clinico-radiological profile of spinal cord multiple sclerosis glenn h. roberson bhavik n. patel...
DESCRIPTION
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:TRANSCRIPT
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!