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Objective biomarkers to monitor progression and treatment response are critically needed. Spinal cord (SC) MRI, including diffusion tensor imaging (DTI), is a promising non-invasive approach, but data in adults remain scarce.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted an exploratory longitudinal study in 26 adults with 5q-SMA (type 2:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094; type 3:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200922; median age 29.5\u00a0years) and 27 controls undergoing 3\u00a0T cervical SC MRI. Gray matter (GM) and total cross-sectional area (CSA) and DTI metrics (FA, MD, AD, RD) were extracted from three white matter tracts. Patients underwent motor (MFM-32, HFMSE, RULM), neurophysiological (CMAP, MUNIX) and fatigue assessments. 22 patients completed 12\u201314-month follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Total SC CSA was reduced across C2\u2013C6 (Cohen d up to 1.02) but showed limited functional correlations. GM CSA was reduced in SMA versus controls (11.90\u2009\u00b1\u20092.56 vs. 13.92\u2009\u00b1\u20091.72 mm\n                      <jats:sup>2<\/jats:sup>\n                      ;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001; Cohen\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.93) and correlated robustly with MFM-32 (\n                      <jats:italic>R<\/jats:italic>\n                      \u2009=\u20090.60), HFMSE (\n                      <jats:italic>R<\/jats:italic>\n                      \u2009=\u20090.56), RULM (\n                      <jats:italic>R<\/jats:italic>\n                      \u2009=\u20090.54) and CMAP (\n                      <jats:italic>R<\/jats:italic>\n                      \u2009=\u20090.46). DTI revealed FA reduction and markedly elevated MD in fasciculi gracilis and cuneatus (Cohen d up to 2.44), without significant RD changes, suggesting axonal pathology. No DTI metric correlated with clinical variables. No longitudinal changes were detected at 12\u201314\u00a0months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Selective GM CSA yields robust functional correlations, supporting its role as a candidate imaging biomarker and outperforming total CSA. DTI abnormalities in sensory tracts extend the known pathological scope of adult SMA beyond motor neurons. Longer follow-up is warranted to detect disease progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14013-7","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:43:29Z","timestamp":1784825009000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal spinal cord MRI in adult 5q-SMA: biomarker and pathophysiological insights"],"prefix":"10.1007","volume":"273","author":[{"given":"Felipe Franco","family":"da Gra\u00e7a","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago Junqueira Ribeiro","family":"de Rezende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Iwabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carelis","family":"Gonz\u00e1lez-Salazar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"de Holanda Mendon\u00e7a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmar","family":"Zanoteli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0898-2419","authenticated-orcid":false,"given":"Marcondes Cavalcante","family":"Fran\u00e7a-Jr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"issue":"1","key":"14013_CR1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-022-00380-8","volume":"8","author":"E Mercuri","year":"2022","unstructured":"Mercuri E, Sumner CJ, Muntoni F, Darras BT, Finkel RS (2022) Spinal muscular atrophy. 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