title: Mean upper cervical cord area (MUCCA) measurement in long-standing multiple sclerosis: relation to brain findings and clinical disability.
abstract: BACKGROUND
  The majority of patients with multiple sclerosis (MS) present with spinal cord pathology. Spinal cord atrophy is thought to be a marker of disease severity, but in long-disease duration its relation to brain pathology and clinical disability is largely unknown.
  
  
  OBJECTIVE
  Our aim was to investigate mean upper cervical cord area (MUCCA) in patients with long-standing MS and assess its relation to brain magnetic resonance imaging (MRI) measures and clinical disability.
  
  
  METHODS
  MUCCA was measured in 196 MS patients and 55 healthy controls using 3DT1-weighted cervical images obtained at 3T MRI. Clinical disability was measured using the Expanded Disability Status Scale (EDSS), Nine-Hole-Peg test (9-HPT), and 25 feet Timed Walk Test (TWT). Stepwise linear regression was performed to assess the association between MUCCA and MRI measures, and between MUCCA and clinical disability.
  
  
  RESULTS
  MUCCA was smaller (mean 11.7%) in MS patients compared with healthy controls (72.56±9.82 and 82.24±7.80 mm2 respectively; p<0.001), most prominently in male patients. MUCCA was associated with normalized brain volume, and number of cervical cord lesions. MUCCA was independently associated with EDSS, TWT, and 9-HPT.
  
  
  CONCLUSIONS
  MUCCA was reduced in MS patients compared with healthy controls. It provides a relevant marker for clinical disability in long-standing disease, independent of other MRI measures.
authors.affiliation: VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands m.daams@vumc.nl.
authors.forename: Marita
authors.initials: M
authors.lastname: Daams
authors.affiliation: Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Weiler
authors.affiliation: Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Martijn D
authors.initials: MD
authors.lastname: Steenwijk
authors.affiliation: Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany.
authors.forename: Horst K
authors.initials: HK
authors.lastname: Hahn
authors.affiliation: Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jeroen Jg
authors.initials: JJ
authors.lastname: Geurts
authors.affiliation: Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Hugo
authors.initials: H
authors.lastname: Vrenken
authors.affiliation: Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: van Schijndel
authors.affiliation: Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Lisanne J
authors.initials: LJ
authors.lastname: Balk
authors.affiliation: Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Prejaas K
authors.initials: PK
authors.lastname: Tewarie
authors.affiliation: Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/ Mayo Clinic, Rochester, MN, USA.
authors.forename: Jan-Mendelt
authors.initials: JM
authors.lastname: Tillema
authors.affiliation: Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Joep
authors.initials: J
authors.lastname: Killestein
authors.affiliation: Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Bernard Mj
authors.initials: BM
authors.lastname: Uitdehaag
authors.affiliation: Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D016022:Case-Control Studies; D002574:Cervical Vertebrae; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology* / Q000503:physiopathology; D009929:Organ Size; D013116:Spinal Cord / Q000473:pathology*; D013997:Time Factors
keywords: Multiple sclerosis; atrophy; disability evaluation; magnetic resonance imaging; spinal cord