Brain, Vol 121, Issue 7 1305-1312, Copyright © 1998 by Oxford University Press
F Riahi, A Zijdenbos, S Narayanan, D Arnold, G Francis, J Antel and AC Evans
We hypothesized that a better correlation between MRI and clinical measures
of neurological disability using the expanded disability status scale
(EDSS) in multiple sclerosis could be obtained by assessing lesion load
only in and around the corticospinal tracts, since the EDSS is weighted
towards motor and ambulatory deficits. Multiple sclerosis lesions in
cerebral MRIs from 39 patients with relapsing-remitting multiple sclerosis
were manually painted using a three-dimensional computer display tool and
mapped into a standardized three-dimensional coordinate space. Total lesion
load was then measured. A mask to expose only the corticospinal tract was
extracted from an MRI atlas and used to measure lesion load in the
corticospinal tract. To account for the residual anatomical variability
among the different MRI volumes after stereotaxic transformation, the
corticospinal tract mask was dilated to various degrees and the lesion load
remeasured. Spearman's rank correlation coefficient was used to calculate
the correlation between the EDSS and total lesion load and corticospinal
tract lesion load and between the EDSS subscores and total lesion load and
corticospinal tract lesion load. Spearman's rank correlation coefficient
between the EDSS and total lesion load was 0.6, probably reflecting the
rather broad EDSS range represented in the study. The highest correlation
of 0.67 was between the EDSS and corticospinal tract lesion load, dilated
with a blurring kernel of 8-10 mm. The pyramidal subscore alone showed a
weaker correlation with total lesion load, and with corticospinal tract
lesion load, than did the overall EDSS, possibly reflecting the narrow
range of disability in these subscores in patients with EDSS scores of
1-6.5. The imperfect correlation between the EDSS and corticospinal tract
lesion load suggests that factors other than cerebral T2-weighted lesion
volume are important determinants of disability.
ARTICLES
Improved correlation between scores on the expanded disability status scale and cerebral lesion load in relapsing-remitting multiple sclerosis. Results of the application of new imaging methods
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Canada.
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