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Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Added value of spinal cord MRI in detecting active disease in non-relapsing progressive multiple sclerosis patients
Marco Vercellino1, S Marasciulo2, C Bosa3,2
1Multiple Sclerosis Center, Neurologia 1 U, Department of Neuroscience, AOU Città della Salute e della Scienza di Torino, Via Cherasco 15, 10126, Turin, Italy. marco.vercellino@unito.it.
Introduction:
Spinal cord MRI is not routinely recommended in the monitoring of MS. In patients with progressive MS (pMS), presence of disease activity is an important predictor of treatment response to currently approved treatments. The aim of this study was to investigate the added usefulness of spinal cord MRI in the identification of active disease in patients with non-relapsing pMS.
Methods:
MRI records were reviewed in a cohort of pMS patients. All patients with at least 2 years of follow-up with the same MRI scanner were included in the study. Patients with clinical relapses during follow-up were excluded from the study. Asymptomatic combined unique active lesions (CUA) were defined as any new T2/STIR lesion or any T1 Gd + lesion, in absence of a clinical relapse.
Results:
185 non-relapsing pMS patients were included in the study (41 primary progressive, 144 secondary progressive; median EDSS 6.0), out of a cohort of 422 pMS patients. Mean length of MRI follow-up was 4.0 years (range 2-8). 28/185 (15.1%) patients showed new asymptomatic CUA brain lesions during follow-up, 14/185 (7.6%) patients showed new asymptomatic CUA spinal cord lesions, 4/185 (3.4%) patients showed new asymptomatic CUA lesions both in the brain and in the spinal cord. Overall, the addition of spinal cord MRI allowed to detect disease activity in + 43.75% more patients than brain MRI only.
Conclusion:
The addition of spinal cord MRI allows to detect active disease in a significantly higher proportion of non-relapsing pMS patients. This is important in stratifying expected response to treatment and to inform treatment choices.
Insights
Adding spinal cord MRI to brain MRI detects active disease in more non-relapsing progressive multiple sclerosis (pMS) patients. This aids in predicting treatment response and guiding therapy choices.
Area of Science:
- Neurology
- Radiology
- Neuroimmunology
Background:
- Spinal cord MRI is not routinely used for monitoring multiple sclerosis (MS).
- Disease activity in progressive MS (pMS) predicts treatment response.
- Identifying active disease in non-relapsing pMS is crucial for treatment decisions.
Purpose of the Study:
- To evaluate the added value of spinal cord MRI in detecting active disease in non-relapsing pMS patients.
- To assess if spinal cord MRI improves the identification of disease activity compared to brain MRI alone.
Main Methods:
- Retrospective review of MRI scans from pMS patients with at least 2 years of follow-up.
- Inclusion of patients without clinical relapses during the follow-up period.
- Definition of asymptomatic combined unique active lesions (CUA) as new T2/STIR or T1 Gd+ lesions without clinical relapse.
Main Results:
- 185 non-relapsing pMS patients were analyzed (41 primary progressive, 144 secondary progressive).
- 15.1% of patients showed new asymptomatic CUA brain lesions, and 7.6% showed new asymptomatic CUA spinal cord lesions.
- Spinal cord MRI detected disease activity in 43.75% more patients than brain MRI alone.
Conclusions:
- Incorporating spinal cord MRI significantly increases the detection rate of active disease in non-relapsing pMS.
- This enhanced detection aids in stratifying patients for expected treatment response.
- Spinal cord MRI findings can inform and personalize treatment choices for pMS patients.
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