Brain and spinal cord MRI lesions in primary progressive vs. relapsing-remitting multiple sclerosis

Abstract

BackgroundPrimary progressive (PP) multiple sclerosis (MS) is considered a clinically distinct entity from the spectrum of relapsing-remitting (RR) forms of the disease.ObjectiveTo compare the presence of brain and spinal cord lesions between PP and RR subjects.MethodsWe studied people with PPMS [n = 40, 17 (42.5%) men, age 50.7 ± 7.7 years, disease duration 10.1 ± 7.4 years, Expanded Disability Status Scale (EDSS) score 4.6 ± 2.1] and RRMS [n = 40, 12 (30%) men, age 47.9 ± 4.2, disease duration 13.7 ± 5.9, EDSS 1.7 ± 1.3]. MRI of the brain and full spinal cord at 1.5T was analyzed to define patients having: 1. brain only, 2. spinal cord only, or 3. brain and spinal cord MS lesions.ResultsLesions in the brain only were less common in PP (n = 1, 2.5% of people) than RR (n = 10, 25%) (Fisher's exact p = 0.007). Lesions in the spinal cord only (PP: n = 6, 15%, RR: n = 3, 7.5%, p = 0.481) or brain plus spinal cord (PP: n = 33, 83%, RR: n = 27, 68%, p = 0.196) were similar between groups. PP had higher EDSS and timed 25-ft walk (Wilcoxon tests, both p < 0.001), higher age (t-test p = 0.049), lower disease duration (t-test, p = 0.02), and a similar sex ratio (Fisher's exact p = 0.352) vs. RR.ConclusionsWe report a topographic difference in MRI lesion involvement between PPMS and RRMS. Lesions restricted to the brain are more common in RRMS. These findings provide support to the notion that PP may have features distinctive from the RR spectrum of the disease. Longitudinal comparisons and quantitative MRI analysis would be necessary to confirm and extend these results.

Additive Effect of Spinal Cord Volume, Diffuse and Focal Cord Pathology on Disability in Multiple Sclerosis

“…This may be due to relatively high proportion of patients with no or mild disability and a low number of patients with high disability (only 33 patients had EDSS 6.0 and higher) in our cohort. Similar results were reported in a study by Dastagir et al (34), where normally appearing SC is described in 25% of patients with RR-RS as well as in study by Rovaris et al (7), describing focal lesions in only 39% of patients with early MS. Moreover, as the majority of data on SC involvement in MS was obtained on 1.5T scanners, it is important to note that a higher total and thoracic SC lesion number was found in progressive MS patients when compared to relapse-remitting MS patients on 1.5T, but not 3.0T (13).…”

3D-Fast Gray Matter Acquisition with Phase Sensitive Inversion Recovery Magnetic Resonance Imaging at 3 Tesla: Application for detection of spinal cord lesions in patients with multiple sclerosis

“…Multiple sclerosis (MS) is an inflammatory disease of the central nervous system affecting both the encephalon and the spinal cord. Spinal cord involvement is detected in up to 68–83% of patients with clinically definite MS on Magnetic Resonance Imaging (MRI), while 7.5–15% of patients with MS have only spinal cord lesions [ 1 ]. Spinal cord imaging is recommended by international guidelines [ 2 , 3 ] for diagnosing and managing patients with MS.…”

Comparison of Reported Spinal Cord Lesions in Progressive Multiple Sclerosis with Theiler’s Murine Encephalomyelitis Virus Induced Demyelinating Disease

“…The etiology of this currently incurable disease is still unknown but a complex interplay of genetic, infectious, environmental, and lifestyle factors contributing to the broad variability of disease phenotypes among MS patients is assumed [ 6 , 7 , 8 , 9 , 10 ]. MS lesions occur in brain and spinal cord (SC) but have almost exclusively been investigated in the brain [ 11 , 12 , 13 , 14 , 15 ]. Damage and loss of axons are key features of chronic disability especially in progressive MS [ 16 , 17 , 18 ].…”