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Eur Radiol Exp. 2018 Jun 22;2:13. doi: 10.1186/s41747-018-0045-6. eCollection 2018 Dec.

Cord cross-sectional area at foramen magnum as a correlate of disability in amyotrophic lateral sclerosis.

Author information

1
1Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova and IRCCS Azienda Ospedale Università San Martino-IST, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
2
2Department of Health Sciences (DISSAL), University of Genova, Via Pastore 1, 16132 Genoa, Italy.
3
3Department of Diagnostic and Interventional Neuroradiology, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
4
4Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova and IRCCS Azienda Ospedale Università San Martino-IST; International School for Advanced Studies (SISSA), Via Bonomea 265, Trieste, Italy.
5
5Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY USA.
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6Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY USA.
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7Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY USA.
8
IRCCS Azienda Ospedale Università San Martino-IST, Largo Rosanna Benzi 10, 16132 Genoa, Italy.

Abstract

Spinal cord atrophy is one of the hallmarks of amyotrophic lateral sclerosis (ALS); however, it is not routinely assessed in routine clinical practice. In the present study, we evaluated whether spinal cord cross-sectional area measured at the foramen magnum level using a magnetic resonance imaging head scan represents a clinically meaningful measure to be added to the whole-brain volume assessment. Using an active surface approach, we measured the cord area at the foramen magnum and brain parenchymal fraction on T1-weighted three-dimensional spoiled gradient recalled head scans in two groups of subjects: 23 patients with ALS (males/females, 13/10; mean ± standard deviation [SD] age 61.7 ± 10.3 years; median ALS Functional Rating Scale-Revised score 39, range 27-46) and 18 age- and sex-matched healthy volunteers (mean ± SD age 55.7 ± 10.2 years). Spinal cord area at the foramen magnum was significantly less in patients than in control subjects and was significantly correlated with disability as measured with the ALS Functional Rating Scale-Revised (ρ = 0.593, p <  0.005). This correlation remained significant after taking into account inter-individual differences in brain parenchymal fraction (ρ = 0.684, p <  0.001). Our data show that spinal cord area at the foramen magnum correlates with disability in ALS independently of whole-brain atrophy, thus indicating its potential as a disease biomarker.

KEYWORDS:

Amyotrophic lateral sclerosis (ALS); Cervical cord atrophy; Foramen magnum; Magnetic resonance imaging (MRI)

Conflict of interest statement

The local Ethics Committee (IRCCS Azienda Ospedale Università San Martino-IST, Largo Rosanna Benzi 10, 16132, Genova, Italia) approved this study, and written informed consent to participate and to publish results was obtained from all participants.Written informed consent to participate and to publish results was obtained from all participants.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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