Spinal cord gray matter atrophy correlates with multiple sclerosis disability.

Area of Science:

• Neuroimaging
• Neurology
• Medical Research

Background:

• Cerebral gray matter (GM) atrophy in multiple sclerosis (MS) correlates with disability, but spinal cord (SC) GM atrophy's role is unclear due to imaging limitations.
• Previous research has focused on white matter (WM) changes in the SC in MS.

Purpose of the Study:

• To investigate the association between SC GM and WM areas and MS-related disability.
• To compare SC GM and WM atrophy in different MS subtypes and with healthy controls.

Main Methods:

• Phase-sensitive inversion recovery (PSIR) MRI at 3T was used to assess SC GM and WM areas at the C2/C3 level in 113 MS patients and 20 controls.
• Two masked readers measured SC areas, and correlations with Expanded Disability Status Score (EDSS) were analyzed.
• Group differences were assessed with age and sex as covariates.

Main Results:

• Relapsing MS (RMS) patients had smaller SC GM areas than controls; progressive MS (PMS) patients had smaller SC GM and SC WM areas than RMS patients.
• SC GM, SC WM, and whole cord areas showed inverse correlations with EDSS (all p ≤ 0.001).
• SC GM area was the strongest predictor of disability in multivariate models, independently contributing alongside brain GM.

Conclusions:

• Spinal cord gray matter atrophy is detectable in vivo in MS, even without white matter atrophy in RMS.
• SC GM atrophy is more severe in progressive MS and is a stronger correlate of disability than SC WM or brain GM atrophy.