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<meta name="DC.Title" content="A 3T MR Imaging Investigation of the Topography of Whole Spinal Cord Atrophy in Multiple Sclerosis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2459" />
<meta name="DC.Date" content="2011-06-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology. 
Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Spinal cord atrophy is a common feature of MS. However, it is unknown which cord levels are most susceptible to atrophy. We performed whole cord imaging to identify the levels most susceptible to atrophy in patients with MS versus controls and also tested for differences among MS clinical phenotypes.

MATERIALS AND METHODS: Thirty-five patients with MS (2 with CIS, 27 with RRMS, 2 with SPMS, and 4 with PPMS phenotypes) and 27 healthy controls underwent whole cord 3T MR imaging. The spinal cord contour was segmented and assigned to bins representing each C1 to T12 vertebral level. Volumes were normalized, and group comparisons were age-adjusted.

RESULTS: There was a trend toward decreased spinal cord volume at the upper cervical levels in PPMS/SPMS versus controls. A trend toward increased spinal cord volume throughout the cervical and thoracic cord in RRMS/CIS versus controls reached statistical significance at the T10 vertebral level. A statistically significant decrease was found in spinal cord volume at the upper cervical levels in PPMS/SPMS versus RRMS/CIS.

CONCLUSIONS: Opposing pathologic factors impact spinal cord volume measures in MS. Patients with PPMS demonstrated a trend toward upper cervical cord atrophy. However patients with RRMS showed a trend toward increased volume at the cervical and thoracic levels, which most likely reflects inflammation or edema-related cord expansion. With the disease causing both expansion and contraction of the cord, the specificity of spinal cord volume measures for neuroprotective therapeutic effect may be limited.

CIS
:   clinically isolated syndrome
EDSS
:   Expanded Disability Status Scale
ICV
:   intracranial volume
MDEFT
:   modified driven equilibrium Fourier transform
MS
:   multiple sclerosis
PPMS
:   primary-progressive multiple sclerosis
RRMS
:   relapsing-remitting multiple sclerosis
SPMS
:   secondary-progressive multiple sclerosis
WC
:   whole cord" />
<meta name="DC.Contributor" content="J.P. Klein" />
<meta name="DC.Contributor" content="A. Arora" />
<meta name="DC.Contributor" content="M. Neema" />
<meta name="DC.Contributor" content="B.C. Healy" />
<meta name="DC.Contributor" content="S. Tauhid" />
<meta name="DC.Contributor" content="D. Goldberg-Zimring" />
<meta name="DC.Contributor" content="C. Chavarro-Nieto" />
<meta name="DC.Contributor" content="J.M. Stankiewicz" />
<meta name="DC.Contributor" content="A.B. Cohen" />
<meta name="DC.Contributor" content="G.J. Buckle" />
<meta name="DC.Contributor" content="M.K. Houtchens" />
<meta name="DC.Contributor" content="A. Ceccarelli" />
<meta name="DC.Contributor" content="E. Dell'Oglio" />
<meta name="DC.Contributor" content="C.R.G. Guttmann" />
<meta name="DC.Contributor" content="D.C. Alsop" />
<meta name="DC.Contributor" content="D.B. Hackney" />
<meta name="DC.Contributor" content="R. Bakshi" />
<meta name="article:published_time" content="2011-06-01" />
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<meta name="citation_title" content="A 3T MR Imaging Investigation of the Topography of Whole Spinal Cord Atrophy in Multiple Sclerosis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Spinal cord atrophy is a common feature of MS. However, it is unknown which cord levels are most susceptible to atrophy. We performed whole cord imaging to identify the levels most susceptible to atrophy in patients with MS versus controls and also tested for differences among MS clinical phenotypes.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Thirty-five patients with MS (2 with CIS, 27 with RRMS, 2 with SPMS, and 4 with PPMS phenotypes) and 27 healthy controls underwent whole cord 3T MR imaging. The spinal cord contour was segmented and assigned to bins representing each C1 to T12 vertebral level. Volumes were normalized, and group comparisons were age-adjusted.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;There was a trend toward decreased spinal cord volume at the upper cervical levels in PPMS/SPMS versus controls. A trend toward increased spinal cord volume throughout the cervical and thoracic cord in RRMS/CIS versus controls reached statistical significance at the T10 vertebral level. A statistically significant decrease was found in spinal cord volume at the upper cervical levels in PPMS/SPMS versus RRMS/CIS.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Opposing pathologic factors impact spinal cord volume measures in MS. Patients with PPMS demonstrated a trend toward upper cervical cord atrophy. However patients with RRMS showed a trend toward increased volume at the cervical and thoracic levels, which most likely reflects inflammation or edema-related cord expansion. With the disease causing both expansion and contraction of the cord, the specificity of spinal cord volume measures for neuroprotective therapeutic effect may be limited.&lt;/p&gt;" />
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<meta name="twitter:title" content="A 3T MR Imaging Investigation of the Topography of Whole Spinal Cord Atrophy in Multiple Sclerosis" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Spinal cord atrophy is a common feature of MS. However, it is unknown which cord levels are most susceptible to atrophy. We performed whole cord imaging to identify the levels most susceptible to atrophy in patients with MS versus controls and also tested for differences among MS clinical phenotypes.

