Spinal cord atrophy predicts progressive disease in relapsing multiple sclerosis

AbstractBackground:The pathophysiological basis for differences in disability in patients with multiple sclerosis is unclear.Methods:We used magnetic resonance imaging to examine whether differences in disability in cohorts of multiple sclerosis patients with similar T2-weighted lesion volume and disease duration were associated with a more destructive disease process in the more disabled patients.Results:The benign and severely disabled groups had similar brain atrophy metrics and similar decreases of the neuronal marker, N-acetylaspartate, in the normal appearing white matter of the cerebrum on magnetic resonance spectroscopy examination in vivo. The severely disabled cohort had more spinal cord atrophy.Conclusion:The dissociation of spinal cord atrophy and cerebral atrophy between these two groups suggests that the difference between the more benign and more disabled groups cannot be explained by a more aggressive pathological process that is affecting the entire neuroaxis in a homogeneous fashion.

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

Brain Sciences ◽

10.3390/brainsci10110857 ◽

2020 ◽

Vol 10 (11) ◽

pp. 857

Author(s):

Yongsheng Chen ◽

Ewart Mark Haacke ◽

Evanthia Bernitsas

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Disease Progression ◽

White Matter Lesions ◽

Quantitative Mri ◽

Axonal Loss ◽

Spinal Cord Atrophy ◽

Diagnosis And Prognosis ◽

Mcdonald Criteria ◽

Spinal Cord Imaging

Spinal cord imaging in multiple sclerosis (MS) plays a significant role in diagnosing and tracking disease progression. The spinal cord is one of four key areas of the central nervous system where documenting the dissemination in space in the McDonald criteria for diagnosing MS. Spinal cord lesion load and the severity of cord atrophy are believed to be more relevant to disability than white matter lesions in the brain in different phenotypes of MS. Axonal loss contributes to spinal cord atrophy in MS and its degree correlates with disease severity and prognosis. Therefore, measures of axonal loss are often reliable biomarkers for monitoring disease progression. With recent technical advances, more and more qualitative and quantitative MRI techniques have been investigated in an attempt to provide objective and reliable diagnostic and monitoring biomarkers in MS. In this article, we discuss the role of spinal cord imaging in the diagnosis and prognosis of MS and, additionally, we review various techniques that may improve our understanding of the disease.

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Advances in spinal cord imaging in multiple sclerosis

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286419840593 ◽

2019 ◽

Vol 12 ◽

pp. 175628641984059 ◽

Cited By ~ 16

Author(s):

Marcello Moccia ◽

Serena Ruggieri ◽

Antonio Ianniello ◽

Ahmed Toosy ◽

Carlo Pozzilli ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Imaging Techniques ◽

Quantitative Imaging ◽

Automated Analysis ◽

Spinal Cord Atrophy ◽

Recent Developments ◽

Magnetic Resonance Imaging Mri ◽

Spinal Cord Imaging

The spinal cord is frequently affected in multiple sclerosis (MS), causing motor, sensory and autonomic dysfunction. A number of pathological abnormalities, including demyelination and neuroaxonal loss, occur in the MS spinal cord and are studied in vivo with magnetic resonance imaging (MRI). The aim of this review is to summarise and discuss recent advances in spinal cord MRI. Advances in conventional spinal cord MRI include improved identification of MS lesions, recommended spinal cord MRI protocols, enhanced recognition of MRI lesion characteristics that allow MS to be distinguished from other myelopathies, evidence for the role of spinal cord lesions in predicting prognosis and monitoring disease course, and novel post-processing methods to obtain lesion probability maps. The rate of spinal cord atrophy is greater than that of brain atrophy (−1.78% versus −0.5% per year), and reflects neuroaxonal loss in an eloquent site of the central nervous system, suggesting that it can become an important outcome measure in clinical trials, especially in progressive MS. Recent developments allow the calculation of spinal cord atrophy from brain volumetric scans and evaluation of its progression over time with registration-based techniques. Fully automated analysis methods, including segmentation of grey matter and intramedullary lesions, will facilitate the use of spinal cord atrophy in trial designs and observational studies. Advances in quantitative imaging techniques to evaluate neuroaxonal integrity, myelin content, metabolic changes, and functional connectivity, have provided new insights into the mechanisms of damage in MS. Future directions of research and the possible impact of 7T scanners on spinal cord imaging will be discussed.

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