Abstract Details

Title Upper Cervical Cord Volume and Its Association with Brain Metrics in MS

Topic Multiple Sclerosis

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-012

Objective Evaluate the association between upper cervical cord (UCC) volume and common brain metrics of MS.

Background Based on their higher availability than cord MRIs, UCC atrophy assessed from brain MRIs is frequently used as an imaging biomarker in MS. Compared to the measurements from the whole cervical cord, UCC atrophy may not be as sensitive, but it seems to correlate well with MS disability metrics. UCC may also be associated with other imaging metrics of MS.

Design/Methods 89 consecutive patients with MS (63F/26M, 72 relapsing/17 progressive) were prospectively enrolled from a single center. For brain structure volumes, automated LesionQuant (Cortechs Labs) was used. For lower brainstem and UCC volumes, a novel automated method was used. To propagate a mask of lower brainstem and UCC regions from the atlas template space to each T1-weighted brain MRI, Advanced Normalization Tools nonlinear registration was utilized. Volumes were calculated as the image's voxel volume multi plied by the sum of voxels in the masks. Automated volumes from each anatomical level (aMedulla, aCervicomedullaryJunction-aCMJ, aC1, aC2) and total volumes from medulla to C2 (aMedulla+UCC) and from CMJ to C2 (aUCC) were identified.

Results 130 brain MRIs were analyzed. Age at MRI was 46.0±12.3 years. Individual aCMJ, aC1 and aC2 volumes and total volumes (aMedulla+UCC and aUCC) associated with whole brain and thalamus volumes(p<0.05). The strongest correlations were between aMedulla and whole brain (unadjusted r=0.67p<0.001; adjusted for age&sex r=0.59 p<0.001) and thalamus volumes (unadjusted r=0.53 p<0.001; adjusted for age&sex r=0.46 p<0.001).

Conclusions Besides the whole brain and thalamus volumes, brain imaging is also used to evaluate UCC atrophy in MS. These common imaging metrics are often considered as independent variables; however, they also seem to interact with each other. Therefore, in MS trials, a composite metric, especially accounting for thalamus and UCC volumes, could serve as a complementary imaging outcome.

Authors/Disclosures
Nur Neyal, MD (Mayo Clinic) PRESENTER	Dr. Neyal has nothing to disclose.
	No disclosure on file
Christopher Schwarz	The institution of Christopher Schwarz has received research support from NIH.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Kejal Kantarci, MD (Mayo Clinic)	The institution of Dr. Kantarci has received research support from Eli Lilly. The institution of Dr. Kantarci has received research support from NIH. The institution of Dr. Kantarci has received research support from ADDF. The institution of Dr. Kantarci has received research support from Eisai. The institution of Dr. Kantarci has received research support from BioArctic.
Orhun H. Kantarci, MD	Dr. Kantarci has nothing to disclose.
Burcu Zeydan, MD (Mayo Clinic)	The institution of Dr. Zeydan has received research support from National Institutes of Health.

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