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Relevance of spinal cord abnormalities to clinical disability in multiple sclerosis: MR imaging findings in a large cohort of patients.
Radiology 2013; 269(2):542-52R

Abstract

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 ρ 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, 72.4-84.9 mm(2)) and PP MS (median, 77.3 mm(2); interquartile range, 69-82.5 mm(2)) was significantly smaller (P < .001) than that in patients with RR MS (median, 84 mm(2); interquartile range, 78.7-89.3 mm(2)). UCCA was inversely correlated with EDSS score, TWT, and nine-hole peg test findings (ρ ≤ -0.29, 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 (R(2) = 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-derived UCCA was found to be the most significant spinal cord parameter for explaining EDSS score.

Authors+Show Affiliations

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St Josef Hospital, Ruhr University Bochum, Gudrunstr. 56, 44791 Bochum, Germany; Departments of Neurology, Radiology, Epidemiology and Biostatistics, Anatomy and Neurosciences, Section of Clinical Neuroscience, and Physics and Medical Technology, MS Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands; Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23737540

Citation

Lukas, Carsten, et al. "Relevance of Spinal Cord Abnormalities to Clinical Disability in Multiple Sclerosis: MR Imaging Findings in a Large Cohort of Patients." Radiology, vol. 269, no. 2, 2013, pp. 542-52.
Lukas C, Sombekke MH, Bellenberg B, et al. Relevance of spinal cord abnormalities to clinical disability in multiple sclerosis: MR imaging findings in a large cohort of patients. Radiology. 2013;269(2):542-52.
Lukas, C., Sombekke, M. H., Bellenberg, B., Hahn, H. K., Popescu, V., Bendfeldt, K., ... Vrenken, H. (2013). Relevance of spinal cord abnormalities to clinical disability in multiple sclerosis: MR imaging findings in a large cohort of patients. Radiology, 269(2), pp. 542-52. doi:10.1148/radiol.13122566.
Lukas C, et al. Relevance of Spinal Cord Abnormalities to Clinical Disability in Multiple Sclerosis: MR Imaging Findings in a Large Cohort of Patients. Radiology. 2013;269(2):542-52. PubMed PMID: 23737540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relevance of spinal cord abnormalities to clinical disability in multiple sclerosis: 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, Y1 - 2013/06/04/ PY - 2013/6/6/entrez PY - 2013/6/6/pubmed PY - 2014/1/10/medline SP - 542 EP - 52 JF - Radiology JO - Radiology VL - 269 IS - 2 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 ρ 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, 72.4-84.9 mm(2)) and PP MS (median, 77.3 mm(2); interquartile range, 69-82.5 mm(2)) was significantly smaller (P < .001) than that in patients with RR MS (median, 84 mm(2); interquartile range, 78.7-89.3 mm(2)). UCCA was inversely correlated with EDSS score, TWT, and nine-hole peg test findings (ρ ≤ -0.29, 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 (R(2) = 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-derived UCCA was found to be the most significant spinal cord parameter for explaining EDSS score. SN - 1527-1315 UR - https://www.unboundmedicine.com/medline/citation/23737540/Relevance_of_spinal_cord_abnormalities_to_clinical_disability_in_multiple_sclerosis:_MR_imaging_findings_in_a_large_cohort_of_patients_ L2 - http://pubs.rsna.org/doi/10.1148/radiol.13122566?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -