Sage Journals: Discover world-class research

Abstract

Background:

The usefulness of performing a spinal cord (SC) magnetic resonance imaging (MRI) in all clinically isolated syndromes (CIS) is controversial.

Objective:

To assess the value of SC lesions for predicting multiple sclerosis (MS) diagnosis and disability accrual in CIS.

Methods:

Concerning SC lesions and MS diagnosis (2010 McDonald), adjusted Cox regression analyses were performed in increasingly specific CIS groups: all cases (n = 207), non-SC CIS (n = 143), non-SC CIS with abnormal brain MRI (n = 90) and non-SC CIS with abnormal brain MRI not fulfilling 2010 MS (n = 67). For the outcome Expanded Disability Status Scale (EDSS) ≥3.0, similar analyses were performed in all cases (n = 207), non-SC CIS (n = 143) and SC CIS (n = 64). Performance at 2 years was assessed for all outcomes.

Results:

The presence of SC lesions increased MS risk 2.0–2.6 times independently of factors like brain lesions. If considering lesion number, the risk ranged from 1.6 to 2.1 for one lesion to 2.4–3.3 for ≥2. SC lesions increased the short-term disability risk around fivefold, better demonstrated in non-SC CIS. SC lesions were very specific for evolution to MS and showed very high sensitivity for EDSS ≥3.0.

Conclusion:

SC lesions are independent predictors of MS in all CIS and contribute to short-term disability accrual. SC MRIs in CIS could be useful to estimate their prognosis.

Keywords

Multiple sclerosis prognosis clinically isolated syndrome spinal cord magnetic resonance imaging

Get full access to this article

View all access options for this article.

References

Kearney

Miller

Ciccarelli

Spinal cord MRI in multiple sclerosis – Diagnostic, prognostic and clinical value. Nat Rev Neurol 2015; 11: 327–338.

Polman

Reingold

Banwell

et al . Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69: 292–302.

Thorpe

Kidd

Moseley

et al . Spinal MRI in patients with suspected multiple sclerosis and negative brain MRI. Brain 1996; 119(Pt 3): 709–714.

Lycklama

Thompson

Filippi

et al . Spinal-cord MRI in multiple sclerosis. Lancet Neurol 2003; 2: 555–562.

Bot

Barkhof

Spinal-cord MRI in multiple sclerosis: Conventional and nonconventional MR techniques. Neuroimaging Clin N Am 2009; 19: 81–99.

Rovira

Wattjes

Tintore

et al . Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process. Nat Rev Neurol 2015; 11: 471–482.

Traboulsee

Simon

Stone

et al . Revised recommendations of the consortium of MS centers task force for a standardized MRI protocol and clinical guidelines for the diagnosis and follow-up of multiple sclerosis. AJNR Am J Neuroradiol 2016; 37: 394–401.

Sombekke

Wattjes

Balk

et al . Spinal cord lesions in patients with clinically isolated syndrome: A powerful tool in diagnosis and prognosis. Neurology 2013; 80: 69–75.

Patrucco

Rojas

Cristiano

Assessing the value of spinal cord lesions in predicting development of multiple sclerosis in patients with clinically isolated syndromes. J Neurol 2012; 259: 1317–1320.

10.

Dalton

Brex

Miszkiel

et al . Spinal cord MRI in clinically isolated optic neuritis. J Neurol Neurosurg Psychiatry 2003; 74: 1577–1580.

11.

Hummel

Bruck

Dreha-Kulaczewski

et al . Pediatric onset multiple sclerosis: McDonald criteria 2010 and the contribution of spinal cord MRI. Mult Scler 2013; 19: 1330–1335.

12.

Swanton

Fernando

Dalton

et al . Early MRI in optic neuritis: The risk for disability. Neurology 2009; 72: 542–550.

13.

Brownlee

Altmann

Alves

Mota

et al . Association of asymptomatic spinal cord lesions and atrophy with disability 5 years after a clinically isolated syndrome. Mult Scler 2017; 23: 665–674.

