title: Multicenter Validation of Mean Upper Cervical Cord Area Measurements from Head 3D T1-Weighted MR Imaging in Patients with Multiple Sclerosis.
abstract: OBJECTIVE
  Spinal cord atrophy is a common and clinically relevant characteristic in multiple sclerosis. We aimed to perform a multicenter validation study of mean upper cervical cord area measurements in patients with multiple sclerosis and healthy controls from head MR images and to explore the effect of gadolinium administration on mean upper cervical cord area measurements.
  
  
  METHODS
  We recruited 97 subjects from 3 centers, including 60 patients with multiple sclerosis of different disease types and 37 healthy controls. Both cervical cord and head 3D T1-weighted images were acquired. In 11 additional patients from 1 center, head images before and after gadolinium administration and cervical cord images after gadolinium administration were acquired. The mean upper cervical cord area was compared between cervical cord and head images by using intraclass correlation coefficients (ICC) for both consistency (ICCconsist) and absolute (ICCabs) agreement.
  
  
  RESULTS
  There was excellent agreement of mean upper cervical cord area measurements from head and cervical cord images in the entire group (ICCabs = 0.987) and across centers and disease subtypes. The mean absolute difference between the mean upper cervical cord area measured from head and cervical cord images was 2 mm(2) (2.3%). Additionally, excellent agreement was found between the mean upper cervical cord area measured from head images with and without gadolinium administration (ICCabs = 0.991) and between the cervical cord and head images with gadolinium administration (ICCabs = 0.992).
  
  
  CONCLUSIONS
  Excellent agreement between mean upper cervical cord area measurements on head and cervical cord images was observed in this multicenter study, implying that upper cervical cord atrophy can be reliably measured from head images. Postgadolinium head or cervical cord images may also be suitable for measuring mean upper cervical cord area.
authors.affiliation: From the Department of Radiology (Y.L., Y.D., K.L.), Xuanwu Hospital, Capital Medical University, Beijing, P.R. China Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam Department of Neurology and Tianjin Neurological Institute (Y.L.), Tianjin Medical University, General Hospital, Tianjin, P.R. China asiaeurope80@gmail.com.
authors.forename: Y
authors.identifier: http://orcid.org/0000-0002-9930-0331
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany.
authors.forename: C
authors.identifier: http://orcid.org/0000-0002-8562-9697
authors.initials: C
authors.lastname: Lukas
authors.affiliation: Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam.
authors.forename: M D
authors.identifier: http://orcid.org/0000-0002-8346-9044
authors.initials: MD
authors.lastname: Steenwijk
authors.affiliation: Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam Department of Anatomy and Neurosciences (M.D.), Section of Clinical Neuroscience.
authors.forename: M
authors.identifier: http://orcid.org/0000-0003-1976-1320
authors.initials: M
authors.lastname: Daams
authors.affiliation: Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam.
authors.forename: A
authors.identifier: http://orcid.org/0000-0003-1375-7873
authors.initials: A
authors.lastname: Versteeg
authors.affiliation: From the Department of Radiology (Y.L., Y.D., K.L.), Xuanwu Hospital, Capital Medical University, Beijing, P.R. China.
authors.forename: Y
authors.identifier: http://orcid.org/0000-0003-2706-9078
authors.initials: Y
authors.lastname: Duan
authors.affiliation: From the Department of Radiology (Y.L., Y.D., K.L.), Xuanwu Hospital, Capital Medical University, Beijing, P.R. China.
authors.forename: K
authors.identifier: http://orcid.org/0000-0001-8442-5695
authors.initials: K
authors.lastname: Li
authors.affiliation: Fraunhofer MEVIS, Institute for Medical Image Computing (F.W., H.K.H.), Bremen, Germany.
authors.forename: F
authors.identifier: http://orcid.org/0000-0002-5647-4577
authors.initials: F
authors.lastname: Weiler
authors.affiliation: Fraunhofer MEVIS, Institute for Medical Image Computing (F.W., H.K.H.), Bremen, Germany.
authors.forename: H K
authors.identifier: http://orcid.org/0000-0001-7512-5762
authors.initials: HK
authors.lastname: Hahn
authors.affiliation: Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam.
authors.forename: M P
authors.identifier: http://orcid.org/0000-0001-9298-2897
authors.initials: MP
authors.lastname: Wattjes
authors.affiliation: Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam.
authors.forename: F
authors.identifier: http://orcid.org/0000-0003-3543-3706
authors.initials: F
authors.lastname: Barkhof
authors.affiliation: Department of Radiology and Nuclear Medicine (Y.L., M.D.S., M.D., A.V., M.P.W., F.B., H.V.), Neuroscience Campus Amsterdam Department of Physics and Medical Technology (H.V.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: H
authors.identifier: http://orcid.org/0000-0001-9106-1172
authors.initials: H
authors.lastname: Vrenken
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy; D066193:Cervical Cord / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D004185:Disability Evaluation; D005260:Female; D005682:Gadolinium; D006257:Head; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000473:pathology; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media; D005682:Gadolinium