Spatial distribution of multiple sclerosis lesions in the cervical spinal cord

Dominique Eden 1 Charley Gros 1 Atef Badji 1 Sara Dupont 1 Benjamin de Leener 1 Josefina Maranzano 2 Ren Zhuoquiong 3 Yaou Liu 3 Tobias Granberg 4 Russell Ouellette 5 Leszek Stawiarz 6 Jan Hillert 6 Jason Talbott 7 Elise Bannier 8 Anne Kerbrat 9 Gilles Edan 8 Pierre Labauge 10 Virginie Callot 11 Jean Pelletier 12 Bertrand Audoin 11 Henitsoa Rasoanandrianina 11 Jean-Christophe Brisset 13 Paola Valsasina 14 Maria Rocca 14 Massimo Filippi 14 Rohit Bakshi 15 Shahamat Tauhid 16 Ferran Prados 17 Marios Yiannakas 18 Hugh Kearney 18 Olga Ciccarelli 18 Seth Smith 19 Constantina Andrada Treaba 20 Caterina Mainero 20 Jennifer Lefeuvre 21 Daniel Reich 21 Govind Nair 21 Timothy Shepherd 22 Erik Charlson 22 Yasuhiko Tachibana 23 Masaaki Hori 24 Kouhei Kamiya 24 Lydia Chougar 24 Sridar Narayanan 25 Julien Cohen-Adad 1, *
Abstract : Spinal cord lesions detected on MRI hold important diagnostic and prognostic value for multiple sclerosis. Previous attempts to correlate lesion burden with clinical status have had limited success, however, suggesting that lesion location may be a contributor. Our aim was to explore the spatial distribution of multiple sclerosis lesions in the cervical spinal cord, with respect to clinical status. We included 642 suspected or confirmed multiple sclerosis patients (31 clinically isolated syndrome, and 416 relapsing-remitting, 84 secondary progressive, and 73 primary progressive multiple sclerosis) from 13 clinical sites. Cervical spine lesions were manually delineated on T2- and T2*-weighted axial and sagittal MRI scans acquired at 3 or 7 T. With an automatic publicly-available analysis pipeline we produced voxelwise lesion frequency maps to identify predilection sites in various patient groups characterized by clinical subtype, Expanded Disability Status Scale score and disease duration. We also measured absolute and normalized lesion volumes in several regions of interest using an atlas-based approach, and evaluated differences within and between groups. The lateral funiculi were more frequently affected by lesions in progressive subtypes than in relapsing in voxelwise analysis (P < 0.001), which was further confirmed by absolute and normalized lesion volumes (P < 0.01). The central cord area was more often affected by lesions in primary progressive than relapse-remitting patients (P < 0.001). Between white and grey matter, the absolute lesion volume in the white matter was greater than in the grey matter in all phenotypes (P < 0.001); however when normalizing by each region, normalized lesion volumes were comparable between white and grey matter in primary progressive patients. Lesions appearing in the lateral funiculi and central cord area were significantly correlated with Expanded Disability Status Scale score (P < 0.001). High lesion frequencies were observed in patients with a more aggressive disease course, rather than long disease duration. Lesions located in the lateral funiculi and central cord area of the cervical spine may influence clinical status in multiple sclerosis. This work shows the added value of cervical spine lesions, and provides an avenue for evaluating the distribution of spinal cord lesions in various patient groups.
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Submitted on : Thursday, March 28, 2019 - 11:16:19 AM
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Dominique Eden, Charley Gros, Atef Badji, Sara Dupont, Benjamin de Leener, et al.. Spatial distribution of multiple sclerosis lesions in the cervical spinal cord. Brain - A Journal of Neurology , Oxford University Press (OUP), 2019, 142 (3), pp.633-646. ⟨10.1093/brain/awy352⟩. ⟨inserm-02082374⟩

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