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Five-year longitudinal changes in quantitative spinal cord MRI in multiple sclerosis.

Jiwon Oh1, Min Chen2, Kateryna Cybulsky3

  • 1Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada/Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.

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Quantitative spinal cord MRI (SC-MRI) reveals significant changes over 5 years in multiple sclerosis (MS) patients. These longitudinal SC-MRI changes correlate with disability, highlighting the importance of individual patient trajectories.

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Area of Science:

  • Neuroimaging
  • Neurology
  • Medical Physics

Background:

  • Spinal cord (SC) integrity is crucial in multiple sclerosis (MS) pathogenesis and disability.
  • Longitudinal quantitative SC magnetic resonance imaging (SC-MRI) studies are limited.
  • Understanding SC changes over time is vital for MS progression assessment.

Purpose of the Study:

  • To investigate the relationship between 5-year changes in SC-MRI metrics and MS-related disability.
  • To characterize longitudinal SC-MRI changes in a cohort of MS patients.
  • To assess the predictive value of short-term SC-MRI changes for long-term disability.

Main Methods:

  • 75 MS patients underwent 3T SC-MRI and clinical assessments (EDSS, MSFC) at baseline, 2, and 5 years.
  • SC cross-sectional area (CSA) and diffusion-tensor indices (FA, MD, λ⊥, λ∥) and MTR were quantified at C3-C4.
  • Mixed-effects regression models with subject-specific slopes analyzed longitudinal SC-MRI changes.

Main Results:

  • SC-CSA and MTR showed significant decreases over 5.1 years (p=0.009, p=0.03).
  • Subject-specific slopes of SC-MRI indices at 2 and 5 years moderately correlated with follow-up EDSS and MSFC scores.
  • Strong correlations (r=0.93-0.97) were observed between 2- and 5-year SC-MRI index changes (FA, λ⊥, SC-CSA, MTR).

Conclusions:

  • Quantitative SC-MRI indices change over 5 years in MS, reflecting ongoing tissue alterations.
  • Individual SC-MRI change trajectories at 2 and 5 years are strongly correlated and predict disability.
  • Individualized assessment of SC-MRI changes is crucial for interpreting longitudinal data and predicting clinical outcomes.