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Magnetic resonance imaging measures of brain and spinal cord atrophy correlate with clinical impairment in secondary progressive multiple sclerosis

Department of Neuroinflammation, Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom j.furby{at}ion.ucl.ac.uk

T Hayton

Department of Neuroinflammation, Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom

V Anderson

Dementia Research Centre, Institute of Neurology, London, United Kingdom

D Altmann

London School of Hygiene and Tropical Medicine, London, United Kingdom

R Brenner

Department of Neurology, Royal Free Hospital, London, United Kingdom

J Chataway

National Hospital for Neurology and Neurosurgery, London, United Kingdom

RAC Hughes

Department of Clinical Neuroscience, King's College London, London, United Kingdom

KJ Smith

Department of Neuroinflammation, Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom

DH Miller

Department of Neuroinflammation, Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom

R Kapoor

Department of Neuroinflammation, Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom

Background

Neuroaxonal loss is a pathological substrate of disability in progressive multiple sclerosis (MS) and can be estimated in vivo by measuring tissue atrophy on magnetic resonance imaging (MRI). While there is some evidence that brain atrophy correlates better with disability than T2 lesion load in secondary progressive MS, the clinical relevance of atrophy within specific regions of the central nervous system requires further evaluation.

Methods

Clinical and MRI examinations were performed in 117 subjects with secondary progressive MS. MRI analysis included measures of normalized brain volume (NBV), normalized grey matter (NGMV) and white matter volume (NWMV), central cerebral volume (CCV), spinal cord cross-sectional area (SCCA), and brain T2 and T1 lesion volume. Clinical assessments included the expanded disability status scale (EDSS) and MS functional composite (MSFC).

Results

All MRI measures correlated significantly with the MSFC score, with the strongest correlation being for the NBV (r = 0.47; P < 0.001). NBV and SCCA were the only significant independent predictors of the MSFC score in a stepwise regression model containing all the MRI measures, and SCCA was the only MRI measure to show a significant association with the EDSS. While NGMV had stronger correlations with the clinical variables than NWMV, NBV was more correlated with clinical impairment than either measure.

Conclusions

This data suggests that measures of atrophy, particularly of the whole brain and spinal cord, are relevant and useful disease markers in secondary progressive MS.

Key Words: atrophy • disability • MRI • multiple sclerosis • secondary progressive multiple sclerosis

This version was published on September 1, 2008

Multiple Sclerosis, Vol. 14, No. 8, 1068-1075 (2008)
DOI: 10.1177/1352458508093617


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