Recent developments in spinal cord imaging
ECTRIMS Online Library. Ciccarelli O. Oct 12, 2018; 232019; 266
Olga Ciccarelli
Olga Ciccarelli

Abstract: 266

Type: Scientific Session

Abstract Category: N/A

Spinal cord pathology is frequent in MS and clinically relevant. Recent developments in advanced imaging of the spinal cord have allowed us to obtain insights into the structural, metabolic and functional changes in-vivo in patients with MS. A recent study using neurite orientation dispersion and density imaging (NODDI) has shown that neurite density index is lower in the spinal cord of MS patients than healthy controls and is associated with clinical disability. A pilot study with sodium MRI has shown increased total sodium concentration in the cervical cord of MS patients when compared to healthy controls, which suggests an increase in intra- and extra-cellular sodium, associated with neurodegeneration. Functional connectivity in the spinal cord of patients with MS has been examined for the first time using resting-state functional MRI at 7 T: spinal cord functional networks appear to be intact in relapsing-remitting MS, but lesions are associated with focal abnormalities. Spinal cord lesion topography has been assessed in a large cohort of patients with MS using registration-based techniques and voxel-based lesion probability mapping, and this has shown a predominance of lesions in the upper cord and dorsal column, confirming histopathological work. Spinal cord area is used as outcome measure in clinical trials only occasionally; changes over time in spinal cord cross-sectional area are calculated by repeating the measurements indipendently at each time point. More recently, registration-based techniques for spinal cord atrophy, which are similar to the techniques used for brain atrophy calculation, have been developed and tested in longitudinal cohorts and clinical trials. Spinal cord atrophy is mostly driven by grey matter atrophy, which is more pronounced in progressive compared to relapsing-remitting MS, and correlates with disability more strongly than total cord area. Thus, spinal cord imaging has the potential of providing parameters that can be used to improve our understanding of the mechanisms of damage in MS, as surrogate outcomes in clinical trials and for monitoring therapeutic response in MS.
Disclosure: OC is a consultant for Novartis, Teva, Roche, Biogen and Merck.

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