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SCGM areas were segmented manually by two independent raters. Muscle strength, self\u2010reported fatigue, depression and pain measures were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Post\u2010polio syndrome patients showed significantly and preferentially reduced SCGM areas at C2\/C3 (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.048), C3\/C4 (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.001), C4\/C5 (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), C5\/C6 (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.004) and<jats:italic>T<\/jats:italic><jats:sub>max<\/jats:sub>(<jats:italic>p<\/jats:italic>\u00a0=\u00a00.041) compared to HC. SCGM areas were significantly associated with muscle strength in corresponding myotomes even after adjustment for fatigue, pain and depression. SCGM area<jats:sub>Tmax<\/jats:sub>together with age and sex explained 68% of ankle dorsiflexion strength variance. No associations were found with age at or time since infection. Patients reporting PPS\u2010related decline in arm function showed significant cervical SCGM atrophy compared to stable patients adjusted for initial disease severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with PPS show significant SCGM atrophy that correlates with muscle strength and is associated with PPS\u2010related functional decline. Our findings suggest a secondary neurodegenerative process underlying SCGM atrophy in PPS that is not explained by aging or residua of the initial infection alone. Confirmation by longitudinal studies is needed. The described imaging methodology is promising for developing novel imaging surrogates for SCGM diseases.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.15261","type":"journal-article","created":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T09:44:12Z","timestamp":1643708652000},"page":"1435-1445","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Spinal cord gray matter atrophy is associated with functional decline in post\u2010polio syndrome"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4812-8807","authenticated-orcid":false,"given":"Maria Janina","family":"Wendebourg","sequence":"first","affiliation":[{"name":"Neurology Clinic and Policlinic Department of Clinical Research University Hospital Basel University of Basel Basel Switzerland"},{"name":"Translational Imaging in Neurology (ThINk) Department of Biomedical Engineering University of Basel Basel 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