Abstract
Several studies have identified changes in the spinal cord DTI measurements in patients with multiple sclerosis (MS). However, correlations between changes in DTI parameters in normal appearing cervical spine and neurological findings have not been clearly established. To determine whether diffusion tensor imaging (DTI) measurements such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) are sufficiently sensitive in detecting microstructure alterations in normal-appearing spinal cords in patients with MS and whether they reflect these patients' clinical disability. Fifteen patients diagnosed with relapsing-remitting MS (RRMS) with normal-appearing cervical spinal cords on plain MRI and 11 asymptomatic volunteers were enrolled in the study. Overall, 75 cervical spinal segments were analyzed. The regions of interest were drawn from the entire spinal cord cross-section and in the normal-appearing white matter tracts: the superior and inferior cerebellar peduncles and the posterior limbs of the internal capsules. Neurological deficit and the level of disability were evaluated using the Expanded Disability Status Scale (EDSS), the timed 25-foot walk test (T25FW) and the 9-hole peg test (9HPT) for manual dexterity. A significant difference (p < 0.05) in FA values between patients with MS and the control group was found at levels C2 (p = 0.047) and C3 (p = 0.023). No significant changes in ADC values were found. There was correlation between FA and ADC values in selected white matter tracts and at particular spinal cord levels. We also observed significant correlations between diffusion tensor imaging parameters and manual dexterity. Our preliminary results may suggest that the spinal cord's structural loss is the dominant factor in the inflammatory/demyelinating component in patients with MS. Diffusion tensor imaging changes in the spinal cord correlate with brain DTI changes. Manual functioning seems to be more affected than walking.
Highlights
Multiple sclerosis (MS) is a chronic disease with a complex background, which is associated with the processes of immune-mediated inflammatory demyelination and axonal loss within the central nervous system (CNS)
Diffusion tensor imaging changes in the spinal cord correlate with brain diffusion tensor imaging (DTI) changes
Fractional anisotropy is a biomarker of white matter integrity, and lower fractional anisotropy (FA) values indicate impairment of the white matter fibers’ integrity; apparent diffusion coefficient (ADC) is a measure of diffusivity which increases over the course of inflammatory/demyelinating processes.[2]
Summary
Multiple sclerosis (MS) is a chronic disease with a complex background, which is associated with the processes of immune-mediated inflammatory demyelination and axonal loss within the central nervous system (CNS). Magnetic resonance imaging (MRI) has become the modality of choice for detecting and assessing MS lesions within both the brain and the spinal cord, due to its sensitivity in detecting focal white matter lesions. Diffusion tensor imaging (DTI) is a method which is sensitive to microstructure alterations even within the normalappearing brain and spinal cord, which enables quantitative assessment of changes almost at the cellular level. The main DTI parameters are fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Fractional anisotropy is a biomarker of white matter integrity, and lower FA values indicate impairment of the white matter fibers’ integrity; ADC is a measure of diffusivity which increases over the course of inflammatory/demyelinating processes.[2]. Several studies have identified changes in the spinal cord DTI measurements in patients with multiple sclerosis (MS). Correlations between changes in DTI parameters in normal appearing cervical spine and neurological findings have not been clearly established
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