Spinal Cord Atrophy Predicts Progressive Disease in Relapsing Multiple Sclerosis

Objective A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper cervical cord area from legacy brain MRI scans we aimed to study the role of spinal cord and brain atrophy for silent progre...

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Published in:Annals of neurology Vol. 91; no. 2; pp. 268 - 281
Main Authors: Bischof, Antje, Papinutto, Nico, Keshavan, Anisha, Rajesh, Anand, Kirkish, Gina, Zhang, Xinheng, Mallott, Jacob M., Asteggiano, Carlo, Sacco, Simone, Gundel, Tristan J., Zhao, Chao, Stern, William A., Caverzasi, Eduardo, Zhou, Yifan, Gomez, Refujia, Ragan, Nicholas R., Santaniello, Adam, Zhu, Alyssa H., Juwono, Jeremy, Bevan, Carolyn J., Bove, Riley M., Crabtree, Elizabeth, Gelfand, Jeffrey M., Goodin, Douglas S., Graves, Jennifer S., Green, Ari J., Oksenberg, Jorge R., Waubant, Emmanuelle, Wilson, Michael R., Zamvil, Scott S., Cree, Bruce A. C., Hauser, Stephen L., Henry, Roland G.
Format: Journal Article
Language:English
Published: Hoboken, USA John Wiley & Sons, Inc 01.02.2022
Wiley Subscription Services, Inc
Subjects:
Adult
Atrophy
Brain
Brain - diagnostic imaging
Brain - pathology
Conversion
Deceleration
Disease Progression
Female
Foramen Magnum - diagnostic imaging
Foramen Magnum - pathology
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Multiple sclerosis
Multiple Sclerosis, Relapsing-Remitting - diagnostic imaging
Multiple Sclerosis, Relapsing-Remitting - pathology
Predictive Value of Tests
Prognosis
Prospective Studies
Spinal cord
Spinal Cord - diagnostic imaging
Spinal Cord - pathology
ISSN:0364-5134, 1531-8249, 1531-8249
Online Access:Get full text
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Summary:Objective A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper cervical cord area from legacy brain MRI scans we aimed to study the role of spinal cord and brain atrophy for silent progression and conversion to secondary progressive disease (SPMS). Methods From a single‐center observational study, all RRMS (n = 360) and SPMS (n = 47) patients and 80 matched controls were evaluated. RRMS patient subsets who converted to SPMS (n = 54) or silently progressed (n = 159), respectively, during the 12‐year observation period were compared to clinically matched RRMS patients remaining RRMS (n = 54) or stable (n = 147), respectively. From brain MRI, we assessed the value of brain and spinal cord measures to predict silent progression and SPMS conversion. Results Patients who developed SPMS showed faster cord atrophy rates (−2.19%/yr) at least 4 years before conversion compared to their RRMS matches (−0.88%/yr, p < 0.001). Spinal cord atrophy rates decelerated after conversion (−1.63%/yr, p = 0.010) towards those of SPMS patients from study entry (−1.04%). Each 1% faster spinal cord atrophy rate was associated with 69% (p < 0.0001) and 53% (p < 0.0001) shorter time to silent progression and SPMS conversion, respectively. Interpretation Silent progression and conversion to secondary progressive disease are predominantly related to cervical cord atrophy. This atrophy is often present from the earliest disease stages and predicts the speed of silent progression and conversion to Progressive MS. Diagnosis of SPMS is rather a late recognition of this neurodegenerative process than a distinct disease phase. ANN NEUROL 2022;91:268–281
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ISSN:0364-5134
1531-8249
1531-8249
DOI:10.1002/ana.26281