Asymptomatic spinal cord lesions predict disease progression in radiologically isolated syndrome

D. T. Okuda, E. M. Mowry, B. A C Cree, E. C. Crabtree, D. S. Goodin, E. Waubant, D. Pelletier

Research output: Contribution to journalArticle

145 Citations (Scopus)

Abstract

BACKGROUND: Technological advancements in neuroimaging and the increased use of these diagnostic modalities are responsible for the discovery of incidentally identified anomalies within the CNS. In addition to the identification of unanticipated brain MRI abnormalities suggestive of demyelinating disease in patients undergoing neuroimaging for a medical reason other than evaluation for multiple sclerosis (MS), asymptomatic spinal cord lesions are periodically identified. OBJECTIVE: To determine if asymptomatic spinal cord lesions are associated with clinical progression in subjects with radiologically isolated syndrome (RIS). METHODS: A retrospective review of RIS cases at the University of California, San Francisco Multiple Sclerosis Center was performed. The presence of asymptomatic cervical spinal cord MRI lesions was analyzed as a potential predictor for clinical progression. RESULTS: Twenty-five of 71 subjects with RIS possessed findings within the cervical spine that were highly suggestive of demyelinating disease. Of these subjects, 21 (84%) progressed clinically to clinically isolated syndrome (n = 19) or primary progressive multiple sclerosis (n = 2) over a median time of 1.6 years from the date of RIS identification (interquartile range 0.8-3.8). The sensitivity, specificity, and positive predictive value of an asymptomatic spinal cord lesion for subsequent development of either a first demyelinating attack or primary progressive MS were 87.5%, 91.5%, and 84%, respectively. The odds ratio of clinical progression was 75.3 (95% confidence interval 16.1-350.0, p < 0.0001). This association remained significant after adjusting for potential confounders. CONCLUSION: These findings suggest that the presence of asymptomatic spinal cord lesions place subjects with RIS at substantial risk for clinical conversion to either an acute or progressive event, a risk that is independent of brain lesions on MRI.

Original languageEnglish (US)
Pages (from-to)686-692
Number of pages7
JournalNeurology
Volume76
Issue number8
DOIs
StatePublished - Feb 22 2011

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Disease Progression
Spinal Cord
Chronic Progressive Multiple Sclerosis
Demyelinating Diseases
Neuroimaging
Multiple Sclerosis
San Francisco
Brain
Spine
Odds Ratio
Confidence Intervals
Sensitivity and Specificity

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Okuda, D. T., Mowry, E. M., Cree, B. A. C., Crabtree, E. C., Goodin, D. S., Waubant, E., & Pelletier, D. (2011). Asymptomatic spinal cord lesions predict disease progression in radiologically isolated syndrome. Neurology, 76(8), 686-692. https://doi.org/10.1212/WNL.0b013e31820d8b1d

Asymptomatic spinal cord lesions predict disease progression in radiologically isolated syndrome. / Okuda, D. T.; Mowry, E. M.; Cree, B. A C; Crabtree, E. C.; Goodin, D. S.; Waubant, E.; Pelletier, D.

In: Neurology, Vol. 76, No. 8, 22.02.2011, p. 686-692.

Research output: Contribution to journalArticle

Okuda, DT, Mowry, EM, Cree, BAC, Crabtree, EC, Goodin, DS, Waubant, E & Pelletier, D 2011, 'Asymptomatic spinal cord lesions predict disease progression in radiologically isolated syndrome', Neurology, vol. 76, no. 8, pp. 686-692. https://doi.org/10.1212/WNL.0b013e31820d8b1d
Okuda, D. T. ; Mowry, E. M. ; Cree, B. A C ; Crabtree, E. C. ; Goodin, D. S. ; Waubant, E. ; Pelletier, D. / Asymptomatic spinal cord lesions predict disease progression in radiologically isolated syndrome. In: Neurology. 2011 ; Vol. 76, No. 8. pp. 686-692.
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