CDMS.…”