Contributions
Abstract: P621
Type: Poster Sessions
Abstract Category: Therapy - Tools for detecting therapeutic response
Background: Magnetic Resonance Imaging (MRI) of the Spinal Cord (SC) is recommended during diagnostic process in suspected Multiple Sclerosis (MS), while its role in monitoring disease evolution or as a surrogate marker in clinical trials, is still controversial. We hypothesize that the use of brain MRI only can reduce the ability to detect inflammatory activity in a proportion of MS patients.
Objective: To study the frequency of SC activity in a large sample of MS patients and to investigate whether MRI activity of brain and SC occurs independently.
Methods: From MS registry of a single clinical center, we selected patients fulfilling the following criteria: 1) at least two different MRI scan (Brain and SC) at two time point (at least 30 days apart); 2) minimum MRI requirements protocol [1.5 T system; Brain: a) Axial dual-echo PD;b) Axial contrast-enhanced T1-weighted. SC: a) sagittal T2-weighted; b) Post-gadolinium (Gd) sagittal T1-weighted]. The presence of inflammatory activity was defined as the detection of at least one Gd enhancing lesion (Gd+). A descriptive statistic was applied.
Results: From an initial cohort of 1332 patients we enrolled 828 subjects [F: 572; medium age: 34.7 ± 9.7; median Expanded Disability Status Scale (EDSS): 2.0 (range: 0-8); medium disease duration: 5.8 ±6.3; Clinically Isolated Syndrome (CIS): 305; Relapsing Remitting (RR): 430; Primary Progressive (PP): 50; Secondary Progressive (SP): 43]. A total of 5717 scans were reviewed (medium scans for patient 7±2); 4537 scans (79,3%) did not present Gd+. Of the 1180 left, 651 scans (55,2%) showed brain Gd+ lesions only, 232 (19,7%) a concomitant presence of brain and SC Gd+ lesions, while 297 (25,2%) showed SC Gd+ lesions exclusively. 58% of the SC Gd+ scan were not associated with a clinical relapse. When considering inflammatory activity along follow up, 282 patients have never presented Gd+ lesions, 546 patients presented Gd+ in at least one scan. The majority of them were CIS/RR=501 vs SP/PP=45. SC Gd+ alone in at least one scan was observed in 223 (approximately 40%) of patients.
Conclusions: MRI activity can be detected frequently in SC and it occurs in approximately 25% scans independently from brain activity. High percentage of SC GD+ can be asymptomatic. Limiting MRI monitoring to brain only, underestimates inflammatory activity in clinical trials. Including MRI of SC in clinical practice will allow switching treatment to more powerful drugs in a larger number of patients.
Disclosure: Dr S Ruggieri has received fee as speaking honoraria from Teva,Merck Serono, Biogen; travel grant from Biogen, Merck Serono; fee as advisory board consultant from Merck Serono and Novartis.
Dr A Logoteta has nothing so disclose
Dr E Tinelli has nothing to disclose
Dr L De Giglio has received speaking onoraria from Genzyme and Novartis, travel grant from Biogen, Merk, Teva, consulting fee from Genzyme, Merk and Novartis.
Dr L Prosperini has received consulting fees Biogen, Genzyme, Novartis and Roche; speaker honoraria from Almirall, Biogen, Genzyme, Merck Serono, Novartis and Teva; travel grants from Biogen, Genzyme, Novartis and Teva; research grants from the Italian MS Society (Associazione Italiana Sclerosi Multipla) and Genzyme.
Dr C Gasperini has served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck Serono, Roche, Teva Italia, Biogen, Almirall, Novartis, Sanofi-Genzyme.
Prof C Pozzilli has received consulting and lecture fees and research funding and travel grants from Almirall, Bayer, Biogen, Genzyme, Merck Serono, Novartis, Roche and Teva.
Abstract: P621
Type: Poster Sessions
Abstract Category: Therapy - Tools for detecting therapeutic response
Background: Magnetic Resonance Imaging (MRI) of the Spinal Cord (SC) is recommended during diagnostic process in suspected Multiple Sclerosis (MS), while its role in monitoring disease evolution or as a surrogate marker in clinical trials, is still controversial. We hypothesize that the use of brain MRI only can reduce the ability to detect inflammatory activity in a proportion of MS patients.
Objective: To study the frequency of SC activity in a large sample of MS patients and to investigate whether MRI activity of brain and SC occurs independently.
Methods: From MS registry of a single clinical center, we selected patients fulfilling the following criteria: 1) at least two different MRI scan (Brain and SC) at two time point (at least 30 days apart); 2) minimum MRI requirements protocol [1.5 T system; Brain: a) Axial dual-echo PD;b) Axial contrast-enhanced T1-weighted. SC: a) sagittal T2-weighted; b) Post-gadolinium (Gd) sagittal T1-weighted]. The presence of inflammatory activity was defined as the detection of at least one Gd enhancing lesion (Gd+). A descriptive statistic was applied.
Results: From an initial cohort of 1332 patients we enrolled 828 subjects [F: 572; medium age: 34.7 ± 9.7; median Expanded Disability Status Scale (EDSS): 2.0 (range: 0-8); medium disease duration: 5.8 ±6.3; Clinically Isolated Syndrome (CIS): 305; Relapsing Remitting (RR): 430; Primary Progressive (PP): 50; Secondary Progressive (SP): 43]. A total of 5717 scans were reviewed (medium scans for patient 7±2); 4537 scans (79,3%) did not present Gd+. Of the 1180 left, 651 scans (55,2%) showed brain Gd+ lesions only, 232 (19,7%) a concomitant presence of brain and SC Gd+ lesions, while 297 (25,2%) showed SC Gd+ lesions exclusively. 58% of the SC Gd+ scan were not associated with a clinical relapse. When considering inflammatory activity along follow up, 282 patients have never presented Gd+ lesions, 546 patients presented Gd+ in at least one scan. The majority of them were CIS/RR=501 vs SP/PP=45. SC Gd+ alone in at least one scan was observed in 223 (approximately 40%) of patients.
Conclusions: MRI activity can be detected frequently in SC and it occurs in approximately 25% scans independently from brain activity. High percentage of SC GD+ can be asymptomatic. Limiting MRI monitoring to brain only, underestimates inflammatory activity in clinical trials. Including MRI of SC in clinical practice will allow switching treatment to more powerful drugs in a larger number of patients.
Disclosure: Dr S Ruggieri has received fee as speaking honoraria from Teva,Merck Serono, Biogen; travel grant from Biogen, Merck Serono; fee as advisory board consultant from Merck Serono and Novartis.
Dr A Logoteta has nothing so disclose
Dr E Tinelli has nothing to disclose
Dr L De Giglio has received speaking onoraria from Genzyme and Novartis, travel grant from Biogen, Merk, Teva, consulting fee from Genzyme, Merk and Novartis.
Dr L Prosperini has received consulting fees Biogen, Genzyme, Novartis and Roche; speaker honoraria from Almirall, Biogen, Genzyme, Merck Serono, Novartis and Teva; travel grants from Biogen, Genzyme, Novartis and Teva; research grants from the Italian MS Society (Associazione Italiana Sclerosi Multipla) and Genzyme.
Dr C Gasperini has served on advisory boards and/or has received travel grants and/or speaker honoraria from Merck Serono, Roche, Teva Italia, Biogen, Almirall, Novartis, Sanofi-Genzyme.
Prof C Pozzilli has received consulting and lecture fees and research funding and travel grants from Almirall, Bayer, Biogen, Genzyme, Merck Serono, Novartis, Roche and Teva.