The relationship of brain and cervical cord volume to disability in clinical subtypes of multiple sclerosis: a three-dimensional MRI study

Objectives - Brain and cervical cord volume is a potentially valuable index marker of irreversible pathological processes in multiple sclerosis (MS). Volume in both brain and cervical cord regions in the same patients has only been investigated in a small number of subjects. We aimed at measuring volume in different parts of the central nervous system, and its relationship with clinical measures, in relapsing-remitting (RR) and secondary progressive (SP) MS patients. Material and methods - Conventional dual echo and three-dimensional (3-D) magnetization prepared rapid acquisition gradient echo imaging was performed on 97 (49 RR and 48 SP) MS patients, and on 31 age- and gender-matched healthy controls. The volumes of the supratentorial brain, lateral ventricles, brainstem, cerebellum and upper cervical cord (UCC) were determined on 3-D magnetic resonance imaging. Results - RR MS patients had significantly smaller supratentorial brain (P = 0.002) and larger lateral ventricles (P = 0.047) compared with controls, but no differences were found for cerebellum, brainstem and UCC volumes. Significantly smaller supratentorial brain (P < 0.0001), cerebellum (P = 0.007), brainstem (P = 0.0004) and UCC (P < 0.0001) volumes, and larger lateral ventricles (P < 0.0001) were observed in SP MS patients than in controls. In RR MS, T-2-lesion volume correlated with supratentorial (r = -0.46, P = 0.0009), lateral ventricular (r = 0.65, P < 0.0001), cerebellar (r = -0.42, P = 0.003) and brainstem (r = -0.35, P = 0.01) volumes, but not with UCC volume (r = -0.18, P = 0.22). In SP MS, apart from lateral ventricular volume (r = 0.52, P = 0.0002), none of the estimated structural volumes correlated with T-2-lesion volume. The UCC volume correlated with brainstem volume in both RR MS (r = 0.35, P = 0.016) and SP MS (r = 0.38, P = 0.007). Multiple regression analysis showed that supratentorial brain volume in RR group, and UCC volume in SP group, were single significant contributors (P = 0.01 and 0.04, respectively) to the Expanded Disability Status Scale of all factors entered into the regression model. Conclusion - Atrophy is confined to the supratentorial compartment early in the disease course corresponding to the RR stage, but becomes more pronounced in the brain and cervical spinal cord in the SP phase. The estimate of cervical cord volume for SP MS is relevant to functional disability and may be helpful in monitoring MS evolution in the progressive form of disease.