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agate Site Admin
Joined: 17 May 2006 Posts: 5694 Location: Oregon
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Posted: Fri Feb 01, 2013 5:36 pm Post subject: Spinal cord imaging in clinically isolated syndrome |
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From Journal Watch Neurology, February 1, 2013:
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Spinal Cord Imaging in Clinically Isolated Syndrome
Spinal cord imaging for nonspinal demyelinating presentations will allow diagnosis of multiple sclerosis in one out of seven patients.
Spinal cord imaging is typically routine in demyelinating syndromes when symptoms and signs indicate spinal cord disease. However, spinal cord imaging is less frequently included for clinically isolated syndromes (CIS) of the cerebrum, optic nerve, or brainstem and cerebellum.
To determine the impact of cord imaging on diagnosis of multiple sclerosis (MS), investigators recruited 121 patients with monofocal CIS (63 referable to the spinal cord, 58 with nonspinal presentations), at least 24 months of follow-up, and both brain and spinal cord magnetic resonance imaging (MRI) at baseline. Spine imaging included sagittal T2-weighted and proton-density sequences of the entire cord. At baseline, 82 patients (67.8%) had focal lesions in the spinal cord; 31 of these patients had a nonspinal CIS. Mean follow-up was 5 years (range, 2–10 years).
At initial presentation, 36 patients fulfilled 2010 McDonald criteria for MS (JW Neurol Jan 25 2011). Six additional patients with nonspinal presentations would meet McDonald criteria if spinal cord imaging were included. The odds ratio for conversion from CIS to clinically definite MS (CDMS) was 3.53 for patients with versus those without baseline spinal cord lesions, and the time to conversion was significantly shorter for those with spinal cord lesions. In the nonspinal presentation subgroup, the odds ratio for CDMS conversion was 6.48 with versus without spinal cord lesions.
Comment:
Diagnosis of CDMS requires dissemination in space and time, which can sometimes be based on a single MRI if there are simultaneous enhancing and nonenhancing lesions in an asymptomatic location. Many neurologists are comfortable recommending treatment for a patient with CIS without additional spinal cord imaging to meet criteria for CDMS. For those reluctant to begin treatment early, cord imaging can lead to more definite diagnosis and prognosis for a second event.
— Robert T. Naismith, MD
Citation(s):
Sombekke MH et al. Spinal cord lesions in patients with clinically isolated syndrome: A powerful tool in diagnosis and prognosis. Neurology 2013 Jan 1; 80:69.
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