Servei de Neurologia / Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Secció de Neuroradiologia, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
J Neurol Neurosurg Psychiatry. 2023 Jul;94(7):502-510. doi: 10.1136/jnnp-2022-330613. Epub 2023 Jan 23.
The spinal cord (SC) is a preferential target of multiple sclerosis (MS) damage highly relevant towards disability. Differential impact of such damage could be due to the initial amount of SC tissue, as described for the brain parenchyma (brain reserve concept). We aimed to test the existence of SC reserve by using spinal canal area (SCaA) as a proxy.
Brain sagittal three-dimensional T1-weighted scans covering down to C5 level were acquired in 2930 people with MS and 43 healthy controls (HCs) in a cross-sectional, multicentre study. SC area (SCA) and SCaA were obtained with the Spinal Cord Toolbox. Demographical data and patient-derived disability scores were obtained. SC parameters were compared between groups with age-adjusted and sex-adjusted linear regression models. The main outcome of the study, the existence of an association between SCaA and Patient Determined Disease Steps, was tested with scaled linear models.
1747 persons with MS (mean age: 46.35 years; 73.2% female) and 42 HCs (mean age: 45.56 years; 78.6% female) were analysed after exclusion of post-processing errors and application of quality criteria. SCA (60.41 mm vs 65.02 mm, p<0.001) was lower in people with MS compared with HC; no differences in SCaA were observed (213.24 mm vs 212.61 mm, p=0.125). Adjusted scaled linear models showed that a larger SCaA was significantly associated with lower scores on Patient Determined Disease Steps (beta coefficient: -0.12, p=0.0124) independently of spinal cord atrophy, brain T2 lesion volume, age and sex.
A larger SCaA may be protective against disability in MS, possibly supporting the existence of SC reserve.
脊髓（SC）是多发性硬化症（MS）损害的首选靶标，与残疾高度相关。这种损害的不同影响可能是由于 SC 组织的初始量，如脑实质（脑储备概念）所述。我们旨在通过使用椎管面积（SCaA）作为替代物来测试 SC 储备的存在。
在一项横断面、多中心研究中，我们共纳入了 2930 名 MS 患者和 43 名健康对照者（HCs）的脑矢状位三维 T1 加权扫描，扫描范围至 C5 水平。使用脊髓工具箱获得 SC 面积（SCA）和 SCaA。获取人口统计学数据和患者残疾评分。使用年龄调整和性别调整的线性回归模型比较组间的 SC 参数。使用缩放线性模型测试 SCaA 与患者确定疾病阶段之间存在关联的研究主要结局。
排除后处理错误和应用质量标准后，共分析了 1747 名 MS 患者（平均年龄：46.35 岁；73.2%为女性）和 42 名 HCs（平均年龄：45.56 岁；78.6%为女性）。与 HCs 相比，MS 患者的 SCA（60.41mm 比 65.02mm，p<0.001）较低；但 SCaA 无差异（213.24mm 比 212.61mm，p=0.125）。调整后的缩放线性模型显示，较大的 SCaA 与患者确定疾病阶段的较低评分显著相关（β系数：-0.12，p=0.0124），独立于脊髓萎缩、脑 T2 病变体积、年龄和性别。
较大的 SCaA 可能对 MS 患者的残疾具有保护作用，这可能支持 SC 储备的存在。
