A conventional and magnetization transfer MRI study of the cervical cord in patients with MS

Objective: To evaluate the contribution made by cervical cord damage, asses sed using a fast short-tau inversion recovery (fast-STIR) sequence and magn etization transfer ratio (MTR histogram analysis to the clinical manifestat ions of MS. Background: Previous studies have failed to show significant co rrelations between the number and extent of T2 spinal cord lesions and the clinical status of patients with MS. Fast-STIR is more sensitive than T2-we ighted imaging for detecting cervical cord MS lesions. MTR histogram analys is provides estimates of the overall disease burden in the cervical cord wi th higher pathologic specificity to the more destructive aspects of MS than T2-weighted scans. Methods: We obtained fast-STIR and magnetization transf er (MT) scans from 96 patients with MS (52 with relapsing-remitting [RRMS], 33 with secondary progressive [SPMS], and 11 with primary progressive [PPM S] MS) and 21 control subjects. Dual-echo scans of the brain were also obta ined and lesion load measured. Results: Eighty-one of the patients with MS had an abnormal cervical cord scan. Patients with SPMS had more cervical co rd lesions and more images with visible cervical cord damage than did patie nts with RRMS or PPMS (p = 0.04). The entire cohort of patients with MS had lower average MTR of the cervical cord (p = 0.006) than control subjects. Compared to control subjects, patients with RRMS had similar cervical cord MTR histogram-derived measures, whereas those with PPMS had lower average M TR (p = 0.01) and peak height (p = 0.02). Patients with SPMS had lower hist ogram peak height than did those with RRMS (p = 0.03). The peak position an d height of the cervical cord MTR histogram were independent predictors of the probability of having locomotor disability. We found no correlation bet ween brain T2 lesion load and any of the cervical cord MTR histogram metric s. Conclusions: This study shows that the amount and severity of MS patholo gy in the cervical cord are greater in the progressive forms of the disease . An accurate assessment of cervical cord damage in MS gives information th at can be used in part to explain the clinical manifestations of the diseas e.