Cervical Spinal Cord Diffusion Tensor Imaging and Gait Analysis in MS

Background: Cervical cord DTI has been utilized as an imaging biomarker for clinical disability related to injuries on a tract level. Body sensors capture detailed information not assessed by straight-line walking velocity, such as posture, gait parameters, and turns.

Objectives: Evaluate the relationship between posture and gait to quantitative imaging alterations within posterior columns and corticospinal tracts in patients with MS. We hypothesize that posterior column radial diffusivity (RD) and fractional anisotropy (FA) will correlate with eyes-closed normalized jerk on flat ground and Activities-specific Balance Confidence scale (ABC) scores. Corticospinal tract RD and FA will correlate with stride velocity normalized to height, single leg support time, and Multiple Sclerosis Walking Scale (MSWS) scores. Finally, we hypothesize that a combination of damage to the PCs and CSTs will better predict reductions in turning velocity and base of support.

Methods: 18 patients with MS underwent a non-contrast MRI of the brain and spine. Spatiotemporal gait analysis was conducted using APDM Opal wireless body-worn sensors. Images of the cervical spinal cord were obtained using a Siemens 3T Trio. Regions of interest were manually drawn for corticospinal tracts and dorsal columns. Generalized estimating equations evaluated DTI within left and right tracts in relation to clinical and patient-reported outcomes.

Results: 16 Relapsing Remitting and 2 Primary Progressive subjects with a median EDSS of 3.5 were evaluated. Subjects had a mean age of 42, and median disease duration of 4 years.  Additional results based upon the hypothesis for this work-in-progress will be presented.

Conclusions: Diffusion imaging can quantify injury within cervical cord tracts in patients with multiple sclerosis. The relationship of DTI parameters to gait analysis and patient reported outcomes will be reported.