title: Cervical spinal cord volume loss is related to clinical disability progression in multiple sclerosis.
abstract: OBJECTIVE
  To examine the temporal evolution of spinal cord (SC) atrophy in multiple sclerosis (MS), and its association with clinical progression in a large MS cohort.
  
  
  METHODS
  A total of 352 patients from two centres with MS (relapsing remitting MS (RRMS): 256, secondary progressive MS (SPMS): 73, primary progressive MS (PPMS): 23) were included. Clinical and MRI parameters were obtained at baseline, after 12 months and 24 months of follow-up. In addition to conventional brain and SC MRI parameters, the annualised percentage brain volume change and the annualised percentage upper cervical cord cross-sectional area change (aUCCA) were quantified. Main outcome measure was disease progression, defined by expanded disability status scale increase after 24 months.
  
  
  RESULTS
  UCCA was lower in SPMS and PPMS compared with RRMS for all time points. aUCCA over 24 months was highest in patients with SPMS (-2.2% per year) and was significantly higher in patients with disease progression (-2.3% per year) than in stable patients (-1.2% per year; p=0.003), while annualised percentage brain volume change did not differ between subtypes (RRMS: -0.42% per year; SPMS -0.6% per year; PPMS: -0.46% per year) nor between progressive and stable patients (p=0.055). Baseline UCCA and aUCCA over 24 months were found to be relevant contributors of expanded disability status scale at month-24, while baseline UCCA as well as number of SC segments involved by lesions at baseline but not aUCCA were relevant contributors of disease progression.
  
  
  CONCLUSIONS
  SC MRI parameters including baseline UCCA and SC lesions were significant MRI predictors of disease progression. Progressive 24-month upper SC atrophy occurred in all MS subtypes, and was faster in patients exhibiting disease progression at month-24.
authors: Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
authors: Carsten
authors: C
authors: Lukas
authors: Department of Epidemiology and Biostatistics, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors: Dirk L
authors: DL
authors: Knol
authors: Department of Neurology, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors: Madeleine H
authors: MH
authors: Sombekke
authors: Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
authors: Barbara
authors: B
authors: Bellenberg
authors: Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany.
authors: Horst K
authors: HK
authors: Hahn
authors: Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors: Veronica
authors: V
authors: Popescu
authors: Department of Neurology, University Hospital Basel, Basel, Switzerland.
authors: Katrin
authors: K
authors: Weier
authors: Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland.
authors: Ernst W
authors: EW
authors: Radue
authors: Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland.
authors: Achim
authors: A
authors: Gass
authors: Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland.
authors: Ludwig
authors: L
authors: Kappos
authors: Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland.
authors: Yvonne
authors: Y
authors: Naegelin
authors: Department of Neurology, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors: Bernard M J
authors: BM
authors: Uitdehaag
authors: Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands. Department of Anatomy and Neurosciences, section of Clinical Neuroscience, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors: Jeroen J G
authors: JJ
authors: Geurts
authors: Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors: Frederik
authors: F
authors: Barkhof
authors: Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands. Department of Physics and Medical Technology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors: Hugo
authors: H
authors: Vrenken
mesh_terms: D000328:Adult; D001284:Atrophy; D001921:Brain / Q000473:pathology; D002574:Cervical Vertebrae / Q000473:pathology*; D015331:Cohort Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D013116:Spinal Cord / Q000473:pathology*
keywords: MRI; Multiple Sclerosis