Cervical spinal cord involvement is common in multiple sclerosis (MS). We performed a comprehensive multiparametric MRI study to explore pathophysiological substrates of damage and to identify the most accurate imaging predictors of disability and disease course. We found that the processes contributing to disability differ according to the stage of the disease. In relapsing-remitting MS patients, lesions and microstructural damage to cervical spinal cord tracts have a prominent role, whereas in progressive MS patients, cervical cord grey matter atrophy becomes clinically meaningful.
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