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Clinico-Radiological Profile of Spinal Cord Multiple Sclerosis

Explore the radiologic patterns and clinical associations of spinal cord involvement in MS. Detailed findings on lesion characteristics, demographics, clinical presentations, and disease courses. Comprehensive analysis for better understanding and management of MS patients.

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Clinico-Radiological Profile of Spinal Cord Multiple Sclerosis

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  1. Clinico-Radiological Profile of Spinal Cord Multiple Sclerosis Glenn H. Roberson Bhavik N. Patel Asim K. Bag University of Alabama at Birmingham, Birmingham, AL, USA

  2. 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

  3. 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

  4. Introduction • 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

  5. Purpose • To identify radiologic pattern of spinal cord involvement in MS • To correlate radiologic findings with clinical symptoms

  6. Materials & Methods: Patients • 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

  7. Materials & Methods: MRI sequences • Axial • T1 • T2 • STIR • T1+c • Sagittal • T1 • T2 • STIR • T1+c

  8. Materials & Methods: Lesion Characterization • 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

  9. Materials & Methods: Clinical Evaluation • Demography of the patient (age, sex and race) • Clinical presentation • Pattern of disease course

  10. Materials & Methods • Association between lesion location and distribution with symptoms • Association between lesion load and disease course

  11. Results • 544 patients were identified with spinal cord T2 abnormality with radiologic concern for MS • Only 166 patients met the Revised McDonald MS Diagnostic Criteria

  12. Results: Demography • Age range: 17-75 • Male:Female 1:12.9 • More common in Caucasian than African-American (1.84:1)

  13. Results: Clinical presentations • Sensory 42.77% • Motor 37.95 % • Gait 21.68 % • Bladder 12.65 % • No Spinal symptom 12.65 % • Lhermitte 3.01 %

  14. Results: Clinical Course • Relapsing remitting 71.68% • Secondary progressive 24.09% • Primary progressive 0% • Progressive relapsing 0% • Neuromyelitis optica 4.21% Diagram

  15. Results: Lesion loads & disease course • Relapsing-remitting • Average number of lesion 2.20 (range 1 to 7) • Secondary-progressive • Average number of lesion 2.14 (range 1 to 5)

  16. Results: Lesion Characterization 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

  17. Imaging example Sagittal & Axial T2

  18. Imaging example Sagittal & Axial STIR

  19. Imaging example Sagittal & Axial T2

  20. Imaging example Sagittal & Axial STIR

  21. Imaging example Sagittal & Axial STIR

  22. Imaging example Sagittal T1, T2 & STIR

  23. Imaging example Pre- & post-contrast axial and sagittal T1

  24. Results: Lesion Location • 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

  25. Results • No association between lesion location and • Sensory symptoms • Bladder symptoms • Motor symptoms

  26. Results • All patients with posterior column signs, positive Romberg test and gait abnormality had posterior lesions

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

  28. Limitations • 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

  29. Conclusion • 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

  30. 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

  31. Thank you!

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