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Multiple sclerosis
Original research
Prognostic value of spinal cord lesion measures in early relapsing-remitting multiple sclerosis
  1. Markus Lauerer1,2,
  2. Julian McGinnis1,3,
  3. Matthias Bussas1,2,
  4. Malek El Husseini4,
  5. Viola Pongratz1,2,
  6. Christina Engl1,
  7. Alexander Wuschek1,
  8. Achim Berthele1,
  9. Isabelle Riederer4,
  10. Jan S Kirschke4,
  11. Claus Zimmer4,
  12. Bernhard Hemmer1,5,
  13. Mark Mühlau1,2
  1. 1 Department of Neurology, School of Medicine, Technical University, Munich, Germany
  2. 2 TUM-Neuroimaging Center, School of Medicine, Technical University, Munich, Germany
  3. 3 Institute for AI in Medicine, Technical University, Munich, Germany
  4. 4 Department of Neuroradiology, School of Medicine, Technical University, Munich, Germany
  5. 5 Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
  1. Correspondence to Dr Mark Mühlau, Department of Neurology, School of Medicine, Technical University of Munich, Munich D-81675, Germany; mark.muehlau{at}tum.de

Abstract

Background Spinal cord (SC) lesions have been associated with unfavourable clinical outcomes in multiple sclerosis (MS). However, the relation of whole SC lesion number (SCLN) and volume (SCLV) to the future occurrence and type of confirmed disability accumulation (CDA) remains largely unexplored.

Methods In this monocentric retrospective study, SC lesions were manually delineated. Inclusion criteria were: age between 18 and 60 years, relapsing-remitting MS, disease duration under 2 years and clinical follow-up of 5 years. The first CDA event after baseline, determined by a sustained increase in the Expanded Disability Status Scale over 6 months, was classified as either progression independent of relapse activity (PIRA) or relapse-associated worsening (RAW). SCLN and SCLV were compared between different (sub)groups to assess their prospective value.

Results 204 patients were included, 148 of which had at least one SC lesion and 59 experienced CDA. Patients without any SC lesions experienced significantly less CDA (OR 5.8, 95% CI 2.1 to 19.8). SCLN and SCLV were closely correlated (rs=0.91, p<0.001) and were both significantly associated with CDA on follow-up (p<0.001). Subgroup analyses confirmed this association for patients with PIRA on CDA (34 events, p<0.001 for both SC lesion measures) but not for RAW (25 events, p=0.077 and p=0.22).

Conclusion Patients without any SC lesions are notably less likely to experience CDA. Both the number and volume of SC lesions on MRI are associated with future accumulation of disability largely independent of relapses.

  • multiple sclerosis
  • MRI
  • clinical neurology
  • image analysis

Data availability statement

Data are available on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/jnnp-2023-331799

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Contributors ML designed the study, analysed the data and co-wrote the manuscript. JM contributed to the processing of the data. MB contributed to the acquisition and processing of the data and commented on the manuscript. MEH contributed to the processing of the data. VP contributed to the data acquisition and commented on the manuscript. CE contributed to the data acquisition. AW contributed to the data acquisition. AB contributed to the data acquisition. IR contributed to the data acquisition and commented on the manuscript. JSK contributed to the acquisition, processing, and analysis of the data, and commented on the manuscript. CZ contributed to the acquisition, processing and analysis of the data. BH contributed to the acquisition, processing and analysis of the data, and commented on the manuscript. MM designed the study, analysed the data and co-wrote the manuscript. Guarantor: MM.

    • Funding ML received funding through the 'Kommission für klinische Forschung' (KKF) of the School of Medicine, Technical University of Munich (TUM). MM received funding by the Bavarian State Ministry for Science and Art (Collaborative Bilateral Research Program Bavaria—Québec: AI in medicine, grant F.4-V0134.K5.1/86/34), by the German Research Foundation (DFG SPP2177, Radiomics: Next Generation of Biomedical Imaging—project number 428223038), and by the National Institutes of Health (grant 1R01NS112161-01). BH received funding for the study by the MultipleMS EU consortium, the Clinspect-M consortium funded by the Bundesministerium für Bildung und Forschung, and the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy—ID 390857198). BH is associated with DIFUTURE (Data Integration for Future Medicine, BMBF 01ZZ1804(A-I)).

    • Competing interests VP has received research funding from Novartis (Oppenheim Förderpreis 2017). AB has received consulting and/or speaker fees from Alexion, Biogen, Celgene, Horizon, Novartis, Roche and Sandoz/Hexal. His institution has received compensation for clinical trials from Alexion, Biogen, Merck, Novartis, Roche, and Sanofi Genzyme. JSK has received research funding from the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG; project 432290010), the German Federal Ministry of Education and Research (13GW0469D) and the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (101045128—iBack-epic—ERC-2021-COG). He is Co-Founder of Bonescreen. BH has served on scientific advisory boards for Novartis; he has served as DMSC member for AllergyCare, Sandoz, Polpharma, Biocon and TG therapeutics; his institution received research grants from Roche for multiple sclerosis research. He has received honoraria for counseling (Gerson Lehrmann Group). He holds part of two patents; one for the detection of antibodies against KIR4.1 in a subpopulation of patients with multiple sclerosis and one for genetic determinants of neutralising antibodies to interferon.

    • Provenance and peer review Not commissioned; externally peer reviewed.