Spinal cord lesions are frequently asymptomatic in relapsing–remitting multiple sclerosis: a retrospective MRI survey

  • Franco Granella
  • Elena Tsantes
  • Stefania Graziuso
  • Veronica Bazzurri
  • Girolamo Crisi
  • Erica CurtiEmail author
Original Communication



Spinal cord (SC) involvement correlates with poor prognosis in patients with multiple sclerosis (MS). Nevertheless, there is no consensus on the use of SC-MRI at follow-up, mainly because of the belief that SC lesions are nearly always symptomatic.


The aim of the present study was to investigate the frequency of asymptomatic SC combined unique activity (CUA, new/enlarging T2 or gadolinium-positive [Gd+] lesions) on MRI in a cohort of patients diagnosed with clinically isolated syndrome (CIS) or relapsing–remitting MS (RRMS).


We retrospectively investigated all scans showing SC-CUA in patients with CIS or RRMS referred to a single Italian MS centre. We determined whether they were symptomatic and whether they had associated brain radiological activity.


In 340 SC-MRI scans with SC-CUA (230 patients), SC-CUA was asymptomatic in 31.2%; 12.1% of SC-CUA had neither clinical activity nor brain radiological activity (44.5% and 25.4%, respectively, considering only follow-up SC-CUA). At multivariate analysis asymptomatic SC-CUAs were associated with older age at onset (34.0 ± 10.37 vs 31.0 ± 9.99 years, p = 0.006), non-spinal onset (76.4 vs 47.4%, p < 0.001), lower EDSS score at MRI (1.8 ± 0.93 vs 2.4 ± 1.28, p = 0.001) and lower number of Gd+ SC lesions (0.1 ± 0.33 vs 0.3 ± 0.54, p = 0.04), compared to symptomatic SC-CUAs.


A substantial proportion of our patients had SC-CUA without clinical symptoms and/or without concomitant brain MRI activity. In these patients, SC-CUA was the only sign of disease activity, suggesting that regular SC-MRI follow-up is required for reliable assessment of radiological activity and may improve the management of patients with MS.


Multiple sclerosis Spinal cord Asymptomatic MRI Follow-up 



This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflicts of interest

F. Granella has received research grants for his Institution from Biogen and Sanofi Genzyme; has served on scientific advisory boards for Biogen, Novartis, Sanofi Genzyme, Roche and Merck Serono; and has received funding for travel from Biogen, Merck Serono and Sanofi Genzyme. E. Tsantes served on scientific advisory boards for Roche and Merck & Co; has received funding for travel from Biogen, Merck & Co, Sanofi Genzyme and Roche V. Bazzurri has received funding for travel from Sanofi Genzyme, Biogen and Roche. E. Curti served on scientific advisory boards for Merck & Co and Novartis; has received funding for travel from Biogen, Merck & Co, Teva Pharmaceutical Industries, Sanofi Genzyme, Roche and Novartis. S. Graziuso and G. Crisi have nothing to disclose.

Supplementary material

415_2019_9526_MOESM1_ESM.pdf (90 kb)
Supplementary file1 (PDF 89 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Neurosciences Unit, Department of Medicine and Surgery (DMEC)University of ParmaParmaItaly
  2. 2.Neuroradiology Unit, Department of DiagnosticUniversity Hospital of ParmaParmaItaly

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