title: Spinal cord atrophy in multiple sclerosis and relationship with disability across clinical phenotypes.
abstract: BACKGROUND
  Several studies have shown a relationship between spinal cord atrophy and clinical disability in patients with multiple sclerosis (MS).
  
  
  OBJECTIVE
  We examined the correlation between cervical cord cross-sectional area at the C2 vertebral level (CSA-C2) and the expanded disability status scale (EDSS) in patients with relapsing-remitting and progressive forms of MS. The latter included both secondary and primary progressive MS patients.
  
  
  METHODS
  A total of 150 patients with MS were recruited from the Wayne State University MS clinic. Ninety-three had relapsing-remitting MS and 57 patients had progressive MS. MRI scan of the cervical cord was obtained for each patient. Correlation studies and multivariate regression analysis was performed, blinded to clinical status.
  
  
  RESULTS
  The mean age was 41.3 year old, 64.6% were women, mean disease duration was 11.2 years, CSA-C2 was 80.2mm(2) and mean EDSS was 3.8. There was significant correlation between CSA-C2 and EDSS (r -0.75, p<0.0001). Sub-group analysis showed CSA-C2 was 68.6mm(2) and 87.3mm(2) in the progressive and relapsing-remitting groups, respectively (p<0.0001). Multivariable regression showed that CSA-C2 was a significant predictor of disability independent of disease duration, and phenotype.
  
  
  CONCLUSIONS
  Our study demonstrates that CSA-C2 has a strong correlation with clinical disability in both RRMS and progressive MS. Greater spinal cord atrophy was seen in patients with progressive than relapsing-remitting MS. CSA-C2, disease duration, and phenotype are independent predictors of disability.
authors: Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA.
authors: Evanthia
authors: E
authors: Bernitsas
authors: The Sastry Foundation Advanced Imaging Laboratory, Department of Neurology, Wayne State University School of Medicine, Detroit, USA.
authors: Fen
authors: F
authors: Bao
authors: Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA; The Sastry Foundation Advanced Imaging Laboratory, Department of Neurology, Wayne State University School of Medicine, Detroit, USA.
authors: Navid
authors: N
authors: Seraji-Bozorgzad
authors: Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA; The Sastry Foundation Advanced Imaging Laboratory, Department of Neurology, Wayne State University School of Medicine, Detroit, USA.
authors: Jessica
authors: J
authors: Chorostecki
authors: Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA; The Sastry Foundation Advanced Imaging Laboratory, Department of Neurology, Wayne State University School of Medicine, Detroit, USA.
authors: Carla
authors: C
authors: Santiago
authors: Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA.
authors: Alexandros
authors: A
authors: Tselis
authors: Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA.
authors: Christina
authors: C
authors: Caon
authors: Department of Radiology, Wayne State University School of Medicine, Detroit, USA.
authors: Imad
authors: I
authors: Zak
authors: Division of Clinical Research & Biostatistics, Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, USA.
authors: Scott
authors: S
authors: Millis
authors: Multiple Sclerosis Center, Wayne State University School of Medicine, Detroit, USA; The Sastry Foundation Advanced Imaging Laboratory, Department of Neurology, Wayne State University School of Medicine, Detroit, USA. Electronic address: okhan@med.wayne.edu.
authors: Omar
authors: O
authors: Khan
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy / Q000209:etiology; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology*; D015999:Multivariate Analysis; D010641:Phenotype; D013116:Spinal Cord / Q000473:pathology*; D018709:Statistics, Nonparametric; D055815:Young Adult
keywords: Disability; Disease progression; Magnetic resonance imaging (MRI); Multiple sclerosis; Spinal cord atrophy