Radiological Changes in the Spinal Cord and Brain of Patients with HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP)

• Published in: Pathogens (Basel) Vol. 13; no. 11; p. 920
• Main Authors: Stack, Emily H., Okar, Serhat V., Wu, Tianxia, Stack, Mallory, Mina, Yair, Gaitán, María, Azodi, Shila, Frazier, Will, Ohayon, Joan, Cortese, Irene C. M., Reich, Daniel S., Nair, Govind, Jacobson, Steven
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.11.2024; MDPI
• Subjects: Adult; Aged; Atrophy; Automation; Brain; Brain - diagnostic imaging; Brain - pathology; central nervous system atrophy; Central nervous system diseases; Disability; Female; Health aspects; Hereditary spastic paraplegia; Histopathology; HTLV-1-associated myelopathy; Human T-lymphotropic virus 1; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multiple sclerosis; Nervous system diseases; Neurological diseases; Paraparesis, Tropical Spastic - diagnostic imaging; Paraparesis, Tropical Spastic - pathology; Patients; Principal components analysis; Quality control; Spinal cord; Spinal Cord - diagnostic imaging; Spinal Cord - pathology; spinal cord atrophy; Substantia alba; Thorax; Tissues; Tropical spastic paraparesis; Tumor necrosis factor-TNF; White Matter - diagnostic imaging; White Matter - pathology; white matter hyperintensities; Maryland; Mississippi; United States > US; HTLV-1-associated myelopathy; magnetic resonance imaging; central nervous system atrophy; spinal cord atrophy; white matter hyperintensities
• ISSN: 2076-0817; 2076-0817
• DOI: 10.3390/pathogens13110920

HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic, progressive neurological disorder and shares many radiological and clinical features with other more prevalent myelopathies. Here, we quantified spinal cord and brain volumes in adults with HAM/TSP in comparison with healthy volunteers (HVs) and individuals diagnosed with relapsing–remitting or progressive multiple sclerosis (RRMS or P-MS). Clinical disability and MRI were assessed in 24 HVs, 43 HAM/TSP subjects, and 46 MS subjects. Spinal cord cross-sectional area (SCCSA) and brain tissue volumes were measured and compared. HAM/TSP subjects had significantly lower SCCSA corresponding to cervical levels 2 and 3 (C2–3) (54.0 ± 8 mm2), cervical levels 4 and 5 (C4–5) (57.8 ± 8 mm2), and thoracic levels 4 to 9 (T4–9) (22.7 ± 4 mm2) and significantly elevated brain white matter hyperintensity (WMH) fraction (0.004 ± 0.008) compared to the HVs (C2–3: 69.4 ± 8 mm2, C4–5: 75.1 ± 9 mm2, T4–9: 34.1 ± 4 mm2; all p < 0.0001; and WMH: 0.0005 ± 0.0007; p < 0.001). In the HAM/TSP subjects, SCCSA at all levels but not WMH showed a significant correlation with clinical disability scores. WMH in HAM/TSP subjects, therefore, may not be related to clinical disability. SCCSA in our limited RRMS cohort was higher than the HAM/TSP cohort (C2–3: 67.6 ± 8 mm2, C4–5: 72.7 ± 9 mm2, T4–9: 33.4 ± 5 mm2; all p < 0.0001) and WMH was lower than in P-MS subjects (p = 0.0067). Principal component analysis suggested that SCCSA and WMH may be used to differentiate HAM/TSP from MS. Understanding these differences msay help establish early diagnostic criteria for HAM/TSP patients.