Cervical Cord T1-weighted Hypointense Lesions at MR Imaging in Multiple Sclerosis: Relationship to Cord Atrophy and Disability

Purpose: To characterize the spatial distribution of cervical cord T1-weighted hypointense lesions in patients with multiple sclerosis (MS) and analyze their association with cord atrophy and disability. Materials and Methods: For this prospective study that took place between 2014 and 2016, 3.0-T high-resolution T1-weighted cervical cord magnetic resonance (MR) images and clinical evaluations were obtained from 82 patients with relapsing-remitting MS (RRMS), 33 patients with secondary progressive MS (SPMS), 25 patients with primary progressive MS (PPMS), and 35 sex-matched healthy control participants. Hypointense cord lesions on T1-weighted imaging were identified and corresponding lesion masks were produced. A semiautomatic method on the basis of active surfaces was used to perform voxel-wise assessment (by using statistical parametric mapping and full factorial models) of T1-weighted hypointense lesion distribution and cord atrophy. Results: T1-weighted hypointense cervical cord lesions were detected in 122 of 140 (87.1%) patients with MS. Lesions were preferentially located in the posterior (P=.01) and upper (P<.001) cervical cord. Lesion extent at C1/C2 and C5 was higher in patient with SPMS versus RRMS, and patients with PPMS versus RRMS and SPMS (P value range, <.001 to .05). Cord atrophy at upper cervical levels was found in patients with MS compared with control participants, especially in progressive MS (P value range, <.001 to .04). Partial overlap (r=0.66; P<.001) occurred between regions with T1-weighted hypointense cord lesions and atrophy. Cord atrophy (r value range, 20.24 to 20.48; P<.001) and T1-weighted hypointense cord lesion extent (r value range, 0.36-0.42; P<.001) were correlated with clinical disability. Conclusion: Hypointense lesions at T1-weighted imaging were observed in the cervical spinal cord of the majority of patients with MS and more widespread in progressive than in relapsing MS phenotypes. Both T1-weighted hypointense cord lesions and atrophy correlated with patient clinical disability. (c) RSNA, 2018