The impact of new asymptomatic spinal cord lesions (a-SL) in multiple sclerosis (MS) course is poorly characterized.
Objective:
The objective of this research paper is to assess the prognostic value of a-SL in predicting MS course.
Methods:
Relapsing–remitting MS patients who received serial MRI (brain and spinal) at baseline (t1) and within 12 to 36 months (t2) during clinical stability, and had a follow-up (t2–t3) ⩾24 months were included. Relapses and disability progression were evaluated between t2 and t3.
Results:
Of 413 consecutive screened MS patients, 103 patients (65 females, median age 43 years) were included. After a median t1–t2 interval of 17 (IQR 13–26) months, 25.2% and 43.7% patients had ⩾1 new a-SL (a-SL+) and asymptomatic brain lesions (a-BL+), respectively. Relapse risk between t2 and t3 (median interval: 42 (IQR 32–57.5) months) was significantly increased in a-SL+ and/or a-BL+ vs a-BL– and a-SL– (HR = 2.31, 95% CI = 1.13–4.72, p = 0.02). No differences in the risk of disability progression were found in a-SL+ and/or a-BL+ vs a-SL- and a-BL–.
Conclusion:
a-SL occur in one-quarter of clinically stable RRMS, and combined with a-BL contribute significantly in predicting future disease course.
BakshiRThompsonAJRoccaMA. MRI in multiple sclerosis: Current status and future prospects. Lancet Neurol2008; 7: 615–625.
2.
FilippiMRoccaMADe StefanoN. Magnetic resonance techniques in multiple sclerosis: The present and the future. Arch Neurol2011; 68: 1514–1520.
3.
PolmanCHReingoldSCBanwellB. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol2011; 69: 292–302.
4.
PetkauJReingoldSCHeldU. Magnetic resonance imaging as a surrogate outcome for multiple sclerosis relapses. Mult Scler2008; 14: 770–778.
5.
SormaniMPBruzziP. MRI lesions as a surrogate for relapses in multiple sclerosis: A meta-analysis of randomised trials. Lancet Neurol2013; 12: 669–676.
6.
TintoréMRoviraARíoJ. Baseline MRI predicts future attacks and disability in clinically isolated syndromes. Neurology2006; 67: 968–972.
7.
KacarKRoccaMACopettiM. Overcoming the clinical-MR imaging paradox of multiple sclerosis: MR imaging data assessed with a random forest approach. AJNR Am J Neuroradiol2011; 32: 2098–2102.
8.
FilippiMRoccaMA. MR imaging of multiple sclerosis. Radiology2011; 259: 659–681.
9.
LublinFDReingoldSCCohenJA. Defining the clinical course of multiple sclerosis: The 2013 revisions. Neurology2014; 83: 278–286.
10.
CoretFBoscaILandeteL. Early diffuse demyelinating lesion in the cervical spinal cord predicts a worse prognosis in relapsing–remitting multiple sclerosis. Mult Scler2010; 16: 935–941.
11.
HonigLSSheremataWA. Magnetic resonance imaging of spinal cord lesions in multiple sclerosis. J Neurol Neurosurg Psychiatry1989; 52: 459–466.
12.
NijeholtGJvan WalderveenMACastelijnsJA. Brain and spinal cord abnormalities in multiple sclerosis. Correlation between MRI parameters, clinical subtypes and symptoms. Brain1998; 121 (Pt 4): 687–697.
13.
TropIBourgouinPMLapierreY. Multiple sclerosis of the spinal cord: Diagnosis and follow-up with contrast-enhanced MR and correlation with clinical activity. AJNR Am J Neuroradiol1998; 19: 1025–1033.
14.
ZivadinovRBakshiR. Role of MRI in multiple sclerosis I: Inflammation and lesions. Front Biosci2004; 9: 665–683.
BotJCBarkhofFPolmanCH. Spinal cord abnormalities in recently diagnosed MS patients: Added value of spinal MRI examination. Neurology2004; 62: 226–233.
17.
Lycklama à NijeholtGJUitdehaagBMBergersE. Spinal cord magnetic resonance imaging in suspected multiple sclerosis. Eur Radiol2000; 10: 368–376.
18.
WeierKMazraehJNaegelinY. Biplanar MRI for the assessment of the spinal cord in multiple sclerosis. Mult Scler2012; 18: 1560–1569.
19.
HittmairKMallekRPrayerD. Spinal cord lesions in patients with multiple sclerosis: Comparison of MR pulse sequences. AJNR Am J Neuroradiol1996; 17: 1555–1565.
20.
Lycklama à NijeholtGJCastelijnsJAWeertsJ. Sagittal MR of multiple sclerosis in the spinal cord: Fast versus conventional spin-echo imaging. AJNR Am J Neuroradiol1998; 19: 355–360.
21.
Langer-GouldAPopatRAHuangSM. Clinical and demographic predictors of long-term disability in patients with relapsing–remitting multiple sclerosis: A systematic review. Arch Neurol2006; 63: 1686–1691.
22.
BotJCBarkhofF. Spinal-cord MRI in multiple sclerosis: Conventional and nonconventional MR techniques. Neuroimaging Clin N Am2009; 19: 81–99.
23.
OkudaDTSivaAKantarciO. Radiologically isolated syndrome: 5-year risk for an initial clinical event. PloS One2014; 9: e90509.
24.
MowryEMDeenSMalikovaI. The onset location of multiple sclerosis predicts the location of subsequent relapses. J Neurol Neurosurg Psychiatry2009; 80: 400–403.
25.
ThorpeJWKiddDMoseleyIF. Serial gadolinium-enhanced MRI of the brain and spinal cord in early relapsing–remitting multiple sclerosis. Neurology. 1996; 46: 373–378.
26.
WiebeSLeeDHKarlikSJ. Serial cranial and spinal cord magnetic resonance imaging in multiple sclerosis. Ann Neurol1992; 32: 643–650.
27.
CapraRMarcianòNVignoloLA. Gadolinium-pentetic acid magnetic resonance imaging in patients with relapsing remitting multiple sclerosis. Arch Neurol1992; 49: 687–689.
28.
BrexPAO’RiordanJIMiszkielKA. Multisequence MRI in clinically isolated syndromes and the early development of MS. Neurology1999; 53: 1184–1190.
SwantonJKFernandoKTDaltonCM. Early MRI in optic neuritis: The risk for disability. Neurology2009; 72: 542–550.
31.
PozzilliCProsperiniLSbardellaE. Post-marketing survey on clinical response to interferon beta in relapsing multiple sclerosis: The Roman experience. Neurol Sci2005; 26 (Suppl 4): S174–S178.
32.
RíoJCastillόJRoviraA. Measures in the first year of therapy predict the response to interferon beta in MS. Mult Scler2009; 15: 848–853.
33.
SombekkeMHWattjesMPBalkLJ. Spinal cord lesions in patients with clinically isolated syndrome: A powerful tool in diagnosis and prognosis. Neurology2013; 80: 69–75.
34.
KearneyHAltmannDRSamsonRS. Cervical cord lesion load is associated with disability independently from atrophy in MS. Neurology2015; 84: 367–373.
35.
LukasCSombekkeMHBellenbergB. Relevance of spinal cord abnormalities to clinical disability in multiple sclerosis: MR imaging findings in a large cohort of patients. Radiology2013; 269: 542–552.
36.
TaberKHHerrickRCWeathersSW. Pitfalls and artifacts encountered in clinical MR imaging of the spine. Radiographics1998; 18: 1499–1521.
