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. 2021 Jan 26;10(3):463.
doi: 10.3390/jcm10030463.

Recurrence and Prognostic Value of Asymptomatic Spinal Cord Lesions in Multiple Sclerosis

Camilla Ostini  1 , Francesca Bovis  2 , Giulio Disanto  1 , Paolo Ripellino  1 , Emanuele Pravatà  3 , Rosaria Sacco  1 , Giovanna Padlina  1 , Maria Pia Sormani  2   4 , Claudio Gobbi  1   5 , Chiara Zecca  1   5
Affiliations

Recurrence and Prognostic Value of Asymptomatic Spinal Cord Lesions in Multiple Sclerosis

Camilla Ostini et al. J Clin Med. .

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.

Keywords: MRI; asymptomatic; multiple sclerosis; prediction; spinal lesions.

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Conflict of interest statement

The author(s) declared the following potential conflict of interest with respect to the research, authorship, and/or publication of this article: Francesca Bovis received teaching honoraria from Novartis. Claudio Gobbi and Chiara Zecca received honoraria for speaking, consulting fees, or research grants from Abbvie, Almirall, Biogen Idec, Celgene, Genzyme, Merck, Novartis, Teva Pharma, Roche. Maria Pia Sormani has received honoraria for lectures or consulting from Teva, Merck Serono, Biogen Idec, Bayer Schering, Novartis, Genzyme and Roche. Rosaria Sacco received travel funding, fees for advisory boards and speaking honoraria from Merk Serono, Biogen Idec, Sanofi Genzyme. All other authors have nothing to declare.

Figures

Figure 1
Figure 1
Inclusion criteria and study design. Spinal MRIs are performed at T1 (baseline) and T2 (9–36 months after T1) in clinically stable multiple sclerosis (MS) patients. When available, information on brain MRIs performed at T1 (±60 days) and at T2 (±60 days) were also collected and used for sensitivity analyses. Patients with vs. without asymptomatic spinal lesions (a-SL) at T2 are then compared in terms of clinical and radiological outcomes at T3 (>6 months after T2). RRMS: relapsing-remitting multiple sclerosis; PPMS: primary progressive multiple sclerosis; SPMS: secondary progressive multiple sclerosis.
Figure 2
Figure 2
Flow chart of study population. A total of 702 MS patients were screened, 300 fulfilled the inclusion criteria and were therefore considered for analysis. A total of 168 patients also had a brain MRI available within ±60 days from T1 and T2 (brain MRI subgroup).
Figure 3
Figure 3
Annualized brain lesion rate between T2 and T3 in: (a) patients with vs. without asymptomatic brain lesions (a-BL) at T2; (b) patients with vs. without asymptomatic spinal lesions (a-SL) at T2; (c) patients with either a-BL or a-SL vs. neither a-BL nor a-SL at T2.
Figure 4
Figure 4
Annualized spinal lesion rate between T2 and T3 in: (a) patients with vs. without asymptomatic brain lesions (a-BL) at T2; (b) patients with vs. without asymptomatic spinal lesions (a-SL) at T2; (c) patients with either a-BL or a-SL vs. neither a-BL nor a-SL at T2.
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