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

• Published in: Brain (London, England : 1878) Vol. 119; no. 3; pp. 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: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.06.1996; Oxford Publishing Limited (England)
• 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; Human; Equilibrium disorder; Nervous system diseases; Spinal cord; Multiple sclerosis; Central nervous system disease; Atrophia; Exploration; Nuclear magnetic resonance imaging; Spinal cord disease; Inflammatory disease
• ISSN: 0006-8950; 1460-2156
• DOI: 10.1093/brain/119.3.701

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.