Background:Performing routine brain magnetic resonance imaging (MRI) is widely accepted as the standard of care for disease monitoring in multiple sclerosis (MS), but the utility of performing routine spinal cord (SC) MRI for this purpose is still debatable.Objective:This study aimed to measure the frequency of new isolated cervical spinal cord lesions (CSLs) in people with MS (pwMS) undergoing routine brain and cervical SC-MRI for disease monitoring and determine the factors associated with the development of new CSLs and their prognostic value.Methods:We retrospectively identified 1576 pwMS who underwent follow-up 3T brain and cervical SC-MRI over a 9-month period. MRI was reviewed for the presence of new brain lesions (BLs) and CSLs. Clinical records were reviewed for interval relapses between sequential scans and subsequent clinical relapse and disability worsening after the follow-up MRI.Results:In 1285 pwMS (median interval: 13–14 months) who were clinically stable with respect to relapses, 73 (5.7%) had new CSLs, of which 49 (3.8%) had concomitant new BLs and 24 (1.9%) had new isolated CSLs only. New asymptomatic CSLs were associated with ⩾ 3 prior relapses ( p = 0.04), no disease-modifying therapy (DMT) use ( p = 0.048), and ⩾ 3 new BLs ( p < 0.001); ⩾ 3 new BLs (OR: 7.11, 95% CI: 4.3–11.7, p < 0.001) remained independently associated with new CSLs on multivariable analysis. Having new asymptomatic CSLs was not independently associated with subsequent relapse or disability worsening after the follow-up MRI (median follow-up time of 26 months).Conclusion:Routine brain and cervical SC-MRI detected new isolated CSLs in only < 2% of clinically stable pwMS. Developing new asymptomatic CSLs was associated with concomitant new BLs and did not confer an independent increased risk of relapse or disability worsening. Performing SC-MRI may not be warranted for routine monitoring in most pwMS, and performing only brain MRI may be sufficient to capture the vast majority of clinically silent disease activity.

中文翻译：

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添加 3T 颈脊髓 MRI 来监测多发性硬化症疾病活动的效用有限

背景：常规脑磁共振成像 (MRI) 被广泛接受为多发性硬化症 (MS) 疾病监测的护理标准，但为此目的进行常规脊髓 (SC) MRI 的效用仍存在争议。 目的：本研究旨在测量接受常规脑部和颈部 SC-MRI 进行疾病监测的多发性硬化症 (pwMS) 患者中新孤立性颈脊髓病变 (CSL) 的频率，并确定与新 CSL 发生相关的因素及其预后价值方法：我们回顾性地确定了 1576 名 pwMS，他们在 9 个月的时间内接受了 3T 脑部和颈部 SC-MRI 随访。检查 MRI 是否存在新的脑损伤 (BL) 和 CSL。对顺序扫描之间的间隔复发和随后的临床复发以及随访 MRI 后残疾恶化的临床记录进行审查。 结果：在 1285 名 pwMS（中位间隔：13-14 个月）中，复发方面临床稳定的 73 名（5.7 名） %）有新的 CSL，其中 49 个（3.8%）有伴随的新 BL，24 个（1.9%）仅有新的孤立 CSL。新的无症状 CSL 与 ⩾ 3 个既往复发 (p = 0.04)、未使用疾病修饰治疗 (DMT) (p = 0.048) 和 ⩾ 3 个新 BL (p < 0.001) 相关；⩾ 3 个新的 BL（OR：7.11，95% CI：4.3–11.7，p < 0.001）在多变量分析中仍然与新的 CSL 独立相关。新出现的无症状 CSL 与随访 MRI（中位随访时间为 26 个月）后的复发或残疾恶化并不独立相关。结论：常规脑部和颈部 SC-MRI 仅在 < 2% 的患者中检测到新的孤立性 CSL。临床稳定的pwMS。出现新的无症状 CSL 与伴随的新 BL 相关，并且不会导致复发或残疾恶化的独立风险增加。在大多数 pwMS 中，可能无法保证进行 SC-MRI 进行常规监测，并且仅进行脑部 MRI 可能足以捕获绝大多数临床上无症状的疾病活动。