Grey matter involvement by focal cervical spinal cord lesions is associated with progressive multiple sclerosis

Mult Scler. 2016 Jun;22(7):910-20. doi: 10.1177/1352458515604905. Epub 2015 Oct 2.


Background: The in vivo relationship of spinal cord lesion features with clinical course and function in multiple sclerosis (MS) is poorly defined.

Objective: The objective of this paper is to investigate the associations of spinal cord lesion features on MRI with MS subgroup and disability.

Methods: We recruited 120 people: 25 clinically isolated syndrome, 35 relapsing-remitting (RR), 30 secondary progressive (SP), and 30 primary progressive (PP) MS. Disability was measured using the Expanded Disability Status Scale. We performed 3T axial cervical cord MRI, using 3D-fast-field-echo and phase-sensitive-inversion-recovery sequences. Both focal lesions and diffuse abnormalities were recorded. Focal lesions were classified according to the number of white matter (WM) columns involved and whether they extended to grey matter (GM).

Results: The proportion of patients with focal lesions involving at least two WM columns and extending to GM was higher in SPMS than in RRMS (p = 0.03) and PPMS (p = 0.015). Diffuse abnormalities were more common in both PPMS and SPMS, compared with RRMS (OR 6.1 (p = 0.002) and 5.7 (p = 0.003), respectively). The number of lesions per patient involving both the lateral column and extending to GM was independently associated with disability (p < 0.001).

Conclusions: More extensive focal cord lesions, extension of lesions to GM, and diffuse abnormalities are associated with progressive MS and disability.

Keywords: MRI; Multiple sclerosis; grey matter; spinal cord.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cervical Vertebrae
  • Cross-Sectional Studies
  • Demyelinating Diseases / diagnostic imaging*
  • Demyelinating Diseases / physiopathology
  • Disability Evaluation
  • Disease Progression
  • Female
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Multiple Sclerosis, Chronic Progressive / diagnostic imaging*
  • Multiple Sclerosis, Chronic Progressive / physiopathology
  • Multiple Sclerosis, Relapsing-Remitting / diagnostic imaging*
  • Multiple Sclerosis, Relapsing-Remitting / physiopathology
  • Predictive Value of Tests
  • Severity of Illness Index
  • Spinal Cord / diagnostic imaging*
  • Spinal Cord / physiopathology
  • White Matter / diagnostic imaging*
  • White Matter / physiopathology
  • Young Adult