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Published on: April 5, 2016
Microstructural Damage and Repair in the Spinal Cord of Patients With Early Multiple Sclerosis and Association With
Malo Gaubert1, Benoit Combès1, Elise Bannier1
1From the Department of Neuroradiology (M.G., E.B., J.-C.F.), Rennes University Hospital; Empenn (M.G., B.C., E.B., A.M., V.C., G.B., J.-C.F., A.K.), INRIA, Rennes University-CNRS-INSERM; Department of Neurology (L.M., E.L.P., G.E., A.K.), Rennes University Hospital; Paris Brain Institute (ICM) (B.S., B.B.), Sorbonne University-CNRS-INSERM; and Neurology Department (B.S., B.B.), APHP St Antoine Hospital, Paris, France.
Background And Objectives:
The dynamics of microstructural spinal cord (SC) damage and repair in people with multiple sclerosis (pwMS) and their clinical relevance have yet to be explored. We set out to describe patient-specific profiles of microstructural SC damage and change during the first year after MS diagnosis and to investigate their associations with disability and SC atrophy at 5 years.
Methods:
We performed a longitudinal monocentric cohort study among patients with relapsing-remitting MS: first relapse <1 year, no relapse <1 month, and high initial severity on MRI (>9 T2 lesions on brain MRI and/or initial myelitis). pwMS and age-matched healthy controls (HCs) underwent cervical SC magnetization transfer (MT) imaging at baseline and at 1 year for pwMS. Based on HC data, SC MT ratio z-score maps were computed for each person with MS. An index of microstructural damage was calculated as the proportion of voxels classified as normal at baseline and identified as damaged after 1 year. Similarly, an index of repair was also calculated (voxels classified as damaged at baseline and as normal after 1 year). Linear models including these indices and disability or SC cross-sectional area (CSA) change between baseline and 5 years were implemented.
Results:
Thirty-seven patients and 19 HCs were included. We observed considerable variability in the extent of microstructural SC damage at baseline (0%-58% of SC voxels). We also observed considerable variability in damage and repair indices over 1 year (0%-31% and 0%-20%), with 18 patients showing predominance of damage and 18 predominance of repair. The index of microstructural damage was associated positively with the Expanded Disability Status Scale score (r = 0.504, p = 0.002) and negatively with CSA change (r = -0.416, p = 0.02) at 5 years, independent of baseline SC lesion volume.
Discussion:
People with early relapsing-remitting MS exhibited heterogeneous profiles of microstructural SC damage and repair. Progression of microstructural damage was associated with disability progression and SC atrophy 5 years later. These results indicate a potential for microstructural repair in the SC to prevent disability progression in pwMS.
Insights
Microstructural spinal cord (SC) damage and repair vary significantly in early multiple sclerosis (MS). Greater SC damage progression predicts increased disability and atrophy years later, highlighting repair
Area of Science:
- Neuroimaging
- Neurology
- Multiple Sclerosis Research
Background:
- Spinal cord (SC) microstructural changes in multiple sclerosis (MS) and their clinical impact remain under-explored.
- Understanding SC damage and repair dynamics is crucial for early MS management.
Purpose of the Study:
- To characterize patient-specific SC microstructural damage and repair profiles within the first year post-MS diagnosis.
- To investigate the association of these SC changes with long-term disability and SC atrophy at 5 years.
Main Methods:
- Longitudinal monocentric cohort study of relapsing-remitting MS patients and healthy controls (HCs).
- Cervical SC magnetization transfer (MT) imaging at baseline and 1 year.
- Calculation of microstructural damage and repair indices based on SC MT ratio z-score maps.
Main Results:
- Significant variability observed in SC microstructural damage at baseline (0%-58% of SC voxels).
- Substantial heterogeneity in SC damage and repair indices over 1 year, with 18 patients showing damage predominance and 18 showing repair predominance.
- Microstructural damage index positively correlated with Expanded Disability Status Scale score (r=0.504, p=0.002) and negatively with SC cross-sectional area (CSA) change (r=-0.416, p=0.02) at 5 years.
Conclusions:
- Early relapsing-remitting MS patients display diverse SC microstructural damage and repair patterns.
- Progressive microstructural SC damage is linked to long-term disability progression and SC atrophy.
- Potential for SC microstructural repair to mitigate disability progression in people with MS (pwMS).
Related Concept Videos
01:19Multiple Sclerosis l: Introduction
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