{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T12:55:48Z","timestamp":1781528148275,"version":"3.54.1"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study assessed whether upper cervical cord area (UCCA) measured on routine brain MRI can serve as a biomarker of conversion to SPMS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a single\u2010center retrospective cohort study of RRMS patients with cross\u2010sectional and longitudinal analyses of clinical and MRI data. Future SPMS converters were matched by age, sex, and disease duration with non\u2010converters. UCCA at C1\u2013C3 was measured at a pre\u2010conversion visit in converters and at the first available visit in non\u2010converters. Analysis was performed using Pearson's correlation and multivariable logistic regression. Longitudinal analyses included patients with \u2265\u20096\u2009months MRI interval (mean follow\u2010up 3.38\u2009\u00b1\u20091.88\u2009years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      97 patients (32 converters, 65 non\u2010converters) were included. Cross\u2010sectionally, reduced C2 and C3 area was associated with conversion (C2: OR 1.09,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01; C3: OR 1.09,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014). Lower UCCA correlated with higher EDSS (C2:\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.496,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), worse T25\u2010FWT (C2:\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.388,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and 9\u2010HPT (C2:\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.312,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), and reduced white matter and thalamic volumes (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.006). Longitudinal analysis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950; 16 converters, 34 non\u2010converters) demonstrated atrophy in converters at C1, C2 and C3 (C1: OR 1.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014; C2: OR 1.74,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003; C3: OR 1.75,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), with mean annual percent reductions of 5.0%, 5.2%, and 6.0%, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Reduced UCCA and accelerated upper cervical cord atrophy were associated with conversion to SPMS and worsening disability, supporting UCCA as an accessible imaging biomarker of MS progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acn3.70452","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T12:23:56Z","timestamp":1781526236000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Upper Cervical Cord Area as a Biomarker of Conversion to Secondary Progressive Multiple Sclerosis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0476-0990","authenticated-orcid":false,"given":"Nabil K.","family":"El Ayoubi","sequence":"first","affiliation":[{"name":"Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sola","family":"Al Ghazal","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Rochester School of Medicine and Dentistry  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5982-3242","authenticated-orcid":false,"given":"Salem","family":"Hannoun","sequence":"additional","affiliation":[{"name":"Medical Imaging Sciences Program, Division of Health Professions, Faculty of Health Sciences American University of Beirut  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6539-3126","authenticated-orcid":false,"given":"Medhat A.","family":"Siddik","sequence":"additional","affiliation":[{"name":"Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nour M.","family":"Najjar","sequence":"additional","affiliation":[{"name":"Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Dagher","sequence":"additional","affiliation":[{"name":"Department of Neurology UH Cleveland Medical Center  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Abboud","sequence":"additional","affiliation":[{"name":"Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myriam G.","family":"Semaan","sequence":"additional","affiliation":[{"name":"Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3198-6063","authenticated-orcid":false,"given":"Samia J.","family":"Khoury","sequence":"additional","affiliation":[{"name":"Nehme and Therese Tohme Multiple Sclerosis Center American 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