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Spatial distribution of multiple sclerosis lesions in the cervical spinal cord.

  • Eden, Dominique1
  • Gros, Charley1
  • Badji, Atef1, 2
  • Dupont, Sara M1, 3
  • De Leener, Benjamin1
  • Maranzano, Josefina4, 5
  • Zhuoquiong, Ren6
  • Liu, Yaou6, 7
  • Granberg, Tobias8, 9
  • Ouellette, Russell8, 9
  • Stawiarz, Leszek8
  • Hillert, Jan8
  • Talbott, Jason3
  • Bannier, Elise10, 11
  • Kerbrat, Anne11, 12
  • Edan, Gilles11, 12
  • Labauge, Pierre13
  • Callot, Virginie14, 15
  • Pelletier, Jean15, 16
  • Audoin, Bertrand15, 16
  • And 25 more
  • 1 NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada. , (Canada)
  • 2 Department of Neuroscience, Faculty of Medicine, University of Montreal, Montreal, QC, Canada. , (Canada)
  • 3 Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA.
  • 4 McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Canada. , (Canada)
  • 5 Department of Anatomy, Université de Québec à Trois-Rivières, Trois-Rivières, QC, Canada. , (Canada)
  • 6 Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P. R. China. , (China)
  • 7 Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China. , (China)
  • 8 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. , (Sweden)
  • 9 Massachusetts General Hospital, Boston, USA.
  • 10 CHU Rennes, Radiology Department, Rennes, France. , (France)
  • 11 Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, EMPENN - ERL U 1228, Rennes, France. , (France)
  • 12 CHU Rennes, Neurology Department, Rennes, France. , (France)
  • 13 MS Unit, Department of Neurology, University Hospital of Montpellier, Montpellier, France. , (France)
  • 14 Aix Marseille University, CNRS, CRMBM, Marseille, France. , (France)
  • 15 APHM, CHU Timone, CEMEREM, Marseille, France. , (France)
  • 16 APHM, Department of Neurology, CHU Timone, APHM, Marseille.
  • 17 Observatoire Français de la Sclérose en Plaques (OFSEP) ; Université de Lyon, Université Claude Bernard Lyon 1; Hospices Civils de Lyon; CREATIS-LRMN, UMR 5220 CNRS and U 1044 INSERM; Lyon, France. , (France)
  • 18 Neuroimaging Research Unit, INSPE, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. , (Italy)
  • 19 Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
  • 20 Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London,UK.
  • 21 Center for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
  • 22 Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA.
  • 23 National Institute of Neurological Disorders and Stroke, National Institutes of Health, Maryland, USA.
  • 24 Department of Radiology, NYU Langone Medical Center, New York, USA.
  • 25 National Institute of Radiological Sciences, Chiba, Chiba, Japan. , (Japan)
  • 26 Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan. , (Japan)
  • 27 Hospital Cochin, Paris, France. , (France)
  • 28 Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada. , (Canada)
Published Article
Oxford University Press
Publication Date
Mar 01, 2019
DOI: 10.1093/brain/awy352
PMID: 30715195


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. © The Author(s) (2019). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please email: [email protected]

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