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

Timothy Reynold U Lim; Sunitha P Kumaran; Suradech Suthiphosuwan; Adrian I Espiritu; Ashley Jones; Amy Wei Lin; Jiwon Oh; Aditya Bharatha

doi:10.1177/13524585241228426

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

Mult Scler. 2024 Apr;30(4-5):505-515. doi: 10.1177/13524585241228426. Epub 2024 Feb 28.

Authors

Timothy Reynold U Lim¹, Sunitha P Kumaran¹, Suradech Suthiphosuwan¹, Adrian I Espiritu², Ashley Jones³, Amy Wei Lin¹, Jiwon Oh⁴, Aditya Bharatha^{5

1}

Affiliations

¹ Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
² Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada/Department of Neurosciences and Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines.
³ Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
⁴ Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada/ Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
⁵ Division of Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada.

PMID: 38419027
DOI: 10.1177/13524585241228426

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: MRI; Multiple sclerosis; NEDA; disease monitoring; spinal cord.

MeSH terms

Brain / diagnostic imaging
Brain / pathology
Cervical Cord* / diagnostic imaging
Cervical Cord* / pathology
Disease Progression
Humans
Magnetic Resonance Imaging / methods
Multiple Sclerosis* / diagnostic imaging
Multiple Sclerosis* / pathology
Recurrence
Retrospective Studies
Spinal Cord / diagnostic imaging
Spinal Cord / pathology
Spinal Cord Diseases* / pathology