title: Asymptomatic spinal cord lesions predict disease progression in radiologically isolated syndrome.
abstract: BACKGROUND
  Technological advancements in neuroimaging and the increased use of these diagnostic modalities are responsible for the discovery of incidentally identified anomalies within the CNS. In addition to the identification of unanticipated brain MRI abnormalities suggestive of demyelinating disease in patients undergoing neuroimaging for a medical reason other than evaluation for multiple sclerosis (MS), asymptomatic spinal cord lesions are periodically identified.
  
  
  OBJECTIVE
  To determine if asymptomatic spinal cord lesions are associated with clinical progression in subjects with radiologically isolated syndrome (RIS).
  
  
  METHODS
  A retrospective review of RIS cases at the University of California, San Francisco Multiple Sclerosis Center was performed. The presence of asymptomatic cervical spinal cord MRI lesions was analyzed as a potential predictor for clinical progression.
  
  
  RESULTS
  Twenty-five of 71 subjects with RIS possessed findings within the cervical spine that were highly suggestive of demyelinating disease. Of these subjects, 21 (84%) progressed clinically to clinically isolated syndrome (n = 19) or primary progressive multiple sclerosis (n = 2) over a median time of 1.6 years from the date of RIS identification (interquartile range 0.8-3.8). The sensitivity, specificity, and positive predictive value of an asymptomatic spinal cord lesion for subsequent development of either a first demyelinating attack or primary progressive MS were 87.5%, 91.5%, and 84%, respectively. The odds ratio of clinical progression was 75.3 (95% confidence interval 16.1-350.0, p < 0.0001). This association remained significant after adjusting for potential confounders.
  
  
  CONCLUSIONS
  These findings suggest that the presence of asymptomatic spinal cord lesions place subjects with RIS at substantial risk for clinical conversion to either an acute or progressive event, a risk that is independent of brain lesions on MRI.
authors.affiliation: Department of Neurology, UCSF Multiple Sclerosis Center, University of California, San Francisco, San Francisco, USA. darin.okuda@chw.edu
authors.forename: D T
authors.initials: DT
authors.lastname: Okuda
authors.forename: E M
authors.initials: EM
authors.lastname: Mowry
authors.forename: B A C
authors.initials: BA
authors.lastname: Cree
authors.forename: E C
authors.initials: EC
authors.lastname: Crabtree
authors.forename: D S
authors.initials: DS
authors.lastname: Goodin
authors.forename: E
authors.initials: E
authors.lastname: Waubant
authors.forename: D
authors.initials: D
authors.lastname: Pelletier
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult