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Abstract
Objective: To investigate whether spinal cord (SC) lesion load, when quantified on axial images with high in-plane resolution, is associated with disability in multiple sclerosis (MS).
Methods: Twenty-eight healthy controls and 92 people with MS had cervical SC 3T MRI with axial phase sensitive inversion recovery, T2, and magnetization transfer (MT) sequences. We outlined all visible focal lesions from C2 to C4 to obtain lesion load and also measured upper cervical cord area. We measured MT ratio in normal-appearing cord tissue and in lesions. Disability was recorded using the Expanded Disability Status Scale (EDSS) and MS Functional Composite. We used linear regression models to determine associations with disability.
Results: SC lesion load was significantly higher in both secondary progressive MS (SPMS) (p = 0.008) and primary progressive MS (PPMS) (p = 0.02) compared to relapsing-remitting MS (RRMS); in each comparison, adjustment was made for age, sex, and brain volume. These differences were not evident when EDSS was added as a covariate. SC area was significantly lower in both SPMS (p < 0.001) and PPMS (p = 0.009) compared to RRMS. In a multiple regression model, cord lesion load (p < 0.001), cord area (p = 0.003), age (p < 0.001), and sex (p = 0.001) were independently associated with EDSS (R2 = 0.58). Cord lesion load (p = 0.003), cord area (p = 0.034), and brain parenchymal fraction (p = 0.007) were independently associated with the 9-hole peg test (R2 = 0.42).
Conclusions: When quantified on axial MRI with high in-plane resolution, upper cervical cord lesion load is significantly and independently correlated with physical disability and is higher in progressive forms of MS than RRMS.
GLOSSARY
- 3D-FFE=
- 3D fat-suppressed fast field echo;
- 3D-PSIR=
- 3D-Phase Sensitive Inversion Recovery;
- 9-HPT=
- 9-Hole Peg Test;
- BPF=
- brain parenchymal fraction;
- CI=
- confidence interval;
- COV=
- coefficient of variation;
- EDSS=
- Expanded Disability Status Scale;
- FOV=
- field of view;
- ICC=
- intraclass correlation coefficient;
- MS=
- multiple sclerosis;
- MT=
- magnetization transfer;
- MTR=
- magnetization transfer ratio;
- NASC=
- normal-appearing spinal cord;
- NEX=
- number of excitations;
- PASAT=
- Paced Auditory Serial Addition Test;
- PPMS=
- primary progressive multiple sclerosis;
- ROI=
- regions of interest;
- RRMS=
- relapsing-remitting multiple sclerosis;
- SC=
- spinal cord;
- SPMS=
- secondary progressive multiple sclerosis;
- T2LV=
- T2 lesion volume;
- TE=
- echo time;
- TR=
- repetition time;
- TWT=
- timed walk test
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received May 30, 2014.
- Accepted in final form September 3, 2014.
- © 2014 American Academy of Neurology
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