No correlation between number of MRI-evident lesions in cerebrum and the soleus stretch reflex in multiple sclerosis patients.

The aim of the study was to investigate if the stretch reflex of the soleus muscle was useful in quantifying upper motor neuron lesions. The soleus stretch reflex was recorded in 10 healthy subjects and 20 patients with active relapsing-remitting multiple sclerosis and correlated to the number of MRI lesions in cerebrum and clinical scores (expanded disability status scale and regional functional scoring system). The short latency stretch reflex was elicited by rotating the left ankle joint 4 degrees with a rise time in the interval of 40-640 ms. The amplitude of the stretch was larger in multiple sclerosis patients being 88.5 microV in patients and 12.8 microV in controls, P = 0.007. The sensitivity of the stretch reflex expressed as the slope of the best linear fit was increased in MS patients to 2.6 microVs/degree compared with 0.6 microVs/degree (0.1-2.2) in controls, P = 0.009. There was no correlation between amplitude of the stretch reflex and number of MRI lesions (r = -0.03). In conclusion, the soleus stretch reflex might be useful to quantify spasticity but is not useful in detecting dysfunction of upper motor neurons in MS.

MRI volume measurements of hypointense objects. A phantom study using stereological methods.

Volume estimates made from thick slabs overestimate the volume of a positive contrast particle in a translucent matrix and underestimate its volume if the particle has negative contrast and the matrix is opaque. For T2-weighted MRI high signal objects the bias can be corrected according to simple geometric models. For negative contrast or hypointense objects the magnitude of the bias is unknown and no corrections have yet been put forward. We wanted to determine the bias of MRI measurements of hypointense objects of known diameter surrounded by a positive contrast solution. One, 3 and 5 mm slices with three different contrast concentrations were obtained according to a stereological MRI protocol. Results were compared with the true object size to estimate the bias. A simple correction for the bias could not be developed due to interslice cross-talk. Cross-talk makes an object appear in more MRI slices than corresponding to its physical size and larger than the true diameter. For phantom measurements an empirical correction could be developed, but for measurements of non-ideal objects such as brain structures the validity of the correction would be unpredictable. Besides avoiding or reducing cross-talk, the best way to deal with this bias is to measure the object's maximal contrast from edge to edge, a solution which is not perfect.