title: Cervical cord area measurement using volumetric brain magnetic resonance imaging in multiple sclerosis.
abstract: BACKGROUND
  In multiple sclerosis (MS), recent work suggests that cervical cord atrophy is more consistently correlated with physical disability than brain white matter lesion load and atrophy. Although spinal cord imaging has not been routinely obtained in many clinical trial and research studies, brain volumetric imaging usually has and includes the upper cervical cord.
  
  
  OBJECTIVE
  Using volumetric T1-weighted brain images, we investigated cross-sectional area measures in the uppermost cervical cord and compared them with areas at the standard C2/3 level.
  
  
  METHODS
  Using T1-weighted brain scans from 13 controls and 37 people with MS, and an active surface technique, cross-sectional area was measured over 5mm and 1mm cord segments at C2/3, below the level of odontoid peg, and 2cm and 2.5cm below the pons. Brain volume was also measured.
  
  
  RESULTS
  Cord area measurements were most reliable in a 5mm segment 2.5cm below the pons (inter-rater coefficient of variation 1.5%, intraclass correlation coefficient 0.99). Cord area at this level correlated more with that at C2/3 area than with brain volume (r=0.811 with C2/3, r=0.502 with brain volume).
  
  
  CONCLUSIONS
  Whereas the standard C2/3 level is often not within the field of view on brain images, the level 2.5cm below the pons usually is, and measurement at this level may be a good way to investigate upper cervical cord atrophy when only brain images are available.
authors: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, UK; Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China.
authors: Zheng
authors: Z
authors: Liu
authors: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, UK.
authors: Özgür
authors: Ö
authors: Yaldizli
authors: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, UK; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
authors: Matteo
authors: M
authors: Pardini
authors: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, UK.
authors: Varun
authors: V
authors: Sethi
authors: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, UK.
authors: Hugh
authors: H
authors: Kearney
authors: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, UK.
authors: Nils
authors: N
authors: Muhlert
authors: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, UK.
authors: Claudia
authors: C
authors: Wheeler-Kingshott
authors: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, UK.
authors: David H
authors: DH
authors: Miller
authors: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, UK; National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre, UK. Electronic address: d.chard@ucl.ac.uk.
authors: Declan T
authors: DT
authors: Chard
mesh_terms: D001921:Brain / Q000473:pathology; D066193:Cervical Cord / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000473:pathology*; D015203:Reproducibility of Results
keywords: Atrophy; MRI; Multiple sclerosis; Spinal cord