Frequency and potential risk factors associated with the development of asymptomatic T2 hyperintense cervical spine lesions on MRI in patients with relapsing-remitting multiple sclerosis
Spinal cord (SC) imaging is less routinely used for monitoring disease activity in patients with multiple sclerosis (MS), and the frequency of clinically silent breakthrough SC disease remains unclear. The objective was to determine the frequency of asymptomatic T2 hyperintense cervical SC (c-SC) le...
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| Vydané v: | Multiple sclerosis Ročník 31; číslo 7; s. 793 |
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| Hlavní autori: | , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
England
01.06.2025
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| ISSN: | 1477-0970, 1477-0970 |
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| Abstract | Spinal cord (SC) imaging is less routinely used for monitoring disease activity in patients with multiple sclerosis (MS), and the frequency of clinically silent breakthrough SC disease remains unclear.
The objective was to determine the frequency of asymptomatic T2 hyperintense cervical SC (c-SC) lesions in patients with relapsing-remitting MS (RRMS) and identify associated risk factors.
We included RRMS patients aged 18-65 years followed at the Johns Hopkins MS Center (2014-2019), with up to four brain and c-SC magnetic resonance imaging (MRI) scans considered per patient. New asymptomatic lesions were identified as hyperintense T2 lesions on MRI during routine surveillance. Univariate and multivariate logistic regression identified factors associated with developing asymptomatic lesions on the first scan, and a generalized estimating equations model assessed factors across successive scans.
Among 869 patients included, the proportion of asymptomatic lesions identified ranged from 4.8% to 12.1% across scans. Roughly half of those with c-SC lesions also showed new brain lesions. Patients receiving higher-efficacy therapies were more likely to have an asymptomatic lesion detected (odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.16-1.88,
= 0.001), as were Black/African American individuals (OR = 1.64, 95% CI = 1.23-2.18,
= 0.001).
These findings suggest a limited but important role for c-SC imaging, especially for Black/African Americans who may benefit from routine surveillance. |
|---|---|
| AbstractList | Spinal cord (SC) imaging is less routinely used for monitoring disease activity in patients with multiple sclerosis (MS), and the frequency of clinically silent breakthrough SC disease remains unclear.
The objective was to determine the frequency of asymptomatic T2 hyperintense cervical SC (c-SC) lesions in patients with relapsing-remitting MS (RRMS) and identify associated risk factors.
We included RRMS patients aged 18-65 years followed at the Johns Hopkins MS Center (2014-2019), with up to four brain and c-SC magnetic resonance imaging (MRI) scans considered per patient. New asymptomatic lesions were identified as hyperintense T2 lesions on MRI during routine surveillance. Univariate and multivariate logistic regression identified factors associated with developing asymptomatic lesions on the first scan, and a generalized estimating equations model assessed factors across successive scans.
Among 869 patients included, the proportion of asymptomatic lesions identified ranged from 4.8% to 12.1% across scans. Roughly half of those with c-SC lesions also showed new brain lesions. Patients receiving higher-efficacy therapies were more likely to have an asymptomatic lesion detected (odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.16-1.88,
= 0.001), as were Black/African American individuals (OR = 1.64, 95% CI = 1.23-2.18,
= 0.001).
