Influence of T2-Hyperintense Lesions on Cervical Spinal Cord Atrophy and Disability in Patients with Multiple Sclerosis (P5.2-052)

Objective: To assess the influence of brain, cervical spinal cord (CSC) and thoracic spinal cord (TSC) T2-hyperintense lesions on CSC atrophy in patients with multiple sclerosis (MS). Relationships with patients’ disability were also investigated. Background: The mechanisms associated to cervical cord atrophy in MS are poorly understood. Design/Methods: Thirty-four MS patients (28 relapsing-remitting and 6 progressive MS) underwent brain, cervical and thoracic spinal cord MRI at 3T, and expanded disability status scale (EDSS) score assessment. Sagittal dual-echo scans and axial multi-echo images were used to assess T2-hyperintense lesion volume (T2 LV) and count (T2 LC) of the cervical and thoracic spinal cord segments. Brain T2 LV was obtained from axial dual echo images. 3D T1-weighted scans were employed to assess the normalized whole CSC cross-sectional area (CSAn) using an active surface method. Age- and sex-adjusted multiple regression models were used to assess univariate correlations of brain and cord T2 LVs/LCs with CSAn and EDSS. The same modelling was then used to identify the variables independently associated with CSAn and EDSS using a stepwise variable selection. Results: CSAn was associated with CSC T2 LV (β=−036, p=0.03), but not with TSC (p=0.5) or brain (p=0.2) T2 LV. The same analysis showed a significant association between EDSS and CSC T2 LV (β=0.42, p=0.01) and brain T2 LV (β=0.34, p=0.04), and a trend towards an association with TSC LC (β=0.30, p=0.07). The multivariable regression analyses retained age, sex and CSC T2 LV as significant predictors of CSAn (explained variance=20%, p=0.023) and EDSS score (explained variance=31%, p=0.004). Conclusions: CSC atrophy was associated with CSC T2 LV, suggesting an effect of secondary degenerative processes on CSC atrophy development. The overall CNS T2 lesion burden was more tightly correlated than CSC atrophy to the disability status of our patients. Disclosure: Dr. Rocca has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen Idec, Novartis, Genzyme, Sanofi-Aventis, Teva, Merck Serono, and Roche . Dr. Preziosa has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen Idec, Novartis and ExceMED. Dr. Pravata has nothing to disclose. Dr. Valsasina has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with ExceMed. Dr. Gobbi has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Novartis, Biogen Idec, Merck & Co., Inc., Almirall, Roche Diagnostics Corporation, and Teva Neuroscience. Dr. Zecca has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Almirall, Biogen, Teva, Merck, Bayer, ROche, Genzyme, Mylan, Novartis. Dr. Filippi has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries. Dr. Filippi has received personal compensation in an editorial capacity for Journal of Neurology. Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceutical Industries, Roche.