In our recent study, we found significant correlations between the volumes of several brain structures and the spinal cord (SC) in patients with mild disability. However, in patients with moderate to severe disability this correlation was significantly reduced.
This suggests independent progression of brain and SC volume loss during the transition to the secondary progressive disease phase. Interestingly, in the mild-to-moderate disability group SCV was the only parameter that discriminated between patients with EDSS 2-2.5 and 3-3.5.
Therefore, this gap between brain and SC volume loss could be a hallmark of secondary progression onset in MS. Spinal cord volume could help to identify patients with mild disability who are at risk of disability progression. This hypothesis has to be verified on our longitudinal data.
Could we reduce the clinical-radiological paradox with spinal cord imaging? Or could SC imaging even contribute to a new definition of secondary progression in MS? We believe so. SC pathology has been the focus of research for decades, but nowadays it is feasible to add MRI of the spinal cord to MRI monitoring protocols, because many MRI scanners allow us to investigate SC in the same session as brain imaging. Our preliminary results have to be verified and investigated further longitudinally to understand the individual dynamic in brain and SC volume loss and its relationship with lesion pathology and disability.
Progression of SC and brain volume loss may be partially independent. SC volume loss may indicate the secondary progressive course, and also be present earlier in the course. The spinal cord pathology is an important piece of the mosaic of MS pathology and an important part of MR monitoring of disease activity. It should be monitored carefully and regularly in MS patients from disease onset.
Fig 1: Differences in percentage volume loss of several brain structures and spinal
cord volume in the three EDSS groups.
Fig. 2 Spinal
cord volume in in the three EDSS groups.
Manuela Vaněčková, MD, Ph.D.
MR unit, Departement of Radiology, First Faculty of
Medicine, Charles University and General University Hospital in Prague, Katerinska 30, 128 08 Prague, Czech
E-MAIL: manuela.vaneckova [at] lf1.cuni.cz, man.van [at] post.cz, Manuela.Vaneckova[at]vfn.cz,
The lead author
completed her PhD in Neuroscience in 2003. From 2009 she was Associate
Professor of Radiology in Charles University. In 2014 she became Professor of
Radiology in Charles University. Her specialization is Imaging, mainly MRI and
Neuroradiology. She has published more than 180 papers, and 3 monographs on
Neuroradiology, MRI and Multiple sclerosis. So far she has been associated with
13 medical research grants. Her main topics are brain and spinal cord
volumetry, MRI monitoring in daily clinical practice in MS, MRI differential
diagnosis of MS, safety monitoring (PML), neurodegenerative disease, pituitary
MRI and prenatal brain MRI.