Clinico-Radiological Profile of Spinal Cord Multiple Sclerosis

Glenn H. Roberson

Bhavik N. PatelAsim K. Bag

University of Alabama at Birmingham,Birmingham, AL, USA

Glenn H. Roberson: Involved in clinical trials sponsored by Guerbet LLC & Wyeith Pharmaceuticals

Bhavik N. Patel: No disclosure

Asim K. Bag: Involved in clinical trials sponsored by ACRIN & Guerbet LLC

Introduction

Multiple sclerosis (MS) has extensive disease burden

MS affects approximately 350,000 individuals in the United States

Typically between the ages of 18 and 45

Medical Clinics of North America 2009;93:451-476

Initial MRI diagnosis of MS does not include spinal cord MRI findings

Spinal cord is involved in >90% of MS patients

Asymptomatic cord lesions are found in 30% to 40% of patients

Spinal cord imaging is very important to identify disease progression in time and space

Neuroimaging Clinics of North America 2009;19:81-99

Introduction

1. To identify radiologic pattern of spinal cord involvement in MS

2. To correlate radiologic findings with clinical symptoms

Purpose

Retrospective identification of all consecutive patients with abnormal T2 signal in the spinal cord with radiologic concern for MS between 2004 and 2009

Inclusion criteria Patients who meet the Revised McDonald MS

Diagnostic Criteria were included in this study

Materials & Methods: Patients

Sagittal T1 T2 STIR T1+c

Axial T1 T2 STIR T1+c

Materials & Methods: MRI sequences

Number of lesions per patient

Involvement pattern of the cord (anterior, posterior, central and diffuse)

Location (cervical, thoracic and lumbar)

Length of lesions

Enhancement pattern

Materials & Methods: Lesion Characterization

Demography of the patient (age, sex and race)

Clinical presentation

Pattern of disease course

Materials & Methods: Clinical Evaluation

Association between lesion location and distribution with symptoms

Association between lesion load and disease course

Materials & Methods

544 patients were identified with spinal cord T2 abnormality with radiologic concern for MS

Only 166 patients met the Revised McDonald MS Diagnostic Criteria

Results

Age range: 17-75

Male:Female 1:12.9

More common in Caucasian than African-American (1.84:1)

Results: Demography

Sensory 42.77%

Motor 37.95 %

Gait 21.68 %

Bladder 12.65 %

No Spinal symptom 12.65 %

Lhermitte 3.01 %

Results: Clinical presentations

Relapsing remitting 71.68%

Secondary progressive 24.09%

Primary progressive 0%

Progressive relapsing 0%

Neuromyelitis optica 4.21%

Results: Clinical Course

Diagram

Relapsing-remitting Average number of lesion 2.20 (range 1 to 7)

Secondary-progressive Average number of lesion 2.14 (range 1 to 5)

Results: Lesion loads & disease course

166 patients had total 340 lesions Location

46.47% posterior 27.94% anterior 22.35% central 3.23% diffuse

Enhancement 4.4%

Lesion length Mean 18.2 mm [range3-108 mm]

Average number of lesions per patient 2.04

Results: Lesion Characterization

Sagittal & Axial T2

Imaging example

Sagittal & Axial STIR

Imaging example

Sagittal & Axial T2

Imaging example

Sagittal & Axial STIR

Imaging example

Sagittal & Axial STIR

Imaging example

Sagittal T1, T2 & STIR

Imaging example

Pre- & post-contrast axial and sagittal T1

Imaging example

Number of lesions in this bar diagram exceeds 340 as some of the lesions involved more than one segments

Only 7 patients had isolated thoracic spine involvement

Results: Lesion Location

No association between lesion location and Sensory symptoms Bladder symptoms Motor symptoms

Results

All patients with posterior column signs, positive Romberg test and gait abnormality had posterior lesions

Results

Source: http://en.wikipedia.org/wiki/File:Spinal_cord_tracts_-_English.svg

The study is based on retrospective analysis of data

There is a component of selection bias as the study patients were identified from prior MRI

Limitations

Demography Age of presentation 17-75 Predominantly in women (13:1)

Clinical Presentation Most common presentation is sensory symptoms Relapsing-remitting is the most common clinical course

Conclusion

Radiologic appearance Cervical spinal cord is most commonly involved Posterior spinal cord is involved most commonly Mean lesion length is 18.2 mm Enhancement is rare

Clinico-radiologic correlation Posterior column signs and gait abnormality are

associated with posteriorly located lesions Average number of lesions is similar in relapsing-

remitting and secondary progressive MS

Conclusion

Thank you!