Routine MRI scan may flag higher risk of MS progression, says study

Changes in the upper part of the spinal cord may help identify people with relapsing-remitting multiple sclerosis (RRMS) who are at higher risk of converting to the secondary progressive form of the disease (SPMS), a study reports.

People with RRMS who later developed SPMS tended to have a lower upper cervical cord area (UCCA), a measure of spinal cord size in the neck, suggesting more spinal cord shrinkage or atrophy.

In a smaller subgroup with repeat MRI data, they also showed a faster decline in UCCA over time than people who did not convert to SPMS.

This portion of the spinal cord, which is located in the neck, is typically captured by routine brain MRI scans. ‘In the context of limited established biomarkers for SPMS conversion and given the feasibility of extracting UCCA from routine brain MRI, our study highlights the practicality of this measure as a candidate biomarker, researchers wrote.

Multiple sclerosis (MS) is a neurological condition characterised by damage to the brain and spinal cord. In relapsing types of MS, periods of worsening symptoms alternate with periods of relative stability. By contrast, people with progressive MS typically experience a steadier decline without clear relapses.

Most people are initially diagnosed with RRMS, but these patients can eventually progress to SPMS. However, due to a lack of reliable biomarkers, it can be difficult to determine precisely when this transition occurs or who may be at greater risk of converting to SPMS.

Research has suggested that spinal cord atrophy, or shrinkage, may be an early biomarker of progressive disease. For this reason, a team led by researchers in Lebanon set out to determine whether the upper spinal cord area was associated with later SPMS conversion in people with RRMS.

The team examined medical records for 32 people with RRMS and available brain MRI scans who later developed SPMS. For comparison, they also included 65 people with RRMS who did not convert to SPMS during follow-up. They matched the groups to have similar ages and disease durations at their first visit.

‘These findings align with previous studies that reported that accelerated cervical cord atrophy is associated with, and may precede, clinical conversion to SPMS,’ the researchers wrote.

The association between annual UCCA decline and SPMS conversion remained significant after adjusting for disability levels, suggesting that the rate of upper spinal cord atrophy may provide information not captured by clinical assessments alone.

The study had several limitations, including its single-centre retrospective design and the relatively short follow-up period. ‘Therefore, our findings provide support for UCCA loss as a marker of near-term SPMS conversion but cannot provide evidence for long-term prediction,’ the team wrote.

Future studies should include healthy controls to help establish normal UCCA ranges and clinically meaningful thresholds for assessing progression risk.

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