MATERIALS AND METHODS: Thirty-five patients with MS (2 with CIS, 27 with RRMS, 2 with SPMS, and 4 with PPMS phenotypes) and 27 healthy controls underwent whole cord 3T MR imaging. The spinal cord contour was segmented and assigned to bins representing each C1 to T12 vertebral level. Volumes were normalized, and group comparisons were age-adjusted.

RESULTS: There was a trend toward decreased spinal cord volume at the upper cervical levels in PPMS/SPMS versus controls. A trend toward increased spinal cord volume throughout the cervical and thoracic cord in RRMS/CIS versus controls reached statistical significance at the T10 vertebral level. A statistically significant decrease was found in spinal cord volume at the upper cervical levels in PPMS/SPMS versus RRMS/CIS.

CONCLUSIONS: Opposing pathologic factors impact spinal cord volume measures in MS. Patients with PPMS demonstrated a trend toward upper cervical cord atrophy. However patients with RRMS showed a trend toward increased volume at the cervical and thoracic levels, which most likely reflects inflammation or edema-related cord expansion. With the disease causing both expansion and contraction of the cord, the specificity of spinal cord volume measures for neuroprotective therapeutic effect may be limited.

CIS
:   clinically isolated syndrome
EDSS
:   Expanded Disability Status Scale
ICV
:   intracranial volume
MDEFT
:   modified driven equilibrium Fourier transform
MS
:   multiple sclerosis
PPMS
:   primary-progressive multiple sclerosis
RRMS
:   relapsing-remitting multiple sclerosis
SPMS
:   secondary-progressive multiple sclerosis
WC
:   whole cord" />
<meta name="og-title" property="og:title" content="A 3T MR Imaging Investigation of the Topography of Whole Spinal Cord Atrophy in Multiple Sclerosis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/32/6/1138" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Spinal cord atrophy is a common feature of MS. However, it is unknown which cord levels are most susceptible to atrophy. We performed whole cord imaging to identify the levels most susceptible to atrophy in patients with MS versus controls and also tested for differences among MS clinical phenotypes.

MATERIALS AND METHODS: Thirty-five patients with MS (2 with CIS, 27 with RRMS, 2 with SPMS, and 4 with PPMS phenotypes) and 27 healthy controls underwent whole cord 3T MR imaging. The spinal cord contour was segmented and assigned to bins representing each C1 to T12 vertebral level. Volumes were normalized, and group comparisons were age-adjusted.

RESULTS: There was a trend toward decreased spinal cord volume at the upper cervical levels in PPMS/SPMS versus controls. A trend toward increased spinal cord volume throughout the cervical and thoracic cord in RRMS/CIS versus controls reached statistical significance at the T10 vertebral level. A statistically significant decrease was found in spinal cord volume at the upper cervical levels in PPMS/SPMS versus RRMS/CIS.

CONCLUSIONS: Opposing pathologic factors impact spinal cord volume measures in MS. Patients with PPMS demonstrated a trend toward upper cervical cord atrophy. However patients with RRMS showed a trend toward increased volume at the cervical and thoracic levels, which most likely reflects inflammation or edema-related cord expansion. With the disease causing both expansion and contraction of the cord, the specificity of spinal cord volume measures for neuroprotective therapeutic effect may be limited.

