Upper cervical spinal cord cross‐sectional area in relapsing remitting multiple sclerosis: Application of a new technique for measuring cross‐sectional area on magnetic resonance images

Abstract

Purpose: To measure accurately the upper cervical cord cross-sectional area (CSA) in patients with relapsing remitting multiple sclerosis (RRMS), and normal control subjects, to address the paradox that longitudinal reduction in CSA has been detected in RRMS while reduction compared to controls has not. We hypothesized that a lack of statistical power and/or measurement sensitivity due to partial volume averaging in previous studies contributed to this paradox. Materials and Methods:Using a technique that corrects for partial volume averaging, we measured the CSA in 35 normal controls and 35 RRMS patients. We used the total intracranial volume (TICV) to normalize the CSA and therefore reduce the normal variance and improve the statistical power. Results:The mean TICV did not differ between groups. Statistical power analysis indicated that a 5% reduction in CSA in the patients could be detected with an estimated power of 0.74 before normalization and 0.9 after. The mean CSA in the patients was not reduced compared to controls after (P ϭ 0.928) or before (P ϭ 0.881) normalization. Conclusion:Using a sensitive analysis method, and apparently appropriate statistical power, we did not detect reduced CSA in RRMS patients. We hypothesize that this may be due to inflammation.

Dehydration affects spinal cord cross-sectional area measurement on MRI in healthy subjects

“…The results of our current study have particular implications for studies of spinal cord disorders that involve an inflammatory response. For example, previous cross-sectional studies have shown that cord volume in MS patients can be increased (with varying levels of statistical significance) when compared with healthy controls, especially in early MS. 3,9 These findings are somewhat unintuitive for a neurodegenerative disease but are hypothesized to reflect the presence of inflammation and associated edema, which can induce a temporary increase in cord volume. Our current results help to bolster that hypothesis by demonstrating that measurable volume changes are associated with fluctuations in water content.…”

“…[5][6][7] However, there have been contradictory findings in patients with the relapsing remitting form of MS (RRMS), which typically precedes a more progressive form. A number of studies have found that cord CSA is not reduced in RRMS patients 8,9 and could be used to distinguish progressive MS from RRMS patients, 8 whereas others have shown that cord atrophy is detectable in RRMS patients. 10 The inconsistent findings of cord involvement in RRMS may be because of many reasons.…”

Vertebral Body Segmentation of Spine MR Images Using Superpixels

“…Previously published works on segmentation of the human spinal cord have involved several classes of algorithms, such as contour and edge detection [2], seeded region growing [3] and B-spline active surface [4]. However, previous works generally require high computational effort which can be time-intensive and not suited to an interactive scenario like a CAD.…”

Spatial Fuzzy C-Means Clustering based Segmentation of Tumor in Vertebral Column Images

“…The segmentation methods in the published papers have been tailored with several classes of algorithms, such as contour and edge detection [5], seeded region growing [6] and B-spline active surface [7], which are not suited to an interactive scenario requirement in CADS.…”