title: Relevance of asymptomatic spinal MRI lesions in patients with multiple sclerosis.
abstract: The impact of new asymptomatic spinal cord lesions (a-SL) in multiple sclerosis (MS) course is poorly characterized.
  
  
  
  The objective of this research paper is to assess the prognostic value of a-SL in predicting MS course.
  
  
  
  Relapsing-remitting MS patients who received serial MRI (brain and spinal) at baseline (t1) and within 12 to 36 months (t2) during clinical stability, and had a follow-up (t2-t3) ⩾24 months were included. Relapses and disability progression were evaluated between t2 and t3.
  
  
  
  Of 413 consecutive screened MS patients, 103 patients (65 females, median age 43 years) were included. After a median t1-t2 interval of 17 (IQR 13-26) months, 25.2% and 43.7% patients had ⩾1 new a-SL (a-SL+) and asymptomatic brain lesions (a-BL+), respectively. Relapse risk between t2 and t3 (median interval: 42 (IQR 32-57.5) months) was significantly increased in a-SL+ and/or a-BL+ vs a-BL- and a-SL- (HR = 2.31, 95% CI = 1.13-4.72, p = 0.02). No differences in the risk of disability progression were found in a-SL+ and/or a-BL+ vs a-SL- and a-BL-.
  
  
  
  a-SL occur in one-quarter of clinically stable RRMS, and combined with a-BL contribute significantly in predicting future disease course.
authors.affiliation: Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Zecca
authors.affiliation: Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Disanto
authors.affiliation: Biostatistics Unit, Department of Health Sciences (DISSAL), University of Genova, Italy.
authors.forename: M P
authors.initials: MP
authors.lastname: Sormani
authors.affiliation: Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland/Neuroimaging Research Unit, Institute of Experimental Neurology, Vita-Salute San Raffaele University, Italy.
authors.forename: G C
authors.initials: GC
authors.lastname: Riccitelli
authors.affiliation: Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Cianfoni
authors.affiliation: Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Del Grande
authors.affiliation: Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Pravatà
authors.affiliation: Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland claudio.gobbi@eoc.ch.
authors.forename: C
authors.initials: C
authors.lastname: Gobbi
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000000981:diagnostic imaging*; D011379:Prognosis; D012008:Recurrence; D013116:Spinal Cord / Q000000981:diagnostic imaging*
keywords: MRI; Nervous system diseases; T2 lesions; diagnosis; multiple sclerosis; nervous system; spinal cord