title: Spinal cord atrophy in anterior-posterior direction reflects impairment in multiple sclerosis.
abstract: OBJECTIVE
  To investigate how atrophy is distributed over the cross section of the upper cervical spinal cord and how this relates to functional impairment in multiple sclerosis (MS).
  
  
  METHODS
  We analysed the structural brain MRI scans of 54 patients with relapsing-remitting MS (n=22), primary progressive MS (n=9), secondary progressive MS (n=23) and 23 age- and sex-matched healthy controls. We measured the cross-sectional area (CSA), left-right width (LRW) and anterior-posterior width (APW) of the spinal cord at the segmental level C2. We tested for a nonparametric linear relationship between these atrophy measures and clinical impairments as reflected by the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Impairment Scale (MSIS).
  
  
  RESULTS
  In patients with MS, CSA and APW but not LRW were reduced compared to healthy controls (P<.02) and showed significant correlations with EDSS, MSIS and specific MSIS subscores.
  
  
  CONCLUSIONS
  In patients with MS, atrophy of the upper cervical cord is most evident in the antero-posterior direction. As APW of the cervical cord can be readily derived from standard structural MRI of the brain, APW constitutes a clinically useful neuroimaging marker of disease-related neurodegeneration in MS.
authors.affiliation: Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: H
authors.identifier: http://orcid.org/0000-0002-7044-442X
authors.initials: H
authors.lastname: Lundell
authors.affiliation: Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: O
authors.initials: O
authors.lastname: Svolgaard
authors.affiliation: Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: A-M
authors.initials: AM
authors.lastname: Dogonowski
authors.affiliation: Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Romme Christensen
authors.affiliation: Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: F
authors.initials: F
authors.lastname: Selleberg
authors.affiliation: Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Soelberg Sørensen
authors.affiliation: Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Blinkenberg
authors.affiliation: Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.|Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
authors.forename: H R
authors.initials: HR
authors.lastname: Siebner
authors.affiliation: Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Garde
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy / Q000000981:diagnostic imaging / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging / Q000473:pathology*; D020528:Multiple Sclerosis, Chronic Progressive / Q000000981:diagnostic imaging / Q000473:pathology; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000000981:diagnostic imaging / Q000473:pathology; D059906:Neuroimaging; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: atrophy; magnetic resonance imaging; multiple sclerosis; spinal cord