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Benefit of repetitive intrathecal triamcinolone acetonide therapy in predominantly spinal multiple sclerosis: prediction by upper spinal cord atrophy

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St Josef Hospital, Ruhr-University of Bochum, Bochum, Germany, Carsten.Lukas@ ruhr-uni-bochum.de

Barbara Bellenberg

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St Josef Hospital, Ruhr-University of Bochum, Bochum, Germany

Horst K. Hahn

Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany

Jan Rexilius

Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany

Robert Drescher

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St Josef Hospital, Ruhr-University of Bochum, Bochum, Germany

Kerstin Hellwig

Kerstin Hellwig Sebastian Schimrigk Department of Neurology, St Josef Hospital, Ruhr-University of Bochum, Bochum, Germany

Odo Köster

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St Josef Hospital, Ruhr-University of Bochum, Bochum, Germany

Sebastian Schimrigk

Kerstin Hellwig Sebastian Schimrigk Department of Neurology, St Josef Hospital, Ruhr-University of Bochum, Bochum, Germany

Intrathecal injection of triamcinolone acetonide (TCA) has been shown to provide substantial benefit in a subset of progressive multiple sclerosis (MS) patients with predominant spinal symptoms. We examined whether atrophy of the upper spinal cord (USC) as measured by MRI can serve as a predictive marker for response to repetitive intrathecal TCA application. Repetitive administration of 40 mg TCA was performed in 31 chronic progressive MS patients up to six times within 3 weeks. Expanded Disability Status Scale (EDSS) and maximum walking distance (WD) were assessed before and after the treatment cycle. Cervical 3D T1-weighted images were acquired on a 1.5T scanner at baseline. Mean cross-sectional area of the USC was determined using a semi-automated volumetry method. Results were compared with a group of 29 healthy controls to group patients into those with and without atrophy. Results show a negative correlation between the degree of USC atrophy and treatment benefit. A higher treatment benefit in patients with little USC atrophy but short initial maximum WD was observed. Absence of USC atrophy as measured on MRI is a predictive marker for intrathecal TCA therapy outcome in progressive MS. Patients with initial poor walking abilities, but only little or no atrophy, benefited most from TCA therapy.

Key Words: atrophy • MRI • multiple sclerosis • spinal cord • triamcinolone acetonide

This version was published on November 1, 2009

Therapeutic Advances in Neurological Disorders, Vol. 2, No. 6, 349-355 (2009)
DOI: 10.1177/1756285609343480


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