Abstract Details

Title Clinical Relevance of Multiparametric MRI Assessment of Spinal Cord Damage in Multiple Sclerosis

Topic Multiple Sclerosis

Presentation(s) S10 - Multiple Sclerosis: Biomarkers and Outcome Measures (3:30 PM-3:42 PM)

Poster/Presentation
Number 001

Objective To explore pathophysiological substrates of cervical spinal cord (cSC) damage in multiple sclerosis (MS) patients and to identify the most accurate imaging predictors of disability and disease course, using a multiparametric MRI approach.

Background cSC involvement is common in MS. However, partly due to technical issues, no comprehensive multiparametric MRI study has been performed yet.

Design/Methods One-hundred and eleven MS patients, 57 with relapsing-remitting (RR) and 54 with progressive MS (PMS), and 32 age- and sex-matched healthy controls (HC) underwent brain and cSC 3 Tesla MRI with pulse sequences for assessing lesions and atrophy, and a diffusion-weighted scan for microstructural damage. Neurological assessment included Expanded Disability Status Scale (EDSS) scoring, and Nine-Hole Peg Test and 25-Foot Walking Test for limb function. Between group differences and associations of MRI variables with these metrics were explored by age-, sex- and phenotype-adjusted linear models.

Results MS patients had cSC lesions, higher brain T2-lesion volume (LV), brain and cSC atrophy and microstructural damage, compared to HC. In MS patients, multivariable analysis identified brain grey matter (GM) volume, cSC lateral funiculi fractional anisotropy (FA) and lateral funiculi T2-LV as independent predictors of EDSS score. The independent predictors of EDSS score were cSC lateral funiculi FA, brain T2-LV and cSC lateral funiculi T2-LV in RRMS (R2=0.48); and cSC lateral funiculi FA and cSC GM atrophy in PMS (R2=0.52). Similar results were confirmed for limb function tests. Logistic regression analysis identified cSC GM atrophy and cSC T2-LV as independent predictors of phenotype (AUC=0.964).

Conclusions cSC involvement has a central role in explaining disability in MS. The processes contributing to disability differ according to the stage of the disease. In RRMS, lesions and microstructural damage to cSC tracts have a prominent role, whereas in PMS, cSC GM atrophy becomes clinically meaningful.

Authors/Disclosures
PRESENTER	No disclosure on file
Maria A. Rocca (Neuroimaging Research Unit)	Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche. Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for AstraZaneca, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Horizon Therapeutics Italy, Merck Serono SpA, Novartis, Roche, Sanofi and Teva. The institution of Maria Assunta Rocca has received research support from MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.
Elisabetta Pagani	Elisabetta Pagani has nothing to disclose.
Alessandro Meani	No disclosure on file
Laura Cacciaguerra, MD, PhD (Mayo Clinic)	Dr. Cacciaguerra has nothing to disclose.
Ermelinda De Meo (San Raffaele, Vita-Salute University, Milan)	Ms. De Meo has nothing to disclose.
Paolo Preziosa (Ospedale San Raffaele)	Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb . Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi Genzyme. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.
Massimo Filippi, MD, FAAN (Ospedale San Raffaele, Neuroimaging Research Unit)	Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA. Dr. Filippi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.

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