الفهرس 
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Abstract
Magnetic resonance imaging (MRI) is the method of choice in the diagnosis of multiple sclerosis (MS) as well as in monitoring the disease’s activity. In recent years many researchers have paid much attention to the correlation between radiological findings and clinical state of the patients. In MS the volume of lesion reflects the inflammatory feature of the disease, while atrophy measures the quantitatively neurodegenerative aspect of the disease, which play an important role in all disease stages. The issue of brain atrophy in MS patients is not sufficiently reported in the literature with regards to the nature of their clinical significance. This study was conducted to measure the brain volumes at cerebellum and brain stem levels in a cohort of Egyptian multiple sclerosis patients, and analyze whether the regional volumes correlate with neurological disability scores of the patients, which may help to understand the differences in patterns of neurological disability. We included a total of 60 subjects; 30 cases diagnosed with RRMS were included in the first group, and 30 healthy controls were included in group B. There was no significant difference between the two groups regarding general demographics (age, gender, and BMI). The mean age of the included MS cases was 30.93 years, and female gender was more predominant than male (60 vs. 40%). The selection criteria were patients with RRMS by clinical and conventional MRI examinations according to modified McDonald’s criteria with no age or sex predilection. Exclusion criteria: general contraindication for MRI scan as cardiac pacemaker, clipsed aneurysm or cochlear implant (absolute contraindication). Patients who refuse examination. Pyramidal dysfunction was the commonest affected functional system (83.3%), followed by visual problems (73.3%), sensory dysfunction (63.3%), and cerebellar dysfunction (60%). Other manifestations included bowel and bladder dysfunction (53.3%), cerebral dysfunction (36.7%), and mental problems (6.7%). The MRI protocol consisted of conventional acquisition data and 3D T1-weighted sequences without contrast. The T1W had the following parameters; sagittal acquisition plane, and isotropic scan with slice thickness of 1mm. Volumetric analysis was done by 3D Slicer software package version 4.6 using semi-automated technique to calculate the volumes of Cerebellar Gray and white matter and brain stem structures. Magnetic resonance volumetry was done for all subjects (case and control groups) to assess volume of medulla oblongata, pons, midbrain, whole brain stem, left cerebellar white matter, left cerebellar grey matter, right cerebellar white matter and right cerebellar grey matter. Brain volumetric analysis showed the following: significant decrease in medulla oblongata volume in cases compared to controls (3.41 vs. 4.71 cm3). Significant decrease in pons volume in MS cases compared to controls (12.08 vs. 14.16 cm3). No significant difference between the two groups regarding midbrain size (5.37 vs. 5.97 cm3). Whole brainstem volume was significantly decreased in cases compared to controls (22.17 vs. 25.09 cm3). Cerebellar white volume matter was not significantly different between cases and controls (21.75 vs. 22.04 on the left side, and 21.41 vs. 22.32 cm3 on the right side). Cerebellar grey matter volume was significantly decreased in MS cases compared to controls (81.64 vs. 92.83 cm3 on the left side, and 80.37 vs. 91.97 cm3 on the right side). Regarding brain stem, using a cut-off value of 23.25 cm3, MRI had sensitivity and specificity of 84 and 86% respectively with an accuracy of 82%. Additionally, using a cut-off value of 83.46 cm3 for cerebellar grey matter, MRI had sensitivity and specificity of 87.8 and 95.7% respectively with an accuracy of 95.2%. EDSS and relapse rates showed a significant negative correlation with medulla, pons, whole brain stem volume, in addition to both right and left cerebellar cortical volumes (p < 0.05).