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Quantitative spinal cord MRI in radiologically isolated syndrome
Paula Alcaide-Leon1, Kateryna Cybulsky1, Stephanie Sankar1
1Division of Neurology (P.A.-L., K.C., S.S., C.C., M.H., D.S., X.M., J.O.), Department of Medicine; Division of Neuroradiology (P.A.-L., G.L., A.B.), Department of Medical Imaging; Division of Neurosurgery (A.B.), Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada; Department of Neurology-Neuroimmunology Neurorehabilitation Unit (X.M.), Multiple Sclerosis Center of Catalonia (Cemcat), Barcelona, Spain; and Department of Neurology (J.O.), Johns Hopkins University, Baltimore, MD.
Radiologically isolated syndrome (RIS) shows minimal spinal cord microstructural changes, with brain atrophy present. These findings suggest the spinal cord may be crucial in initiating clinical symptoms in multiple sclerosis (MS).
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Radiologically isolated syndrome (RIS) is a condition where individuals present with incidental findings suggestive of demyelinating disease on MRI without a clinical diagnosis.
- Understanding the early pathological changes in RIS is crucial for predicting disease progression and developing timely interventions.
Purpose of the Study:
- To compare quantitative spinal cord MRI (SC-MRI) measures, including diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) metrics, between individuals with RIS and healthy controls (HCs).
- To investigate early signs of spinal cord atrophy and microstructural alterations in RIS.
Main Methods:
- A cross-sectional study involving 24 participants with RIS and 14 HCs who underwent cervical SC-MRI on a 3T scanner.
- Quantitative SC-MRI measures including spinal cord cross-sectional area (SC-CSA), DTI metrics (fractional anisotropy, mean, perpendicular, and parallel diffusivity), and magnetization transfer ratio (MTR) were extracted.
- Spinal cord lesions, gray matter (GM), and white matter (WM) areas were manually segmented. Multivariable linear regression controlled for age and sex.
Main Results:
- Approximately 71% of participants with RIS exhibited cervical spinal cord lesions.
- A trend towards lower spinal cord MTR was observed in RIS compared to HCs (p=0.06), indicating potential demyelination or inflammation.
- Evidence of brain atrophy was found in the RIS group (p=0.05), while no significant differences in SC-DTI metrics, GM, WM, or CSA were detected between groups.
Conclusions:
- The spinal cord in RIS shows subtle microstructural changes, hinting at early demyelination and inflammation.
- These findings contrast with established multiple sclerosis (MS) pathology and suggest the spinal cord might play a key role in the onset of MS symptoms.
- Further longitudinal studies are needed to elucidate the spinal cord's role in MS initiation and progression.
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