Hong Jérémy, Gaubert Malo, Lefort Mathilde, Ferré Jean Christophe, Le Page Emmanuelle, Michel Laure, Labauge Pierre, Pelletier Jean, de Seze Jérôme, Durand-Dubief Françoise, Cotton François, Edan Gilles, Bannier Elise, Combès Benoit, Kerbrat Anne
Univ Rennes, CHU Rennes, Service de radiologie, 35000, Rennes, France.
EMPENN research team, U1128, Univ Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Rennes, France.
J Neurol. 2025 Apr 5;272(4):316. doi: 10.1007/s00415-025-13068-2.
The utility of systematic spinal cord (SC) MRI for monitoring disease activity after a multiple sclerosis (MS) diagnosis remains a topic of debate.
To evaluate the frequency of disease activity when considering brain MRI alone versus both brain and SC MRI and to identify factors associated with the occurrence of new SC lesions.
We conducted a retrospective analysis of clinical and imaging data prospectively collected over 5 years as part of the EMISEP cohort study. A total of 221 intervals (with both brain and spinal cord MRI scans available at 2 consecutive time-points) from 68 patients were analysed. For each interval, brain (3D Fluid-Attenuated Inversion Recovery (FLAIR, axial T2 and axial PD) and SC MRI (sagittal T2 and phase-sensitive inversion recovery, axial T2*w and 3D T1) were reviewed to detect new lesions. Each interval was classified as symptomatic (with relapse) or asymptomatic. The baseline brain and SC lesion numbers were computed.
SC MRI activity without clinical relapse and/or brain MRI activity was rare (4 out of 221 intervals, 2%). The occurrence of a new SC lesion was associated with the number of brain lesions at baseline (OR = 1.002 [1.000; 1.0004], p = 0.015) and the occurrence of a new brain lesion during the interval (OR = 1.170 [1.041; 1.314], p = 0.009), but not with the baseline SC lesion number (p = 0.6).
These findings support the current guidelines recommending routine disease monitoring with brain MRI alone, even in patients with a high SC lesion load.
对于多发性硬化症（MS）诊断后，系统性脊髓（SC）磁共振成像（MRI）在监测疾病活动方面的效用仍是一个有争议的话题。
评估仅考虑脑部MRI与同时考虑脑部和脊髓MRI时疾病活动的频率，并确定与新脊髓病变发生相关的因素。
我们对作为EMISEP队列研究一部分在5年期间前瞻性收集的临床和影像数据进行了回顾性分析。分析了68例患者的总共221个时间间隔（在连续两个时间点均有脑部和脊髓MRI扫描）。对于每个时间间隔，回顾脑部（三维液体衰减反转恢复序列（FLAIR）、轴向T2加权像和轴向质子密度加权像）和脊髓MRI（矢状位T2加权像和相位敏感反转恢复序列、轴向T2*加权像和三维T1加权像）以检测新病变。每个时间间隔分为有症状（伴有复发）或无症状。计算基线时脑部和脊髓病变数量。
无临床复发和/或脑部MRI活动的脊髓MRI活动很少见（221个时间间隔中有4个，占2%）。新脊髓病变的发生与基线时脑部病变数量相关（比值比（OR）=1.002[1.000；1.0004]，p=0.015）以及该时间间隔内新脑部病变的发生相关（OR=1.170[1.041；1.314]，p=0.009），但与基线时脊髓病变数量无关（p=0.6）。
这些发现支持当前指南推荐仅使用脑部MRI进行常规疾病监测，即使是脊髓病变负荷高的患者。
