Atrophy and structural variability of the upper cervical cord in early multiple sclerosis

作者：Biberacher Viola^*; Boucard Christine C; Schmidt Paul; Engl Christina; Buck Dorothea; Berthele Achim; Hoshi Muna Miriam; Zimmer Claus; Hemmer Bernhard; Muehlau Mark

来源：Multiple Sclerosis, 2015, 21(7): 875-884.

DOI：10.1177/1352458514546514

• Cervical cord
• clinically isolated syndrome
• relapsing-remitting multiple sclerosis
• magnetic resonance imaging

Background: Despite agreement about spinal cord atrophy in progressive forms of multiple sclerosis (MS), data on clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS) are conflicting.
Objective: To determine the onset of spinal cord atrophy in the disease course of MS.
Methods: Structural brain magnetic resonance imaging (MRI) was acquired from 267 patients with CIS (85) or RRMS (182) and 64 healthy controls (HCs). The upper cervical cord cross-sectional area (UCCA) was determined at the level of C2/C3 by a segmentation tool and adjusted for focal MS lesions. The coefficient of variation (CV) was calculated from all measurements between C2/C3 and 13 mm above as a measure of structural variability.
Results: Compared to HCs (76.16.9 mm(2)), UCCA was significantly reduced in CIS patients (73.5 +/- 5.8 mm(2), p=0.018) and RRMS patients (72.4 +/- 7.0 mm(2), p<0.001). Structural variability was higher in patients than in HCs, particularly but not exclusively in case of focal lesions (mean CV HCs/patients without/with lesions: 2.13%/2.55%/3.32%, all p-values<0.007). UCCA and CV correlated with Expanded Disability Status Scale (EDSS) scores (r =-0.131/0.192, p=0.044/<0.001) and disease duration (r=-0.134/0.300, p=0.039/< 0.001). CV additionally correlated with hand and arm r=0.180, p=0.014).
Conclusion: In MS, cervical cord atrophy already occurs in CIS. In early stages, structural variability may be a more meaningful marker of spinal cord pathology than atrophy.

• 出版日期2015-6