Magnetization-transfer histogram analysis of the cervical cord in patients with multiple sclerosis.

BACKGROUND AND PURPOSE Previous studies have failed to show significant correlations between the number and extent of T2 spinal cord lesions and the clinical status of multiple sclerosis (MS) patients. We evaluated 1) whether it is feasible to create magnetization transfer-ratio (MTR) histograms of the cervical cord in patients with MS by using two different acquisition schemes, and 2) whether cervical cord MTR histogram metrics were different from those of healthy control subjects and between MS patients with and without locomotor disability. METHODS We obtained two sets of gradient-echo sequences with and without a saturation pulse from 90 MS patients and 20 sex- and age-matched healthy control subjects. One set consisted of 20 axial, contiguous slices with a thickness equal to 5 mm. The other set consisted of 17 sagittal slices with a thickness equal to 3 mm and an interslice gap equal to 0.3 mm. After image coregistration and removal of tissues around the cervical cord, MTR histograms were created. The average MTR, the peak height, and the peak position of the histograms were measured. All of these measurements were from the whole of the cervical cord, thus including both MS lesions and normal-appearing tissue. RESULTS When comparing the MTR histograms obtained using axial, contiguous, 5-mm-thick slices, MS patients had significantly lower average cervical cord MTR and peak height than did control subjects. When comparing the MTR histograms obtained using sagittal, 3-mm-thick slices, MS patients also had significantly lower average cervical cord MTR and peak location than did control subjects. Patients with locomotor disability had significantly lower average cord MTR and peak location than those without. CONCLUSION This study shows that it is feasible to obtain MTR histograms of the cervical cord from MS patients by using different acquisition schemes. Our results also suggest that the assessment of MS cervical cord damage, achieved using MTR histograms, may lead to a better understanding of the clinical manifestations of the disease.