Peripheral nerve involvement in hereditary spastic paraplegia characterized by quantitative magnetic resonance neurography

Eur J Neurol. 2023 Aug;30(8):2442-2452. doi: 10.1111/ene.15841. Epub 2023 May 26.


Background and objectives: Hereditary spastic paraplegias (HSPs) are heterogenous genetic disorders. While peripheral nerve involvement is frequent in spastic paraplegia 7 (SPG7), the evidence of peripheral nerve involvement in SPG4 is more controversial. We aimed to characterize lower extremity peripheral nerve involvement in SPG4 and SPG7 by quantitative magnetic resonance neurography (MRN).

Methods: Twenty-six HSP patients carrying either the SPG4 or SPG7 mutation and 26 age-/sex-matched healthy controls prospectively underwent high-resolution MRN with large coverage of the sciatic and tibial nerve. Dual-echo turbo-spin-echo sequences with spectral fat-saturation were utilized for T2-relaxometry and morphometric quantification, while two gradient-echo sequences with and without an off-resonance saturation rapid frequency pulse were applied for magnetization transfer contrast (MTC) imaging. HSP patients additionally underwent detailed neurologic and electroneurographic assessments.

Results: All microstructural (proton spin density [ρ], T2-relaxation time, magnetization transfer ratio) and morphometric (cross-sectional area) quantitative MRN markers were decreased in SPG4 and SPG7 indicating chronic axonopathy. ρ was superior in differentiating subgroups and identifying subclinical nerve damage in SPG4 and SPG7 without neurophysiologic signs of polyneuropathy. MRN markers correlated well with clinical scores and electroneurographic results.

Conclusions: MRN characterizes peripheral nerve involvement in SPG4 and SPG7 as a neuropathy with predominant axonal loss. Evidence of peripheral nerve involvement in SPG4 and SPG7, even without electroneurographically manifest polyneuropathy, and the good correlation of MRN markers with clinical measures of disease progression, challenge the traditional view of the existence of HSPs with isolated pyramidal signs and suggest MRN markers as potential progression biomarkers in HSP.

Keywords: T2-relaxometry; electrophysiology; hereditary spastic paraplegia; magnetic resonance neurography (MRN); magnetization transfer contrast imaging.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Humans
  • Magnetic Resonance Imaging / methods
  • Magnetic Resonance Spectroscopy
  • Peripheral Nerves / diagnostic imaging
  • Peripheral Nerves / pathology
  • Peripheral Nervous System Diseases* / diagnostic imaging
  • Peripheral Nervous System Diseases* / pathology
  • Polyneuropathies* / pathology
  • Spastic Paraplegia, Hereditary* / diagnostic imaging
  • Spastic Paraplegia, Hereditary* / genetics

Supplementary concepts

  • Spastic Paraplegia 7, Autosomal Recessive