Multiple lesions on spinal cord signal a 2 times higher risk of MS, per study
Finding damage on scans may help doctors predict condition earlier
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Doctors can use imaging scans of the head, neck, and back to look for lesions that may be indicative of increased MS risk. (Photo from iStock)
- Multiple spinal cord lesions seen on imaging scans, though asymptomatic, indicate a twofold greater risk of multiple sclerosis, according to a new study.
- Such damage suggests an increased likelihood of developing MS for people with a first episode of myelitis, or inflammation of the spinal cord.
- Doctors may use these scans to identify high-risk individuals for earlier MS diagnosis and treatment.
The presence of multiple asymptomatic spinal cord lesions — areas of damage, as captured by imaging scans — is associated with about a twofold higher risk of developing multiple sclerosis (MS) for people with a first episode of myelitis, or inflammation of the spinal cord, a new study suggests.
The researchers also found that the cervical, or neck, region of the spinal cord was more frequently affected in people who later developed MS than in individuals who did not.
Because myelitis is one of the most common early signs of MS, these findings suggest that spinal cord damage seen on MRI scans may help identify, earlier on, people at higher risk of the progressive neurological disease, according to the researchers.
“Multiple asymptomatic spinal cord lesions are associated with a higher risk of conversion to MS, supporting their value as a radiological marker of risk,” the researchers wrote, noting that such damage “at onset doubled MS conversion risk.”
The study, “Reassessing dissemination in space: The role of spinal cord lesion burden in early multiple sclerosis diagnosis,” was published in the journal Multiple Sclerosis and Related Disorders.
An autoimmune disease, MS is characterized by inflammatory damage in the brain and spinal cord, collectively known as the central nervous system (CNS). Diagnosis is often based on evidence that disease activity has affected the CNS in characteristic ways.
Spinal cord lesions alone don’t always meet MS diagnostic criteria
Much of this evidence is assessed with MRI scans, which can show areas of damage in the brain and spinal cord. The spinal cord is one of the five regions used to demonstrate that inflammation has damaged multiple parts of the CNS — a key criterion for diagnosing the disease in most cases.
Myelitis is often one of the first manifestations of MS, and studies suggest that about half of people who experience inflammatory myelitis are eventually diagnosed with MS.
However, when myelitis occurs without brain lesions, its significance is less clear, as spinal cord lesions alone are not always sufficient to meet current diagnostic criteria. This has raised questions about whether certain spinal cord MRI features — such as the number of lesions — could help predict which people are more likely to develop MS.
To understand more, researchers in Argentina retrospectively analyzed medical records from 112 individuals with a first episode of myelitis and no brain lesions. All were evaluated between 2008 and 2024 at a hospital in Buenos Aires.
Slightly more than two-thirds of the patients were women, and the median age overall at myelitis onset was 38. About one-third of the patients had multiple spinal cord lesions at the time of their initial episode.
Patients were followed for a median of 32.6 months, or nearly three years. During that time, 37 (33%) were diagnosed with MS.
Compared with participants who did not develop MS, those who did were younger at myelitis onset (34.8 vs. 42 years) and more likely to have multiple spinal cord lesions (51% vs. 25%). The individuals who developed MS also more frequently had lesions with active inflammation (70% vs. 52%).
Damage seen in myelitis patients tied to higher risk of conversion to MS
After accounting for factors such as age, sex, and the presence of active inflammatory lesions, statistical analyses showed that having multiple spinal cord lesions at myelitis onset was associated with about a twofold higher risk of developing MS, according to the researchers.
Although lesion location was not included in this analysis, the cervical region was more frequently affected in patients who developed MS (70% vs. 44%), a finding the researchers described as “clinically relevant.”
“Cervical lesions may reflect a more disseminated inflammatory process and have been associated with higher risk of disability and disease evolution,” the researchers wrote, noting that “the presence of cervical involvement at myelitis onset may further support closer monitoring and earlier therapeutic consideration in selected patients.”
Establishing the correct diagnosis after a first episode of myelitis remains a critical challenge in clinical practice. … Incorporation of spinal cord-based markers into future diagnostic frameworks could contribute to more individualized and earlier MS diagnosis.
Overall, the findings show that “multiple asymptomatic spinal cord lesions at the time of myelitis onset, particularly in the absence of brain lesions, are associated with a substantially increased risk of conversion to multiple sclerosis,” the researchers wrote.
The team noted that recognizing these imaging patterns may help “refine early risk stratification” and support “timely therapeutic decision-making.”
“Establishing the correct diagnosis after a first episode of myelitis remains a critical challenge in clinical practice,” the researchers wrote, concluding that the “incorporation of spinal cord-based markers into future diagnostic frameworks could contribute to more individualized and earlier MS diagnosis.”
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