Limited utility of adding 3T cervical spinal cord MRI to monitor disease activity in multiple sclerosis

Abstract

Background:

Performing routine brain magnetic resonance imaging (MRI) is widely accepted as the standard of care for disease monitoring in multiple sclerosis (MS), but the utility of performing routine spinal cord (SC) MRI for this purpose is still debatable.

Objective:

This study aimed to measure the frequency of new isolated cervical spinal cord lesions (CSLs) in people with MS (pwMS) undergoing routine brain and cervical SC-MRI for disease monitoring and determine the factors associated with the development of new CSLs and their prognostic value.

Methods:

We retrospectively identified 1576 pwMS who underwent follow-up 3T brain and cervical SC-MRI over a 9-month period. MRI was reviewed for the presence of new brain lesions (BLs) and CSLs. Clinical records were reviewed for interval relapses between sequential scans and subsequent clinical relapse and disability worsening after the follow-up MRI.

Results:

In 1285 pwMS (median interval: 13–14 months) who were clinically stable with respect to relapses, 73 (5.7%) had new CSLs, of which 49 (3.8%) had concomitant new BLs and 24 (1.9%) had new isolated CSLs only. New asymptomatic CSLs were associated with ⩾ 3 prior relapses (p = 0.04), no disease-modifying therapy (DMT) use (p = 0.048), and ⩾ 3 new BLs (p < 0.001); ⩾ 3 new BLs (OR: 7.11, 95% CI: 4.3–11.7, p < 0.001) remained independently associated with new CSLs on multivariable analysis. Having new asymptomatic CSLs was not independently associated with subsequent relapse or disability worsening after the follow-up MRI (median follow-up time of 26 months).

Conclusion:

Routine brain and cervical SC-MRI detected new isolated CSLs in only < 2% of clinically stable pwMS. Developing new asymptomatic CSLs was associated with concomitant new BLs and did not confer an independent increased risk of relapse or disability worsening. Performing SC-MRI may not be warranted for routine monitoring in most pwMS, and performing only brain MRI may be sufficient to capture the vast majority of clinically silent disease activity.

Keywords

Multiple sclerosis MRI spinal cord disease monitoring NEDA

Get full access to this article

View all access options for this article.

References

Thompson

Banwell

Barkhof

, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018; 17(2): 162–173.

Gass

Rocca

Agosta

, et al. MRI monitoring of pathological changes in the spinal cord in patients with multiple sclerosis. Lancet Neurol 2015; 14(4): 443–454.

Moccia

Ruggieri

Ianniello

, et al. Advances in spinal cord imaging in multiple sclerosis. Ther Adv Neurol Disord 2019; 12: 1756286419840593.

Kearney

Miller

Ciccarelli

. Spinal cord MRI in multiple sclerosis-diagnostic, prognostic and clinical value. Nat Rev Neurol 2015; 11(6): 327–338.

Suthiphosuwan

Kim

Bharatha

, et al. Imaging markers for monitoring disease activity in multiple sclerosis. Curr Treat Options Neurol 2017; 19(5): 18.

Muccilli

Seyman

. Spinal cord MRI in multiple sclerosis. Neurol Clin 2018; 36(1): 35–57.

Wattjes

Ciccarelli

Reich

, et al. 2021 MAGNIMS–CMSC–NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol 2021; 20: 653–670.

Kearney

. Clinical monitoring of multiple sclerosis should routinely include spinal cord imaging—No. Mult Scler J 2018; 24(12): 1537–1539.

Cortese

Ciccarelli

. Clinical monitoring of multiple sclerosis should routinely include spinal cord imaging—Yes. Mult Scler 2018; 24(12): 1536–1537.

10.

Wattjes

Rovira

Miller

, et al. Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis—Establishing disease prognosis and monitoring patients. Nat Rev Neurol 2015; 11(10): 597–606.

11.

Thorpe

Kidd

Moseley

, et al. Serial gadolinium-enhanced MRI of the brain and spinal cord in early relapsing-remitting multiple sclerosis. Neurology 1996; 46(2): 373–378.

12.

Silver

Good

Sormani

, et al. A modified protocol to improve the detection of enhancing brain and spinal cord lesions in multiple sclerosis. J Neurol 2001; 248(3): 215–224.

