Brain, Vol. 119, No. 3, 701-708, 1996
© 1996 Guarantors of Brain
research-article |
Spinal cord atrophy and disability in multiple sclerosis
A new reproducible and sensitive MRI method with potential to monitor disease progression
NMR Research Unit, Institute of Neurology London
Correspondence to:
Correspondence to: Dr A. J. Thompson, NMR Research Unit, Institute of Neurology, Queen Square, London WC1N 3BG, UK
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.
multiple sclerosis; MRI; disability; spinal cord atrophy; clinical measurement
Received December 12, 1995. Revised January 16, 1996. Accepted February 16, 1996.
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T L Luks, D E Goodkin, S J Nelson, S Majumdar, P Bacchetti, D Portnoy, and R Sloan A longitudinal study of ventricular volume in early relapsing-remitting multiple sclerosis Multiple Sclerosis, October 1, 2000; 6(5): 332 - 337. [Abstract] [PDF]
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P. D Molyneux, P. A Brex, C. Fogg, S. Lewis, C. Middleditch, F. Barkhof, M. P Sormani, M. Filippi, and D. H Miller The precision of T1 hypointense lesion volume quantification in multiple sclerosis treatment trials: a multicenter study Multiple Sclerosis, August 1, 2000; 6(4): 237 - 240. [Abstract] [PDF]
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A. M. Saindane, Y. Ge, J. K. Udupa, J. S. Babb, L. J. Mannon, and R. I. Grossman The effect of gadolinium-enhancing lesions on whole brain atrophy in relapsing-remitting MS Neurology, July 12, 2000; 55(1): 61 - 65. [Abstract] [Full Text] [PDF]
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V L Stevenson, D H Miller, S M Leary, M Rovaris, F Barkhof, B Brochet, V Dousset, V Dousset, M Filippi, R Hintzen, et al. One year follow up study of primary and transitional progressive multiple sclerosis J. Neurol. Neurosurg. Psychiatry, June 1, 2000; 68(6): 713 - 718. [Abstract] [Full Text] [PDF]
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A. Bitsch, J. Schuchardt, S. Bunkowski, T. Kuhlmann, and W. Bruck Acute axonal injury in multiple sclerosis: Correlation with demyelination and inflammation Brain, June 1, 2000; 123(6): 1174 - 1183. [Abstract] [Full Text] [PDF]
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A. C. Scanderbeg, F. Tomaiuolo, U. Sabatini, U. Nocentini, M. G. Grasso, and C. Caltagirone Demyelinating Plaques in Relapsing-remitting and Secondary-progressive Multiple Sclerosis: Assessment with Diffusion MR Imaging AJNR Am. J. Neuroradiol., May 1, 2000; 21(5): 862 - 868. [Abstract] [Full Text]
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P. A. Brex, R. Jenkins, N. C. Fox, W. R. Crum, J. I. O'Riordan, G. T. Plant, and D. H. Miller Detection of ventricular enlargement in patients at the earliest clinical stage of MS Neurology, April 25, 2000; 54(8): 1689 - 1691. [Abstract] [Full Text] [PDF]
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D. B. McGavern, P. D. Murray, C. Rivera-Quinones, J. D. Schmelzer, P. A. Low, and M. Rodriguez Axonal loss results in spinal cord atrophy, electrophysiological abnormalities and neurological deficits following demyelination in a chronic inflammatory model of multiple sclerosis Brain, March 1, 2000; 123(3): 519 - 531. [Abstract] [Full Text] [PDF]
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W. J. Jagust and J. H. Noseworthy Brain atrophy as a surrogate marker in MS: Faster, simpler, better? Neurology, February 22, 2000; 54(4): 782 - 783. [Full Text] [PDF]
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N. C. Fox, R. Jenkins, S. M. Leary, V. L. Stevenson, N. A. Losseff, W. R. Crum, R. J. Harvey, M. N. Rossor, D. H. Miller, and A. J. Thompson Progressive cerebral atrophy in MS: A serial study using registered, volumetric MRI Neurology, February 22, 2000; 54(4): 807 - 812. [Abstract] [Full Text] [PDF]
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C. L. A. Mann, M. B. Davies, M. D. Boggild, J. Alldersea, A. A. Fryer, P. W. Jones, C. Ko Ko, C. Young, R. C. Strange, and C. P. Hawkins Glutathione S-transferase polymorphisms in MS: Their relationship to disability Neurology, February 8, 2000; 54(3): 552 - 552. [Abstract] [Full Text] [PDF]
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G. Lovas, N. Szilagyi, K. Majtenyi, M. Palkovits, and S. Komoly Axonal changes in chronic demyelinated cervical spinal cord plaques Brain, February 1, 2000; 123(2): 308 - 317. [Abstract] [Full Text] [PDF]
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O. Gonen, I. Catalaa, J. S. Babb, Y. Ge, L. J. Mannon, D. L. Kolson, and R. I. Grossman Total brain N-acetylaspartate: A new measure of disease load in MS Neurology, January 11, 2000; 54(1): 15 - 15. [Abstract] [Full Text] [PDF]
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M. A. Lee, A. M. Blamire, S. Pendlebury, K.-H. Ho, K. R. Mills, P. Styles, J. Palace, and P. M. Matthews Axonal Injury or Loss in the Internal Capsule and Motor Impairment in Multiple Sclerosis Arch Neurol, January 1, 2000; 57(1): 65 - 70. [Abstract] [Full Text] [PDF]
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C H POLMAN, D H MILLER, W I MCDONALD, and A J THOMPSON Treatment recommendations for interferon-beta in multiple sclerosis J. Neurol. Neurosurg. Psychiatry, November 1, 1999; 67(5): 561 - 564. [Full Text]
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M. Bozzali, M. A. Rocca, G. Iannucci, C. Pereira, G. Comi, and M. Filippi Magnetization-Transfer Histogram Analysis of the Cervical Cord in Patients with Multiple Sclerosis AJNR Am. J. Neuroradiol., November 1, 1999; 20(10): 1803 - 1808. [Abstract] [Full Text]
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R. A. Rudick, E. Fisher, J.-C. Lee, J. Simon, and L. Jacobs Use of the brain parenchymal fraction to measure whole brain atrophy in relapsing-remitting MS Neurology, November 1, 1999; 53(8): 1698 - 1698. [Abstract] [Full Text] [PDF]
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D. B. Hackney MR Studies of the Spinal Cord in Patients with Multiple Sclerosis: What Should We Do? AJNR Am. J. Neuroradiol., October 1, 1999; 20(9): 1581 - 1583. [Full Text]
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I. Catalaa, J. C. Fulton, X. Zhang, J. K. Udupa, D. Kolson, M. Grossman, L. Wei, J. C. McGowan, M. Polansky, and R. I. Grossman MR Imaging Quantitation of Gray Matter Involvement in Multiple Sclerosis and Its Correlation with Disability Measures and Neurocognitive Testing AJNR Am. J. Neuroradiol., October 1, 1999; 20(9): 1613 - 1618. [Abstract] [Full Text]
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J. Chong, A. D. Rocco, M. Tagliati, F. Danisi, D. M. Simpson, and S. W. Atlas MR Findings in AIDS-Associated Myelopathy AJNR Am. J. Neuroradiol., September 1, 1999; 20(8): 1412 - 1416. [Abstract] [Full Text]
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