These findings suggest a limited but important role for c-SC imaging, especially for Black/African Americans who may benefit from routine surveillance. Spinal cord (SC) imaging is less routinely used for monitoring disease activity in patients with multiple sclerosis (MS), and the frequency of clinically silent breakthrough SC disease remains unclear.BACKGROUNDSpinal cord (SC) imaging is less routinely used for monitoring disease activity in patients with multiple sclerosis (MS), and the frequency of clinically silent breakthrough SC disease remains unclear.The objective was to determine the frequency of asymptomatic T2 hyperintense cervical SC (c-SC) lesions in patients with relapsing-remitting MS (RRMS) and identify associated risk factors.OBJECTIVEThe objective was to determine the frequency of asymptomatic T2 hyperintense cervical SC (c-SC) lesions in patients with relapsing-remitting MS (RRMS) and identify associated risk factors.We included RRMS patients aged 18-65 years followed at the Johns Hopkins MS Center (2014-2019), with up to four brain and c-SC magnetic resonance imaging (MRI) scans considered per patient. New asymptomatic lesions were identified as hyperintense T2 lesions on MRI during routine surveillance. Univariate and multivariate logistic regression identified factors associated with developing asymptomatic lesions on the first scan, and a generalized estimating equations model assessed factors across successive scans.METHODSWe included RRMS patients aged 18-65 years followed at the Johns Hopkins MS Center (2014-2019), with up to four brain and c-SC magnetic resonance imaging (MRI) scans considered per patient. New asymptomatic lesions were identified as hyperintense T2 lesions on MRI during routine surveillance. Univariate and multivariate logistic regression identified factors associated with developing asymptomatic lesions on the first scan, and a generalized estimating equations model assessed factors across successive scans.Among 869 patients included, the proportion of asymptomatic lesions identified ranged from 4.8% to 12.1% across scans. Roughly half of those with c-SC lesions also showed new brain lesions. Patients receiving higher-efficacy therapies were more likely to have an asymptomatic lesion detected (odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.16-1.88, p = 0.001), as were Black/African American individuals (OR = 1.64, 95% CI = 1.23-2.18, p = 0.001).RESULTSAmong 869 patients included, the proportion of asymptomatic lesions identified ranged from 4.8% to 12.1% across scans. Roughly half of those with c-SC lesions also showed new brain lesions. Patients receiving higher-efficacy therapies were more likely to have an asymptomatic lesion detected (odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.16-1.88, p = 0.001), as were Black/African American individuals (OR = 1.64, 95% CI = 1.23-2.18, p = 0.001).These findings suggest a limited but important role for c-SC imaging, especially for Black/African Americans who may benefit from routine surveillance.CONCLUSIONThese findings suggest a limited but important role for c-SC imaging, especially for Black/African Americans who may benefit from routine surveillance. |
| Author | Tian, Fan Calabresi, Peter A Mowry, Ellen M Wang, Yujie Fadlallah, Yasser Malik, Muhammad Taimur Izbudak, Izlem Fitzgerald, Kathryn C Huang, Yishang |
| Author_xml | – sequence: 1 givenname: Yasser orcidid: 0009-0001-6806-1841 surname: Fadlallah fullname: Fadlallah, Yasser organization: Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA – sequence: 2 givenname: Yujie orcidid: 0000-0002-0593-7439 surname: Wang fullname: Wang, Yujie organization: Department of Neurology, School of Medicine, University of Washington, Seattle, WA, USA – sequence: 3 givenname: Muhammad Taimur surname: Malik fullname: Malik, Muhammad Taimur organization: Department of Neurology, St Luke's University Health Network, Bethlehem, PA, USA – sequence: 4 givenname: Fan surname: Tian fullname: Tian, Fan organization: Department of Mathematics, Tufts University, Medford, MA, USA – sequence: 5 givenname: Peter A orcidid: 0000-0002-7776-6472 surname: Calabresi fullname: Calabresi, Peter A organization: Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA – sequence: 6 givenname: Izlem surname: Izbudak fullname: Izbudak, Izlem organization: Department of Radiology, Adventhealth Medical Group Radiology, Orlando, FL, USA – sequence: 7 givenname: Yishang surname: Huang fullname: Huang, Yishang organization: Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA – sequence: 8 givenname: Kathryn C orcidid: 0000-0003-3137-0322 surname: Fitzgerald fullname: Fitzgerald, Kathryn C organization: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA – sequence: 9 givenname: Ellen M surname: Mowry fullname: Mowry, Ellen M organization: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA |
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| SubjectTerms | Adolescent Adult Aged Cervical Cord - diagnostic imaging Cervical Cord - pathology Cervical Vertebrae - diagnostic imaging Cervical Vertebrae - pathology Female Humans Magnetic Resonance Imaging Male Middle Aged Multiple Sclerosis, Relapsing-Remitting - diagnostic imaging Multiple Sclerosis, Relapsing-Remitting - pathology Risk Factors Young Adult |
| Title | Frequency and potential risk factors associated with the development of asymptomatic T2 hyperintense cervical spine lesions on MRI in patients with relapsing-remitting multiple sclerosis |
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