ArticleFrontiers in neuroimaging2025
Fully-automated estimation of upper cervical cord cross-sectional area using pontomedullary junction referencing in multiple sclerosis.
Article in Frontiers in neuroimaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Spinal cord cross-sectional area (CSA) is a biomarker of disability in multiple sclerosis (MS). Vertebral-based CSA suffers from anatomical variability and positional bias. Objectives: To evaluate a fully automated PMJ-referenced approach, as implemented in the open-source Spinal Cord Toolbox, to assess cervical cord CSA at a fixed distance from the pontomedullary junction (PMJ) in MS. Methods: Retrospective study performed at the MS center of Lugano (Switzerland). Inclusion criteria were treatment with natalizumab or ocrelizumab and absence of clinical/radiological disease activity over ≥2 years. CSA at 64 mm caudal to the PMJ (CSA PMJ) and at C2-C3 vertebral level (CSA C2-C3) were calculated using the Spinal Cord Toolbox. Results: Seventy-five MS patients [females = 44 (58.7%), age = 45.1 (36.7-53.8) years, natalizumab = 36 (48%), ocrelizumab = 39 (52%)] were included. Median CSA PMJ and CSA C2-C3 were 57.7 (53.1-62.1) and 58.1 (53.2-62.6) mm Conclusion: Automated measurement of spinal cord CSA at fixed distance from the PMJ is applicable in MS, performs better than vertebral-based CSA, and correlates with neurological disability.
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