| Abstrakt: |
BACKGROUND: Multiple sclerosis (MS) is one of the most common, nontraumatic neurologic disorders affecting young adults in the United States. Brain MRI is an important tool for monitoring disease activity and treatment efficacy in people with MS. Spinal cord imaging has been less consistently used for monitoring inflammatory disease activity, and it is unknown whether clinically silent breakthrough disease is common enough to warrant including imaging as part of routine surveillance. We previously presented an interim analysis showing that asymptomatic cervical cord lesions are not exceptionally common but do occur in a subpopulation. The eligible cohort had not been fully evaluated at the time, and we couldn't confirm if these patients had concomitant silent brain lesions. OBJECTIVES: To determine how frequently cervical (C)-spine follow-up MRI in patients with MS reveals asymptomatic T2 hyperintense lesions and identify potential associated risk factors for developing these lesions. METHODS: A list of patients with central nervous system demyelinating disease was obtained from electronic medical records. Patients included were between the ages of 18 and 65 years who were diagnosed with relapsing-remitting MS and were seen in longitudinal follow-up at the Johns Hopkins MS Center from January 1, 2014, to December 1, 2019, with a brain and C-spine MRI performed during that period. RESULTS: There were 858 patients that met eligibility criteria and were included. Of those, 669 patients were female (78%), mean age was 37.96 (± 7.12) years, 580 (67.60%) were White, and 191 (22.26%) were Black/African American. The mean disease duration was 5.84 (± 5.45) years with a median Expanded Disability Status Scale score of 1.5 (range, 1-2.5). A total of 858 cervical spine MRI scans for routine surveillance (no suspected cord relapse) were performed at year 1, 655 scans at year 2, 429 scans at year 3, and 240 scans at year 4. Of these, the corresponding numbers (percentages) of incidental asymptomatic lesions discovered were 64 (7.42%) at year 1, 66 (10.08%) at year 2, 25 (5.83%) at year 3, and 11 (4.58%) at year 4. Univariate analyses revealed that Black/African American race (OR = 2.25, 95% CI = 1.27-3.98, P = .006) was associated with increased odds of developing asymptomatic cervical cord lesions. Final multivariate analyses incorporating brain MRI findings are underway. CONCLUSIONS: There may be subgroups of individuals who are at higher risk of developing an asymptomatic cervical cord lesion detectable by MRI. These findings inspire the creation and validation of predictive models to inform the utility cord imaging at a given time point for an individual with MS, which could enhance health care quality and reduce costs. [ABSTRACT FROM AUTHOR] |
