Additive Effect of Spinal Cord Volume, Diffuse and Focal Cord Pathology on Disability in Multiple Sclerosis.

Introduction: Spinal cord (SC) pathology is strongly associated with disability in multiple sclerosis (MS). We aimed to evaluate the association between focal and diffuse SC abnormalities and spinal cord volume and to assess their contribution to physical disability in MS patients. Methods: This large sample-size cross-sectional study investigated 1,249 patients with heterogeneous MS phenotypes. Upper cervical-cord cross-sectional area (MUCCA) was calculated on an axial 3D-T2w-FatSat sequence acquired at 3T using a novel semiautomatic edge-finding tool. SC images were scored for the presence of sharply demarcated hyperintense areas (focal lesions) and homogenously increased signal intensity (diffuse changes). Patients were dichotomized according EDSS in groups with mild (EDSS up to 3.0) and moderate (EDSS ≥ 3.5) physical disability. Analysis of covariance was used to identify factors associated with dichotomized MUCCA. In binary logistic regression, the SC imaging parameters were entered in blocks to assess their individual contribution to risk of moderate disability. In order to assess the risk of combined SC damage in terms of atrophy and lesional pathology on disability, secondary analysis was carried out where patients were divided into four categories (SC phenotypes) according to median dichotomized MUCCA and presence/absence of focal and/or diffuse changes. Results: MUCCA was strongly associated with total intracranial volume, followed by presence of diffuse SC pathology, and disease duration. Compared to the reference group (normally appearing SC, MUCCA>median), patients with the most severe SC changes (SC affected with focal and/or diffuse lesions, MUCCA

[A rare case of mobile atherosclerotic plaque with a high embolic potential in the femoral artery]. / Vzácný prípad mobilního aterosklerotického plátu ve femorální tepne s vysokým embolizacním potenciálem.

Atherosclerosis is a diffuse disease which may lead to the development of unstable atherosclerotic plaque. Its rupture can result in acute ischemic event. The atherosclerotic plaques with a mobile component are typical presentations of such instability and patients with these plaques are at high risk of acute ischemic events. In the current literature, substantial data regarding the mobile atherosclerotic plaques in carotid arteries and thoracic aorta is published. However there are almost no data concerning the mobile plaques in the peripheral arteries of the lower limbs. We present a rare case of a patient with generalized atherosclerosis, in whom an asymptomatic mobile atherosclerotic plaque in the common femoral artery with a high embolic potential was diagnosed. This plaque was successfully removed by femoral endarterectomy. On the basis of this case, we review the possibilities and limitations of the current imaging methods in detection of mobile plaques in the peripheral arteries. Moreover optimal therapeutic approaches in such patients are discussed.