14.

Barkhof

Spinal cord MRI should always be performed in clinically isolated syndrome patients: Yes. Mult Scler 2014; 20: 1688–1689.

15.

Rovira

Tintore

Spinal cord MRI should always be performed in clinically isolated syndrome patients: No. Mult Scler 2014; 20: 1686–1687.

16.

Hutchinson

Spinal cord MRI should always be performed in clinically isolated syndrome patients: Commentary. Mult Scler 2014; 20: 1690–1691.

17.

Tintore

Rovira

Rio

et al . Defining high, medium and low impact prognostic factors for developing multiple sclerosis. Brain 2015; 138: 1863–1874.

18.

Stankiewicz

Neema

Alsop

et al . Spinal cord lesions and clinical status in multiple sclerosis: A 1.5 T and 3 T MRI study. J Neurol Sci 2009; 279: 99–105.

19.

Poser

Paty

Scheinberg

et al . New diagnostic criteria for multiple sclerosis: Guidelines for research protocols. Ann Neurol 1983; 13: 227–231.

20.

Minneboo

Barkhof

Polman

et al . Infratentorial lesions predict long-term disability in patients with initial findings suggestive of multiple sclerosis. Arch Neurol 2004; 61: 217–221.

21.

Tintore

Rovira

Arrambide

et al . Brainstem lesions in clinically isolated syndromes. Neurology 2010; 75: 1933–1938.

22.

McDonald

Compston

Edan

et al . Recommended diagnostic criteria for multiple sclerosis: Guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001; 50: 121–127.

23.

Tintore

Otero-Romero

Rio

et al . Contribution of the symptomatic lesion in establishing MS diagnosis and prognosis. Neurology 2016; 87(13): 1368–1374.

24.

Kearney

Miszkiel

Yiannakas

et al . Grey matter involvement by focal cervical spinal cord lesions is associated with progressive multiple sclerosis. Mult Scler 2016; 22: 910–920.

25.

Schlaeger

Papinutto

Panara

et al . Spinal cord gray matter atrophy correlates with multiple sclerosis disability. Ann Neurol 2014; 76: 568–580.

26.

O’Riordan

Losseff

Phatouros

et al . Asymptomatic spinal cord lesions in clinically isolated optic nerve, brain stem, and spinal cord syndromes suggestive of demyelination. J Neurol Neurosurg Psychiatry 1998; 64: 353–357.

27.

Cordonnier

de Seze

Breteau

et al . Prospective study of patients presenting with acute partial transverse myelopathy. J Neurol 2003; 250: 1447–1452.

28.

Lycklama à Nijeholt

Uitdehaag

Bergers

et al . Spinal cord magnetic resonance imaging in suspected multiple sclerosis. Eur Radiol 2000; 10: 368–376.

29.

Polman

Reingold

Edan

et al . Diagnostic criteria for multiple sclerosis: 2005 revisions to the ‘McDonald Criteria’. Ann Neurol 2005; 58: 840–846.

30.

Galassi

Prosperini

Logoteta

et al . A lesion topography-based approach to predict the outcomes of patients with multiple sclerosis treated with Interferon Beta. Mult Scler Relat Disord 2016; 8: 99–106.

31.

Kearney

Altmann

Samson

et al . Cervical cord lesion load is associated with disability independently from atrophy in MS. Neurology 2015; 84: 367–373.

32.

Lukas

Knol

Sombekke

et al . Cervical spinal cord volume loss is related to clinical disability progression in multiple sclerosis. J Neurol Neurosurg Psychiatry 2015; 86: 410–418.

33.

Biberacher

Boucard

Schmidt

et al . Atrophy and structural variability of the upper cervical cord in early multiple sclerosis. Mult Scler 2015; 21: 875–884.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.08 MB

0.31 MB

Spinal cord lesions: A modest contributor to diagnosis in clinically isolated syndromes but a relevant prognostic factor

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material