[S10.007] Asymptomatic Spinal Cord Lesions Predict Clinical Progression in Radiologically Isolated Syndrome (RIS) Subjects

Darin T. Okuda, Elizabeth Crabtree, Ellen M. Mowry, Bruce A. C. Cree, Ari J. Green, Dorothee Chabas-Chanezon, Scott S. Zamvil, Emmanuelle Waubant, Douglas S. Goodin, Daniel Pelletier, San Francisco, CA

OBJECTIVE: To determine if asymptomatic spinal cord lesions are associated with clinical progression in radiologically isolated syndrome (RIS) subjects. BACKGROUND: Technological advancements in neuroimaging and the increased use of these diagnostic modalities in medicine are responsible for the discovery of incidentally identified anomalies within the CNS. In addition to the identification of brain MRI abnormalities that may be highly suggestive of demyelinating disease, asymptomatic spinal cord lesions are periodically identified. The relationship between asymptomatic spinal cord lesions and clinical outcomes is unknown. DESIGN/METHODS: A retrospective review of RIS cases at the UCSF Multiple Sclerosis Center was performed. The presence of asymptomatic cervical spinal cord MRI lesions (defined by ovoid, well-circumscribed, non-contiguous lesions involving < 2 spinal segments) was analyzed as a potential predictor for clinical conversion to clinically isolated syndrome (CIS), using a logistic regression model. To control for potential confounders, a multivariate logistic regression model was used, incorporating significant covariates. RESULTS: Imaging studies were performed for a variety of indications other than for the evaluation for demyelinating disease. Clinical data and cervical spinal cord imaging were available in 68 RIS cases (F:55; median age: 37.4 (range: 18.7-68.4)). Of those RIS subjects with cervical spinal cord abnormalities, 88% converted to CIS over a median time of 0.95 years (range: 0.1-5.3). In multivariate models, a substantial increase in the odds of clinical conversion was observed when abnormalities typical for MS were present in the cervical spinal cord parenchyma (odds ratio (OR) = 24.2, 95% CI 4.3 to 136.9, p<0.001). This association remained after adjusting for significant covariates. CONCLUSIONS/RELEVANCE: The presence of asymptomatic spinal cord lesions place RIS subjects at substantial risk for clinical conversion to CIS, a risk that is independent of brain lesions on MRI. Additional investigations in this population are needed to further define this risk. Supported by: Dr. Pelletier is a Harry Weaver Neuroscience Scholar of the National MS Society.
Category - MS and Related Diseases - Clinical Science

Tuesday, April 13, 2010 3:15 PM

Scientific Sessions: Multiple Sclerosis: MRI I (1:45 PM-3:45 PM)