ABSTRACT
OBJECTIVE
To determine the interrelationships between MRI‐defined lesion and atrophy measures of spinal cord involvement and brain involvement and their relationships to disability in a ...small cohort of patients with multiple sclerosis (MS).
BACKGROUND
Although it is known that cervical spinal cord atrophy correlates with disability in MS, it is unknown whether it is the most important determinant when compared to other regions of the central nervous system (CNS). Furthermore, it is not clear to what extent brain and cord lesions and atrophy are related.
DESIGN AND METHODS
3T MRI of the whole brain and whole spinal cord was obtained in 21 patients with MS, including 18 with relapsing‐remitting, one with secondary progressive, one with primary progressive, and one with a clinically isolated syndrome. Brain global gray and white matter volumes were segmented with Statistical Parametric Mapping 8. Spinal cord contour volume was segmented in whole by a semi‐automated method with bins assigned to either the cervical or thoracic regions. All CNS volumes were normalized by the intracranial volume. Brain and cord T2 hyperintense lesions were segmented using a semi‐automated edge finding tool.
RESULTS
Among all MRI measures, only upper cervical spinal cord volume significantly correlated with Expanded Disability Status Scale score (r =−.515, P = .020). The brain cord relationships between whole or regional spinal cord volume or lesions and gray matter, white matter, or whole brain volume or whole brain lesions were generally weak and all nonsignificant.
CONCLUSIONS AND RELEVANCE
In this preliminary study of mildly disabled, treated MS patients, cervical spinal cord atrophy most strongly correlates with physical disability in MS when accounting for a wide range of other CNS measures of lesions and atrophy, including thoracic or whole spinal cord volume, and cerebral gray, white or whole brain volume. The weak relationship between spinal cord and brain lesions and atrophy may suggest that they progress rather independently in patients with MS. J Neuroimaging 2012;22:122‐128
The same evolutionary and ecological principles that organize our understanding of organisms and organic communities can be used to help understand criminal behavior and our responses to it. This ...approach suggests solutions for an important dilemma that confronts the United States. The dilemma is that preoccupation with problems such as gang violence, drug abuse, and street crime increasingly diverts resources and attention away from child development problems associated with the health, education, and welfare of young people. Just as a consensus is emerging about the importance of balancing traditional criminal justice system approaches to crime control with nurturant approaches that address child development concerns, child development program resources are dwindling. This dynamic is driven by a vicious cycle of media sensationalism, political expediency, and public impatience that encourages ineffective “quick fixes” for crime. An evolutionary ecological approach to crime control suggests ways to reverse this vicious cycle and increase the political, programmatic, and economic feasibility of child development programs.
To assess whole and regional spinal cord atrophy in patients with multiple sclerosis (MS) using 3T MRI.
Spinal cord damage is common in MS and provides a unique and clinically relevant means to ...monitor disease progression and therapeutic effects. Whereas regional spinal cord atrophy has been studied extensively in MS, whole spinal cord atrophy has not been previously assessed.
Whole spinal cord 3 mm thick T2-weighted axial fast spin-echo MRI images were obtained at 3T on 34 patients with MS 26 women and 8 men; 26 relapsing–remitting, 2 clinically isolated syndrome, 4 secondary progressive, 2 primary progressive; Expanded Disability Status Scale (EDSS) (mean ± SD) 1.95 ± 1.72, range 0–6.5 and 15 age-matched normal controls 11 women and 4 men. The global and regional (cervical, C2–3, and thoracic) cord volumes were determined using a semi-automated tool and were normalized by the segment length and intracranial volume. Spinal cord lesions were also determined using a semi-automated edge finding tool.
Whole cord, C2–3, cervical, and thoracic volumes were lower in progressive vs. relapsing patients or normal controls (all
p < 0.05). Spinal cord volumes were not related to spinal cord lesion load but were related to EDSS scores (
r = −0.35 to −0.46;
p < 0.05). Only the C2–3 volume correlated with timed 25-foot walk (
r = −0.40;
p < 0.05). Whole cord, cervical, C2–3, and thoracic volumes were all highly inter-correlated (
r = 0.83–0.98;
p < 0.05).
The established method of estimating spinal cord atrophy, C2–3 cross-sectional volume, provides a useful surrogate of overall global or regional spinal cord atrophy. Spinal cord atrophy is most common in progressive forms of MS and is related to neurologic disability.
This study was supported by grants from the
National Institutes of Health (
1R01NS055083-01) and the
National Multiple Sclerosis Society (
RG3705A1;
RG3798A2).
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