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MRI advances in spinal cord offer deeper understanding of MS (CMSC 2015)
Developments in magnetic resonance imaging are providing a better awareness of the effects of multiple sclerosis in the spinal cord, according to a presentation at the 2015 Annual Meeting of the Consortium of Multiple Sclerosis Centers, held May 27–30 in Indianapolis.
“Spinal cord imaging is getting more realistic and feasible, and more adaptable into clinical trials across sites as well as eventually into clinical practice, which is the ultimate goal of all translational work,” said Omar Khan, MD, director of the Sastry Foundation Advanced Imaging Laboratory at Wayne State University in Detroit.
New research is adding detail to a relationship that MRI pioneers began noting in the mid-1990s regarding spinal cord area and MS severity. A 2015 study from Dr. Khan’s group found that cervical cord cross-sectional area at the C2 level was significantly correlated with expanded disability status scale (EDSS). It also significantly differed between patients with progressive and relapsing-remitting MS (68.6 vs 87.3 mm2).
A recent study from UCSF undertook a more intensive examination into the effects of MS on gray matter in the spinal cord, using phase-sensitive inversion recovery (PSIR) MRI. The authors concluded that spinal cord gray matter atrophy is more pronounced in progressive MS than relapsing MS, and it plays a larger role in disability than atrophy of spinal cord white matter or brain gray matter.
“Gray matter within the spinal cord is something that needs to be paid attention to, although I think … this requires validation across centers,” Dr. Khan said. “Whenever you introduce the element of manual shimming and delineation, you also introduce the element of error. And error in an area that’s only millimeters big is something we can’t afford.”
Other developments in spinal cord pathology in MS that Dr. Khan reviewed included:
Research that associated leptomeningeal inflammation with spinal cord pathology in patients with progressive MS.
A new study from the Queen Square MS Centre group in the UK that assessed magnetization transfer ratio (MTR) values in the pia mater and subpial region in controls and patients with varying forms of MS. “One of the main conclusions was that patients with early MS probably have early outer spinal cord subpial injury, and as the disease becomes more progressive, you will see it is uniformly affected,” Dr. Khan said.
Dr. Khan concluded by noting that “these spinal cord MR modalities are becoming more feasible. We’re getting into very small voxel based delineation of leptomeningeal inflammation. I think this is going to be very critical as we look at larger cohorts of patients in predicting disability. Finally, I think the application of so-called advanced metrics [such as MTR] may be very useful in linking pathology to imaging markers.”
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Kearney H, Yiannakas MC. Investigation of magnetization transfer ratio-derived pial and subpial abnormalities in the multiple sclerosis spinal cord. Brain. 2014; 137(Pt 9): 2456–68.