ArticleFrontiers in neurology2025
Optimization of cervical cord atrophy measurement using a real-world, multicentre dataset in multiple sclerosis.
Article in Frontiers in neurology, 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: Cervical cord atrophy is linked to disability in multiple sclerosis (MS). Cervical cord cross-sectional area (CSA) measurement for atrophy quantification using magnetic resonance imaging (MRI) has been technically validated, but information about effects of methodological choices on associations of CSA with clinical variables is lacking. Aim: Assessing how image acquisition, cord level selection, CSA normalization and segmentation software affect measurement variance, separation of clinical groups, correlations with clinical scores, and to formulate recommendations for future study designs. Methods: Head and neck 3D-T1-weighted MRI of people with MS (pwMS, Results: For all combinations of imaging, cord level, and segmentation software, unnormalized CSA differed between HC and pMS. CV in HC varied between 10.5 and 13.5% for unnormalized CSA and was lower for CSA normalized by C1-C2 (range: 9.4-12.0%) and C1-C3 vertebral height (8.6-12.6%). Unnormalized and normalized CSA correlated with EDSS scores for all measurement combinations (Spearman's rho between -0.646 and -0.372, all corrected Conclusion: Clinical performance of CSA quantification regarding discrimination between rMS and pMS and correlations with EDSS was better for whole cervical cord (C1-7) than for C1-2 measurements, and for normalization by C1-C2 or C1-C3 vertebral height. Based on the quantitative results of this exploratory multi-center study and on previous literature, we formulated recommendations to support future study design decisions.
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