Spinal cord magnetic resonance imaging in multiple sclerosis: importance of determining degree of atrophy as a marker of disease course

Spinal cord magnetic resonance imaging (MRI) is of particular interest in t he management of multiple sclerosis (MS) especially in primary progressive forms. Most of the demyelinating lesions are located in the cervical or dor sal cord Spinal cord area reduction has been recently correlated with the p rogression of disability (Losseff et ai., 1996, Lycklama a Nijeholt et al., 1998). The aim of this study was to confirm this first result, to assess t he reproducibility of this method and to correlate demyelinating lesions wi th spinal cord area reduction. Fifty two patients were included and compare d with 15 controls (normal subjects). T2 Sagittal and axial plane images we re performed to localized hypersignal lesions, Spinal cord area was obtaine d by a volume acquired inversion prepared fast spoiled gradient echo acquis ition (MP-Rage) sequence. We compared the mean area value with clinical par ameters (age, course of the disease, expanded disability status scale [EDSS ]) and with the number and location of demyelinating lesions. Demyelinating lesions were found in 82% of MS patients and in none of controls. Mean spi nal cord area was closely similar to Losseff et ai. (1996) results and was reduced compared with controls (p<0.001). Spinal cord reduction was correla ted with disability, studied by the EDSS. Furthermore, no correlation was f ound between demyelinating lesions and spinal cord area reduction, This stu dy confirms the interest of spinal cord area mesurement in MS. Spinal cord atrophy is a reliable marker for axonal loss. This method should be of part icular interest for the follow-up of axonal loss in thepeutic trials especi ally in primary progressive MS.