Abstract
Spinal magnetic resonance imaging (MRI) is currently not recommended for the routine monitoring of clinically stable multiple sclerosis (MS) patients. We aimed to investigate the occurrence of asymptomatic spinal lesions (a-SL) in clinically stable MS patients, and their association with clinical and radiological outcomes, including the recurrence of spinal lesions. The hospital MS registry was searched for clinically stable MS patients (no relapses, no disability progression) with spinal MRIs performed at T1 (baseline) and T2 (9–36 months after T1). Information on relapses, disability and new brain/spinal MRI lesions at T3 (≥6 months after T2) was collected and analyzed. Out of 300 MS patients, 45 showed a-SL between T1 and T2. The presence of a-SL was not associated with the subsequent occurrence of relapses or disability progression at T3, but did correlate with the risk of new brain (rate ratio (RR) = 1.63, 95% CI = 1.16−2.25, p = 0.003) and recurrent spinal lesions (RR = 7.28, 95% CI = 4.02–13.22, p < 0.0001). Accounting for asymptomatic brain lesions (a-BL), the presence of either a-BL or a-SL was associated with subsequent risk for new brain (OR = 1.81, 95% CI = 1.25–2.60, p = 0.001) or spinal (RR = 2.63, 95% CI = 1.27–5.45, p = 0.009) lesions. Asymptomatic spinal demyelinating lesions occurred in 15% of clinically stable MS patients within a median period of 14 months and conferred an increased risk of future radiological activity at the brain and spinal level.
Highlights
Multiple sclerosis (MS) is the most common inflammatory disease of the central nervous system in young adults leading to long-term disability, with spinal cord involvement being one of its most relevant determinants [1]
We aimed to investigate the occurrence of asymptomatic spinal lesions (a-SL) in clinically stable multiple sclerosis (MS) patients, and their association with clinical and radiological outcomes, including the recurrence of spinal lesions
A-SL occurred in 15% of the clinically stable MS cohort—including relapsing and progressive patients—over a median period of 14 months
Summary
Multiple sclerosis (MS) is the most common inflammatory disease of the central nervous system in young adults leading to long-term disability, with spinal cord involvement being one of its most relevant determinants [1]. Lesions in the spinal cord are often located in clinically eloquent areas with tightly packed fibers, and fewer compensatory capacities, resulting in an increased risk of disability [2]. Spinal magnetic resonance imaging (MRI) is not recommended for the routine monitoring of clinically stable MS patients [4,5,6], mainly because of technical difficulties, limited MRI access, costs, and the belief that clinically silent lesions in the spinal cord are unlikely [7].
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