Introduction: Histopathological and neuroimaging data have demonstrated the presence of an outside-in pathological gradient in both grey and white matter (GM, WM) pathology in the brain of patients with multiple sclerosis (MS), with the most marked abnormalities in the CSF-surface brain regions including the periventricular white matter and the subpial layers of the cortex. These findings have been interpreted as consistent with CSF- or ependymal-mediated inflammatory pathogenesis for tissue demyelination. Whether this pattern is also associated with the development of spinal cord (SC) pathology remains uncertain. Aims: To use 7T MRI to characterize the dispersion of GM and WM MS pathology in the cervical spinal cord of relapsing-remitting and secondary progressive MS (RRMS, SPMS) patients. Methods: Thirty-one MS subjects (18 early RRMS, 13 SPMS) and 11 age-matched healthy controls (HC) underwent 7T T2* imaging of the cervical SC (0.41x0.41x3.6 mm3) Cervical SC WM and GM were segmented using Spinal Cord Toolbox for C2-C3 cross sectional area (CSA). SC lesion fraction (LF) is the proportion of lesioned tissue to the total respective tissue volume. The SC was inside-out segmented into voxel-wise concentric rings extending from the central canal towards the subpial surface by scikit-image, Described in percent, beginning from the central canal at 0% expanding towards the subpial surface at 100%, compared by Mann-Whitney U test. Results: Cervical SC lesions were identified in 84% of MS subjects, with a LF in WM and GM of 5.0±9.1% and 5.0±16.0%. Relative to HC, MS subjects had lower CSA in both WM (52.6±8.6 mm2 vs 58.1±4.9 mm2, P=0.015) and GM (6.7±1.4 mm2 vs 7.7±0.94 mm2, P=0.016). Relative to SPMS, RRMS subjects had increased SC whole LF at 60-70% (P=0.008), 70-80% (P=0.006), and 80-90% (P=0.046). Compared to RRMS, SPMS subjects had greater SC whole LF at 20-30% (P=0.057) and 30-40% (P=0.026). Regarding WM SC pathology, RRMS subjects had increased WM LF in the outer 60-70% (P=0.013), 70-80% (P=0.006), and 80-90% (P=0.052), and SPMS subjects had higher WM LF in the inner 20-30% (P=0.041) and 30-40% (P=0.020). Regarding GM SC pathology, RRMS subjects had increased GM LF in the outer 50-60% (P=0.039) and 60-70% (P=0.015). Conclusion: The localization of cervical spinal cord lesions nearer the central canal in early SPMS and the subpial surface seen in early RRMS patients could imply a CSF-mediated pathogenic mechanism, comparable to that observed in the brain.
Characterization of outer and inner spinal cord pathology in multiple sclerosis by 7 Tesla imaging. ECTRIMS 2019 / Ouellette, R.; Treaba, C. A.; Granberg, T.; Herranz, E.; Barletta, VALERIA TERESA; Mehndiratta, A.; De Leener, B.; Tauhid, S.; Yousuf, F.; Dupont, S.; Klawiter, E. C.; Sloane, J. A.; Bakshi, R.; Cohen-Adad, J.; Mainero, C.. - (2019). (Intervento presentato al convegno ECTRIMS 2019 tenutosi a Stoccolma).
Characterization of outer and inner spinal cord pathology in multiple sclerosis by 7 Tesla imaging. ECTRIMS 2019
BARLETTA, VALERIA TERESA;C. Mainero
2019
Abstract
Introduction: Histopathological and neuroimaging data have demonstrated the presence of an outside-in pathological gradient in both grey and white matter (GM, WM) pathology in the brain of patients with multiple sclerosis (MS), with the most marked abnormalities in the CSF-surface brain regions including the periventricular white matter and the subpial layers of the cortex. These findings have been interpreted as consistent with CSF- or ependymal-mediated inflammatory pathogenesis for tissue demyelination. Whether this pattern is also associated with the development of spinal cord (SC) pathology remains uncertain. Aims: To use 7T MRI to characterize the dispersion of GM and WM MS pathology in the cervical spinal cord of relapsing-remitting and secondary progressive MS (RRMS, SPMS) patients. Methods: Thirty-one MS subjects (18 early RRMS, 13 SPMS) and 11 age-matched healthy controls (HC) underwent 7T T2* imaging of the cervical SC (0.41x0.41x3.6 mm3) Cervical SC WM and GM were segmented using Spinal Cord Toolbox for C2-C3 cross sectional area (CSA). SC lesion fraction (LF) is the proportion of lesioned tissue to the total respective tissue volume. The SC was inside-out segmented into voxel-wise concentric rings extending from the central canal towards the subpial surface by scikit-image, Described in percent, beginning from the central canal at 0% expanding towards the subpial surface at 100%, compared by Mann-Whitney U test. Results: Cervical SC lesions were identified in 84% of MS subjects, with a LF in WM and GM of 5.0±9.1% and 5.0±16.0%. Relative to HC, MS subjects had lower CSA in both WM (52.6±8.6 mm2 vs 58.1±4.9 mm2, P=0.015) and GM (6.7±1.4 mm2 vs 7.7±0.94 mm2, P=0.016). Relative to SPMS, RRMS subjects had increased SC whole LF at 60-70% (P=0.008), 70-80% (P=0.006), and 80-90% (P=0.046). Compared to RRMS, SPMS subjects had greater SC whole LF at 20-30% (P=0.057) and 30-40% (P=0.026). Regarding WM SC pathology, RRMS subjects had increased WM LF in the outer 60-70% (P=0.013), 70-80% (P=0.006), and 80-90% (P=0.052), and SPMS subjects had higher WM LF in the inner 20-30% (P=0.041) and 30-40% (P=0.020). Regarding GM SC pathology, RRMS subjects had increased GM LF in the outer 50-60% (P=0.039) and 60-70% (P=0.015). Conclusion: The localization of cervical spinal cord lesions nearer the central canal in early SPMS and the subpial surface seen in early RRMS patients could imply a CSF-mediated pathogenic mechanism, comparable to that observed in the brain.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
