title: The relationships among MRI-defined spinal cord involvement, brain involvement, and disability in multiple sclerosis.
abstract: OBJECTIVE
  To determine the interrelationships between MRI-defined lesion and atrophy measures of spinal cord involvement and brain involvement and their relationships to disability in a small cohort of patients with multiple sclerosis (MS).
  
  
  BACKGROUND
  Although it is known that cervical spinal cord atrophy correlates with disability in MS, it is unknown whether it is the most important determinant when compared to other regions of the central nervous system (CNS). Furthermore, it is not clear to what extent brain and cord lesions and atrophy are related.
  
  
  METHODS
  3T MRI of the whole brain and whole spinal cord was obtained in 21 patients with MS, including 18 with relapsing-remitting, one with secondary progressive, one with primary progressive, and one with a clinically isolated syndrome. Brain global gray and white matter volumes were segmented with Statistical Parametric Mapping 8. Spinal cord contour volume was segmented in whole by a semi-automated method with bins assigned to either the cervical or thoracic regions. All CNS volumes were normalized by the intracranial volume. Brain and cord T2 hyperintense lesions were segmented using a semi-automated edge finding tool.
  
  
  RESULTS
  Among all MRI measures, only upper cervical spinal cord volume significantly correlated with Expanded Disability Status Scale score (r =-.515, P = .020). The brain cord relationships between whole or regional spinal cord volume or lesions and gray matter, white matter, or whole brain volume or whole brain lesions were generally weak and all nonsignificant.
  
  
  CONCLUSIONS
  In this preliminary study of mildly disabled, treated MS patients, cervical spinal cord atrophy most strongly correlates with physical disability in MS when accounting for a wide range of other CNS measures of lesions and atrophy, including thoracic or whole spinal cord volume, and cerebral gray, white or whole brain volume. The weak relationship between spinal cord and brain lesions and atrophy may suggest that they progress rather independently in patients with MS.
authors: Departments of Neurology and Radiology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA.
authors: Adam B
authors: AB
authors: Cohen
authors: Mohit
authors: M
authors: Neema
authors: Ashish
authors: A
authors: Arora
authors: Elisa
authors: E
authors: Dell'oglio
authors: Ralph H B
authors: RH
authors: Benedict
authors: Shahamat
authors: S
authors: Tauhid
authors: Daniel
authors: D
authors: Goldberg-Zimring
authors: Christian
authors: C
authors: Chavarro-Nieto
authors: Antonella
authors: A
authors: Ceccarelli
authors: Joshua P
authors: JP
authors: Klein
authors: James M
authors: JM
authors: Stankiewicz
authors: Maria K
authors: MK
authors: Houtchens
authors: Guy J
authors: GJ
authors: Buckle
authors: David C
authors: DC
authors: Alsop
authors: Charles R G
authors: CR
authors: Guttmann
authors: Rohit
authors: R
authors: Bakshi
mesh_terms: D000328:Adult; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D013116:Spinal Cord / Q000473:pathology*