Brain, Vol. 122, No. 2, 291-301,
February 1999
© 1999 Oxford University Press
Infratentorial atrophy on magnetic resonance imaging and disability in multiple sclerosis
1 Division of Clinical Neurology, University of Nottingham, 2 Department of Diagnostic Imaging, University Hospital, Queen's Medical Centre, Nottingham and 3 Magnetic Resonance Research Centre, University of Liverpool, UK
Correspondence to:
Professor Lance D. Blumhardt, Division of Clinical Neurology, Faculty of Medicine, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH, UK
Loss of tissue volume in the central nervous system may provide an index of fixed neurological dysfunction in multiple sclerosis. Recent magnetic resonance studies have shown a modest relationship between clinical disability rating scores and transverse sectional area of the cervical spinal cord. To explore further the relationship between atrophy and disability in multiple sclerosis, we estimated the volumes of infratentorial structures from MRIs in a cross-sectional study of 41 patients, 21 with relapsing–remitting multiple sclerosis and 20 with secondary progressive multiple sclerosis. We used the Cavalieri method of modern design stereology with point counting to estimate the volume of brainstem, cerebellum and upper cervical spinal cord from three-dimensional MRIs acquired with an MPRAGE (Magnetization-prepared Rapid Acquisition Gradient Echo) sequence. The volume of the upper (C1–C3) cervical spinal cord was significantly correlated with a composite spinal cord score derived from the appropriate Functional Scale scores of the Expanded Disability Status Scale (r = –0.50, P < 0.01). The cerebellar (r = 0.49, P < 0.01) and brainstem (r = 0.34, P < 0.05) volumes correlated with the Scripp's Neurological Disability Rating Scale scores. The upper cervical cord volumes (r = –0.39, P < 0.01), but not the brainstem or cerebellar volumes, were significantly associated with disease duration. MRI-estimated structural volumes may provide a simple index of axonal and/or myelin loss, the presumed pathological substrates of irreversible impairment and disability in multiple sclerosis.
multiple sclerosis; MRI; MPRAGE; infratentorial; atrophy
EDSS = Expanded Disability Status Scale; IFS = Infratentorial Functional Score; KFS = Kurtzke Functional System Scores; SNRS = Scripp's Neurological Rating Scale; UCC = upper cervical spinal cord
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