13.

Rocca

Preziosa

Filippi

. What role should spinal cord MRI take in the future of multiple sclerosis surveillance? Expert Rev Neurother 2020; 20(8): 783–797.

14.

Zecca

Disanto

Sormani

, et al. Relevance of asymptomatic spinal MRI lesions in patients with multiple sclerosis. Mult Scler 2016; 22(6): 782–791.

15.

Ostini

Bovis

Disanto

, et al. Recurrence and prognostic value of asymptomatic spinal cord lesions in multiple sclerosis. J Clin Med 2021; 10(3): 463.

16.

Rotstein

Healy

Malik

, et al. Evaluation of no evidence of disease activity in a 7-year longitudinal multiple sclerosis cohort. JAMA Neurol 2015; 72(2): 152–158.

17.

Tummala

Singhal

Oommen

, et al. Spinal cord as an adjunct to brain magnetic resonance imaging in defining “no evidence of disease activity” in multiple sclerosis. Int J MS Care 2017; 19(3): 158–164.

18.

Di Sabatino

Gaetani

Sperandei

, et al. The no evidence of disease activity (NEDA) concept in MS: Impact of spinal cord MRI. J Neurol 2022; 269: 3129–3135.

19.

Freedman

Devonshire

Duquette

, et al. Treatment optimization in multiple sclerosis: Canadian MS working group recommendations. Can J Neurol Sci 2020; 47(4): 437–455.

20.

Montalban

Gold

Thompson

, et al. ECTRIMS/EAN Guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler 2018; 24(2): 96–120.

21.

Rae-Grant

Day

Marrie

, et al. Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis. Neurology 2018; 90(17): 777–788.

22.

Alcaide-Leon

Pauranik

Alshafai

, et al. Comparison of Sagittal FSE T2, STIR, and T1-weighted phase-sensitive inversion recovery in the detection of spinal cord lesions in MS at 3T. AJNR Am J Neuroradiol 2016; 37(5): 970–975.

23.

Fechner

Savatovsky

El Methni

, et al. A 3T phase-sensitive inversion recovery MRI sequence improves detection of cervical spinal cord lesions and shows active lesions in patients with multiple sclerosis. AJNR Am J Neuroradiol 2019; 40(2): 370–375.

24.

Weier

Mazraeh

Naegelin

, et al. Biplanar MRI for the assessment of the spinal cord in multiple sclerosis. Mult Scler 2012; 18(11): 1560–1569.

25.

Saini

Bach

Poliakov

, et al. Magnetic resonance imaging of spinal cord lesions in patients with multiple sclerosis in Saskatchewan, Canada. Int J MS Care 2021; 23(2): 47–52.

26.

Granella

Tsantes

Graziuso

, et al. Spinal cord lesions are frequently asymptomatic in relapsing–remitting multiple sclerosis: A retrospective MRI survey. J Neurol 2019; 266(12): 3031–3037.

27.

Galletto Pregliasco

Collin

Guéguen

, et al. Improved detection of new MS lesions during follow-up using an automated MR coregistration-fusion method. AJNR Am J Neuroradiol 2018; 39(7): 1226–1232.

28.

Dahan

Pereira

Malpas

, et al. PACS integration of semiautomated imaging software improves day-to-day MS disease activity detection. AJNR Am J Neuroradiol 2019; 40: 1624–1629.

29.

Río

Nos

Tintoré

, et al. Defining the response to interferon-β in relapsing-remitting multiple sclerosis patients. Ann Neurol 2006; 59(2): 344–352.

30.

Rajendran

Lapointe

, et al. Three-dimensional MRI sequences in MS diagnosis and research. Mult Scler 2019; 25(13): 1700–1709.

31.

Hagens

Burggraaff

Kilsdonk

, et al. Impact of 3 Tesla MRI on interobserver agreement in clinically isolated syndrome: A MAGNIMS multicentre study. Mult Scler J 2019; 25(3): 352–360.

32.

Dekker

Sombekke

Witte

, et al. Asymptomatic spinal cord lesions do not predict the time to disability in patients with early multiple sclerosis. Mult Scler J 2018; 24(4): 481–490.