CIS
:   clinically isolated syndrome
EDSS
:   Expanded Disability Status Scale
ICV
:   intracranial volume
MDEFT
:   modified driven equilibrium Fourier transform
MS
:   multiple sclerosis
PPMS
:   primary-progressive multiple sclerosis
RRMS
:   relapsing-remitting multiple sclerosis
SPMS
:   secondary-progressive multiple sclerosis
WC
:   whole cord" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node9519--5" data-node-nid="9519" id="top-node-9519--61375577051" data-pisa="ajnr;32/6/1138" data-pisa-master="ajnr;ajnr.A2459" data-apath="/ajnr/32/6/1138.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">A 3T MR Imaging Investigation of the Topography of Whole Spinal Cord Atrophy in Multiple Sclerosis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.P. Klein</span>, <span class="highwire-citation-author" data-delta="1">A. Arora</span>, <span class="highwire-citation-author" data-delta="2">M. Neema</span>, <span class="highwire-citation-author" data-delta="3">B.C. Healy</span>, <span class="highwire-citation-author" data-delta="4">S. Tauhid</span>, <span class="highwire-citation-author" data-delta="5">D. Goldberg-Zimring</span>, <span class="highwire-citation-author" data-delta="6">C. Chavarro-Nieto</span>, <span class="highwire-citation-author" data-delta="7">J.M. Stankiewicz</span>, <span class="highwire-citation-author" data-delta="8">A.B. Cohen</span>, <span class="highwire-citation-author" data-delta="9">G.J. Buckle</span>, <span class="highwire-citation-author" data-delta="10">M.K. Houtchens</span>, <span class="highwire-citation-author" data-delta="11">A. Ceccarelli</span>, <span class="highwire-citation-author" data-delta="12">E. Dell'Oglio</span>, <span class="highwire-citation-author" data-delta="13">C.R.G. Guttmann</span>, <span class="highwire-citation-author" data-delta="14">D.C. Alsop</span>, <span class="highwire-citation-author" data-delta="15">D.B. Hackney</span> and <span class="highwire-citation-author" data-delta="16">R. Bakshi</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">June 2011,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1138-1142; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2459 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9519--61375577051" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.P. Klein </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.P.%2BKlein%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Klein%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.P.%2BKlein%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">A. 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        <h2 class="pane-title">Data supplements</h2>
    
  
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            <h2>Supplemental Online Tables</h2>
            <p><strong>Files in this Data Supplement:</strong></p>
            <ul><li><a href="/highwire/filestream/52105/field_highwire_adjunct_files/0/2459_tables.pdf" class="rewritten" data-icon-position="" data-hide-link-title="0">Online Tables 1-3 (PDF)</a> -
                  		<br/><br/>
                  <em>Online Table 1:</em>  Subject demographics and clinical characteristics
                  <br/><br/>
                  <em>Online Table 2:</em>  All patients with MS versus controls
                  <br/><br/>
                  <em>Online Table 3:</em>  Group comparisons
               </li></ul>
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 32</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 6 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jun 2011 </div></div>
      
      
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      <div class="highwire-cite-title">A 3T MR Imaging Investigation of the Topography of Whole Spinal Cord Atrophy in Multiple Sclerosis</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.P.</span> <span class="nlm-surname">Klein</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Arora</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Neema</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">B.C.</span> <span class="nlm-surname">Healy</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Tauhid</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Goldberg-Zimring</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Chavarro-Nieto</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">J.M.</span> <span class="nlm-surname">Stankiewicz</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">A.B.</span> <span class="nlm-surname">Cohen</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">G.J.</span> <span class="nlm-surname">Buckle</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">M.K.</span> <span class="nlm-surname">Houtchens</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Ceccarelli</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Dell'Oglio</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">C.R.G.</span> <span class="nlm-surname">Guttmann</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">D.C.</span> <span class="nlm-surname">Alsop</span></span>, <span class="highwire-citation-author" data-delta="15"><span class="nlm-given-names">D.B.</span> <span class="nlm-surname">Hackney</span></span>, <span class="highwire-citation-author" data-delta="16"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Bakshi</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1138-1142; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2459 </span></div>
  
  
  
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      <div class="highwire-cite-title">A 3T MR Imaging Investigation of the Topography of Whole Spinal Cord Atrophy in Multiple Sclerosis</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.P.</span> <span class="nlm-surname">Klein</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Arora</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Neema</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">B.C.</span> <span class="nlm-surname">Healy</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Tauhid</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Goldberg-Zimring</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Chavarro-Nieto</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">J.M.</span> <span class="nlm-surname">Stankiewicz</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">A.B.</span> <span class="nlm-surname">Cohen</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">G.J.</span> <span class="nlm-surname">Buckle</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">M.K.</span> <span class="nlm-surname">Houtchens</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Ceccarelli</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Dell'Oglio</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">C.R.G.</span> <span class="nlm-surname">Guttmann</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">D.C.</span> <span class="nlm-surname">Alsop</span></span>, <span class="highwire-citation-author" data-delta="15"><span class="nlm-given-names">D.B.</span> <span class="nlm-surname">Hackney</span></span>, <span class="highwire-citation-author" data-delta="16"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Bakshi</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1138-1142; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2459 </span></div>
  
  
  
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