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Published on: July 19, 2019
Reassessing dissemination in space: The role of spinal cord lesion burden in early multiple sclerosis diagnosis
Brenda Victoria Schimpf1, Mariano Marrodan2, Micaela Hernandez2
1Neurology Department, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (Fleni), Ciudad Autónoma de Buenos Aires, Argentina; Neurology Department, Hospital Interzonal de Agudos Eva Peron, Buenos Aires, Argentina.
Introduction:
The presence of multiple spinal cord lesions has been suggested as an additional risk factor for conversion. However, their prognostic significance in the absence of brain lesions remains uncertain.
Objective:
To determine whether baseline spinal cord MRI features predict conversion to multiple sclerosis in patients presenting with isolated myelitis, and to compare baseline clinical, radiological, and paraclinical characteristics between converters and non-converters.
Methods:
A retrospective cohort study involving patients with a first episode of acute or subacute myelitis, without brain lesions at baseline MRI was conducted. All patients underwent a standardized diagnostic evaluation including brain and spinal MRI with contrast, cerebrospinal fluid analysis, and serum testing for aquaporin-4 and MOG antibodies to confirm inflammatory myelitis and exclude alternative etiologies. Clinical and paraclinical variables were analyzed.
Results:
We evaluated 112 patients, of whom 33% converted to MS during a median follow-up of 32.6 months. Multiple asymptomatic spinal cord lesions were associated with a higher risk of conversion to MS (HR=2.04; 95%CI:1-3.9; p = 0.03), even after adjusting for age, female sex, and the presence of gadolinium-enhancing lesions. Patients who converted to MS more frequently had cervical lesions (70% vs. 44%; p = 0.01) and were significantly younger at onset (median 34.8 vs. 42 years; p = 0.02).
Conclusion:
Multiple asymptomatic spinal cord lesions are associated with a higher risk of conversion to MS, supporting their value as a radiological marker of risk.
Insights
Multiple spinal cord lesions increase the risk of developing multiple sclerosis (MS) in patients with isolated myelitis. These lesions serve as a valuable radiological marker for predicting MS conversion.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- The prognostic value of spinal cord lesions for multiple sclerosis (MS) conversion is unclear when brain lesions are absent.
- Previous studies suggest multiple spinal cord lesions may indicate increased MS risk.
Purpose of the Study:
- To investigate if baseline spinal cord MRI features predict conversion to MS in patients with isolated myelitis.
- To compare clinical, radiological, and paraclinical factors between MS converters and non-converters.
Main Methods:
- Retrospective cohort study of 112 patients with first episode of myelitis and no baseline brain lesions.
- Standardized diagnostic workup including brain/spinal MRI, CSF analysis, and antibody testing.
- Analysis of clinical and paraclinical variables.
Main Results:
- 33% of patients converted to MS within a median follow-up of 32.6 months.
- Multiple asymptomatic spinal cord lesions significantly increased MS conversion risk (HR=2.04).
- Cervical lesions and younger age at onset were associated with higher conversion rates.
Conclusions:
- Multiple asymptomatic spinal cord lesions are a significant radiological marker for MS risk.
- These findings support the use of spinal cord MRI in predicting MS development in myelitis patients.
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