Spinal cord atrophy and disability in multiple sclerosis : A new reproducible and sensitive MRI method with potential to monitor disease progression

Recent MRI studies in multiple sclerosis have highlighted the potential importance of spinal cord atrophy (implicating axonal loss) in the development of disability. However, the techniques applied in these initial studies have poor reproducibility which limits their application in the serial monito...

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Bibliographic Details
Published in:Brain (London, England : 1878) England : 1878), 1996-06, Vol.119 (3), p.701-708
Main Authors: LOSSEFF, N. A, WEBB, S. L, O'RIORDAN, J. I, PAGE, R, WANG, L, BARKER, G. J, TOFTS, P. S, MCDONALD, W. I, MILLER, D. H, THOMPSON, A. J
Format: Article
Language:English
Subjects:
Adult
Atrophy
Biological and medical sciences
Data Interpretation, Statistical
Disability Evaluation
Disease Progression
Female
Humans
Investigative techniques, diagnostic techniques (general aspects)
Magnetic Resonance Imaging - methods
Male
Medical sciences
Middle Aged
Multiple Sclerosis - diagnosis
Multiple Sclerosis - pathology
Nervous system
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Reproducibility of Results
Spinal Cord - pathology
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Summary:Recent MRI studies in multiple sclerosis have highlighted the potential importance of spinal cord atrophy (implicating axonal loss) in the development of disability. However, the techniques applied in these initial studies have poor reproducibility which limits their application in the serial monitoring of patients. The aim of this study was to develop a highly reproducible and accurate method for the quantification of atrophy. The technique we describe demonstrates an intra-observer coefficient of variation (scan-rescan) of only 0.8%. When applied to 60 patients with clinically definite multiple sclerosis there was a strong correlation between spinal cord area and disability measured by Kurtzke's Expanded Disability Status Scale (EDSS) (r = -0.7, P < 0.001). The correlation was graded providing evidence for a causal connection. At levels 3 and 8 of the EDSS we observed a reduction in average cord area of 12 and 35%, respectively. Given its reproducibility, the magnitude of the change detected and the strong correlation with disability, this new technique should prove to be a sensitive measure of progressive neurological deterioration and could be readily incorporated into imaging protocols aimed at monitoring therapy.
ISSN:0006-8950
1460-2156
DOI:10.1093/brain/119.3.701