MRI of the Entire Spinal Cord-Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis.

Esben Nyborg Poulsen,Anna Olsson,Stefan Gustavsen,Annette Bang Oturai,Jonathan Frederik Carlsen,Annika Reynberg Langkilde

doi:10.3390/diagnostics11081424

Esben Nyborg Poulsen, Anna Olsson + Show 4 more

Open Access

https://doi.org/10.3390/diagnostics11081424

Copy DOI

Abstract

Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

Highlights

Multiple sclerosis (MS) is an inflammatory demyelinating disease affecting both the brain and the spinal cord [1,2]
The cohort included 79 patients diagnosed with RRMS or CIS
We demonstrated that demyelinating lesions were present throughout the spinal cord with a bimodal distribution comprising a cervical and a thoracolumbar peak

Summary

Introduction

Multiple sclerosis (MS) is an inflammatory demyelinating disease affecting both the brain and the spinal cord [1,2]. Growing evidence suggests that early diagnosis and treatment may delay or even prevent disability in MS patients [4]. With the promise of effective disease control, fiscal societal costs for treating MS have increased steadily since the 1990s [5,6]. The costs for treating patients with severe disabilities from MS especially are mounting. Though generally well-tolerated, new disease-modifying therapies do carry risks of complications and warrant repeated monitoring of patients [7,8]. Clinicians face the task of balancing the efficacy of treatment against safety and costs. Reliable diagnostic tools are essential in procuring prompt and correct diagnosis and to secure optimal treatment evaluation

Objectives

Results

Discussion

Conclusion