Certain brain and spinal cord imaging features may be useful for the prediction of disability and disease progression in patients with multiple sclerosis (MS), according to a study published in the Journal of Neurology, Neurosurgery & Psychiatry.

A number of brain and spinal cord magnetic resonance imaging features were found to independently predict clinical worsening, measured through a change in Expanded Disability Status Scale (EDSS) score, the evolution to secondary progressive MS (SPMS), and the reaching of EDSS milestones.

“The combined assessment of brain and spinal cord damage may contribute to identify patients with MS having long-term disease progression, and the introduction of automated analysis methods for cord lesion and atrophy quantification may expedite a wider use of these metrics to clinical practice,” the authors said.

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Multivariate predictors specific to clinical worsening during 5-year follow-up included progressive onset of the disease (beta =.97), higher baseline EDSS score (beta =.41), higher number of cord lesions (beta=.41), lower normalized cortical grey matter volume (NcGMV; beta=-.15), and lower cord normalized cross-sectional area (CSAn; beta=-.28). Together these predictors yielded an area under the curve (C-index) of .79.

In regards to evolution from relapsing-remitting MS to SPMS, older patient age (beta=.86), higher baseline EDSS score (beta=1.40, and a higher number of spinal cord lesions (beta=.87) were all independent predictors in a multivariate analysis. The multivariate model gave a C-index of .91.

Higher baseline EDSS (beta=1.49), higher cervical cord lesion number (beta=1.02), and lower NcGMV (beta=-.56) were all multivariate predictors of patients reaching an EDSS of 3.0 during the 5-year follow-up. Multivariate predictors of reaching an EDSS equal to 4.0 included older age, higher baseline EDSS score, a higher number of spinal cord lesions, and a lower cord CSAn. Only higher baseline EDSS score and a higher number of spinal cord lesions were found to be predictors of patients reaching an EDSS of 6.0 during the follow-up period.

During the study, a total of 367 patients with MS and 179 healthy controls were recruited. Of the patients with MS, 326 had relapse-onset disease and 41 had progressive-onset disease. The median EDSS of the patients with MS at baseline was 3.0 with a median EDSS of 3.5 at follow-up. EDSS worsening occurred in 120 (33%) of the patients with MS during the follow-up time. Relapsing-remitting MS evolved into SPMS in 36 out of 256 patients (14%).


Rocca MA, Valsasina P, Meani A, et al. Spinal cord lesions and brain grey matter atrophy independently predict clinical worsening in definite multiple sclerosis: a 5-year, multicentre study. J Neurol Neurosurg Psychiatry. Published online September 28, 2022. doi:10.1136/jnnp-2022-329854