TY - JOUR
T1 - Relevance of spinal cord abnormalities to clinical disability in multiple sclerosis
T2 - MR imaging findings in a large cohort of patients
AU - Lukas, Carsten
AU - Sombekke, Madeleine H.
AU - Bellenberg, Barbara
AU - Hahn, Horst K.
AU - Popescu, Veronica
AU - Bendfeldt, Kerstin
AU - Radue, Ernst W.
AU - Gass, Achim
AU - Borgwardt, Stefan J.
AU - Kappos, Ludwig
AU - Naegelin, Yvonne
AU - Knol, Dirk L.
AU - Polman, Chris H.
AU - Geurts, Jeroen J.G.
AU - Barkhof, Frederik
AU - Vrenken, Hugo
PY - 2013/11
Y1 - 2013/11
N2 - Purpose: To determine whether spinal cord atrophy differs among disease subtypes in multiple sclerosis (MS) and whether it offers diagnostic and clinical correlative information beyond that provided by other magnetic resonance (MR) imaging markers. Materials and Methods: The institutional review board approved the study; all subjects gave written informed consent. Upper cervical cord cross-sectional area (UCCA), brain and spinal cord lesion loads, and brain atrophy were measured in 440 patients with MS (311 with relapsing-remitting [RR] MS, 92 with secondary-progressive [SP] MS, and 37 with primary-progressive [PP] MS) studied in two centers. Disability was scored with the Expanded Disability Status Scale (EDSS), the timed 25-foot walk test (TWT), and the nine-hole peg test. UCCA was compared between groups with the Mann-Whitney U test. Correlations were assessed with the Spearman r test. Multivariate associations between UCCA and clinical and other MR imaging parameters, including number of hypointense brain lesions on T1-weighted MR images, presence of diffuse abnormalities, and number of involved segments in the spinal cord, were assessed by using multiple linear regression, adjusted for study center site. Results: The UCCA in patients with SP MS (median, 79 mm 2; interquartile range, 72.4°C84.9 mm2) and PP MS (median, 77.3 mm2; interquartile range, 69°C82.5 mm2) was significantly smaller (P <.001) than that in patients with RR MS (median, 84 mm2; interquartile range, 78.7°C89.3 mm2). UCCA was inversely correlated with EDSS score, TWT, and nine-hole peg test findings (ρ ≤ 20.29, P <.001 for all comparisons). UCCA, number of hypointense brain lesions on T1-weighted MR images, presence of diffuse abnormalities, and number of involved segments in the spinal cord were found to be significant explanatory factors for clinical disability (R2= 0.564). The UCCA and the number of hypointense brain lesions on T1-weighted images were the strongest MR imaging parameters for explaining physical disability, as measured with the EDSS. Conclusion: Spinal cord abnormalities have a strong effect on clinical disability in MS. MR imaging°Cderived UCCA was found to be the most significant spinal cord parameter for explaining EDSS score.
AB - Purpose: To determine whether spinal cord atrophy differs among disease subtypes in multiple sclerosis (MS) and whether it offers diagnostic and clinical correlative information beyond that provided by other magnetic resonance (MR) imaging markers. Materials and Methods: The institutional review board approved the study; all subjects gave written informed consent. Upper cervical cord cross-sectional area (UCCA), brain and spinal cord lesion loads, and brain atrophy were measured in 440 patients with MS (311 with relapsing-remitting [RR] MS, 92 with secondary-progressive [SP] MS, and 37 with primary-progressive [PP] MS) studied in two centers. Disability was scored with the Expanded Disability Status Scale (EDSS), the timed 25-foot walk test (TWT), and the nine-hole peg test. UCCA was compared between groups with the Mann-Whitney U test. Correlations were assessed with the Spearman r test. Multivariate associations between UCCA and clinical and other MR imaging parameters, including number of hypointense brain lesions on T1-weighted MR images, presence of diffuse abnormalities, and number of involved segments in the spinal cord, were assessed by using multiple linear regression, adjusted for study center site. Results: The UCCA in patients with SP MS (median, 79 mm 2; interquartile range, 72.4°C84.9 mm2) and PP MS (median, 77.3 mm2; interquartile range, 69°C82.5 mm2) was significantly smaller (P <.001) than that in patients with RR MS (median, 84 mm2; interquartile range, 78.7°C89.3 mm2). UCCA was inversely correlated with EDSS score, TWT, and nine-hole peg test findings (ρ ≤ 20.29, P <.001 for all comparisons). UCCA, number of hypointense brain lesions on T1-weighted MR images, presence of diffuse abnormalities, and number of involved segments in the spinal cord were found to be significant explanatory factors for clinical disability (R2= 0.564). The UCCA and the number of hypointense brain lesions on T1-weighted images were the strongest MR imaging parameters for explaining physical disability, as measured with the EDSS. Conclusion: Spinal cord abnormalities have a strong effect on clinical disability in MS. MR imaging°Cderived UCCA was found to be the most significant spinal cord parameter for explaining EDSS score.
UR - http://www.scopus.com/inward/record.url?scp=84886681717&partnerID=8YFLogxK
U2 - 10.1148/radiol.13122566
DO - 10.1148/radiol.13122566
M3 - Journal articles
C2 - 23737540
AN - SCOPUS:84886681717
SN - 0033-8419
VL - 269
SP - 542
EP - 552
JO - Radiology
JF - Radiology
IS - 2
ER -
