title: Unraveling the neuroimaging predictors for motor dysfunction in long-standing multiple sclerosis.
abstract: OBJECTIVE
  To find the strongest neuroimaging predictors for motor dysfunction using conventional and quantitative imaging measures focusing on the corticospinal tract (CST) in a large cohort of patients with long-standing multiple sclerosis (MS).
  
  
  METHODS
  In this cross-sectional study, a wide spectrum of neuroimaging measures at the whole-brain, cervical, and CST level were analyzed in 195 patients with MS and 54 healthy controls. Motor function was assessed using the Expanded Disability Status Scale (EDSS), 9-Hole Peg Test, Timed 25-Foot Walk Test, and Multiple Sclerosis Walking Scale. Associations between damage in different parts of the motor system and motor functioning were assessed using stepwise linear regression.
  
  
  RESULTS
  Patients had an average disease duration of 19.98 (±6.99) years and a median EDSS score of 4 (range: 1.0-8.0). EDSS score was associated with number of infratentorial and cervical cord lesions, lesion volume in the CST, and mean upper cervical cord area (adjusted R(2) = 0.403). Timed 25-Foot Walk Test score was associated with number of infratentorial lesions and cerebellar volume (adjusted R(2) = 0.150), 9-Hole Peg Test score with number of infratentorial lesions and thickness of the cortex connected to the CST (adjusted R(2) = 0.245), and Multiple Sclerosis Walking Scale with number of infratentorial and cervical lesions, thickness of the cortex connected to the CST, and mean upper cervical cord area (adjusted R(2) = 0.354).
  
  
  CONCLUSIONS
  Motor dysfunction in MS has a complex substrate that cannot be ascribed to a single neuroimaging finding, but is the consequence of infratentorial and spinal cord damage, as well as damage in the CST.
authors.affiliation: From the Departments of Radiology and Nuclear Medicine (M.D., M.D.S., M.P.W., F.B.), Anatomy and Neurosciences (M.D., J.J.G.G.), Neurology (B.M.J.U., P.K.T., L.J.B., J.K.), and Physics and Medical Technology (P.J.W.P.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands. m.daams@vumc.nl.
authors.forename: Marita
authors.initials: M
authors.lastname: Daams
authors.affiliation: From the Departments of Radiology and Nuclear Medicine (M.D., M.D.S., M.P.W., F.B.), Anatomy and Neurosciences (M.D., J.J.G.G.), Neurology (B.M.J.U., P.K.T., L.J.B., J.K.), and Physics and Medical Technology (P.J.W.P.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Martijn D
authors.initials: MD
authors.lastname: Steenwijk
authors.affiliation: From the Departments of Radiology and Nuclear Medicine (M.D., M.D.S., M.P.W., F.B.), Anatomy and Neurosciences (M.D., J.J.G.G.), Neurology (B.M.J.U., P.K.T., L.J.B., J.K.), and Physics and Medical Technology (P.J.W.P.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Mike P
authors.initials: MP
authors.lastname: Wattjes
authors.affiliation: From the Departments of Radiology and Nuclear Medicine (M.D., M.D.S., M.P.W., F.B.), Anatomy and Neurosciences (M.D., J.J.G.G.), Neurology (B.M.J.U., P.K.T., L.J.B., J.K.), and Physics and Medical Technology (P.J.W.P.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Jeroen J G
authors.initials: JJ
authors.lastname: Geurts
authors.affiliation: From the Departments of Radiology and Nuclear Medicine (M.D., M.D.S., M.P.W., F.B.), Anatomy and Neurosciences (M.D., J.J.G.G.), Neurology (B.M.J.U., P.K.T., L.J.B., J.K.), and Physics and Medical Technology (P.J.W.P.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Bernard M J
authors.initials: BM
authors.lastname: Uitdehaag
authors.affiliation: From the Departments of Radiology and Nuclear Medicine (M.D., M.D.S., M.P.W., F.B.), Anatomy and Neurosciences (M.D., J.J.G.G.), Neurology (B.M.J.U., P.K.T., L.J.B., J.K.), and Physics and Medical Technology (P.J.W.P.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Prejaas K
authors.initials: PK
authors.lastname: Tewarie
authors.affiliation: From the Departments of Radiology and Nuclear Medicine (M.D., M.D.S., M.P.W., F.B.), Anatomy and Neurosciences (M.D., J.J.G.G.), Neurology (B.M.J.U., P.K.T., L.J.B., J.K.), and Physics and Medical Technology (P.J.W.P.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Lisanne J
authors.initials: LJ
authors.lastname: Balk
authors.affiliation: From the Departments of Radiology and Nuclear Medicine (M.D., M.D.S., M.P.W., F.B.), Anatomy and Neurosciences (M.D., J.J.G.G.), Neurology (B.M.J.U., P.K.T., L.J.B., J.K.), and Physics and Medical Technology (P.J.W.P.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Petra J W
authors.initials: PJ
authors.lastname: Pouwels
authors.affiliation: From the Departments of Radiology and Nuclear Medicine (M.D., M.D.S., M.P.W., F.B.), Anatomy and Neurosciences (M.D., J.J.G.G.), Neurology (B.M.J.U., P.K.T., L.J.B., J.K.), and Physics and Medical Technology (P.J.W.P.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Joep
authors.initials: J
authors.lastname: Killestein
authors.affiliation: From the Departments of Radiology and Nuclear Medicine (M.D., M.D.S., M.P.W., F.B.), Anatomy and Neurosciences (M.D., J.J.G.G.), Neurology (B.M.J.U., P.K.T., L.J.B., J.K.), and Physics and Medical Technology (P.J.W.P.), 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; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019957:Motor Skills Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000453:epidemiology*; D059906:Neuroimaging / Q000639:trends*; D011237:Predictive Value of Tests; D011446:Prospective Studies