Silent lesions on MRI imaging – Shifting goal posts for treatment decisions in multiple sclerosis

Myintzu Min, Tim Spelman, Alessandra Lugaresi, Cavit Boz, Daniele L.A. Spitaleri, Eugenio Pucci, Francois Grand’Maison, Franco Granella, Guillermo Izquierdo, Helmut Butzkueven, Jose Luis Sanchez-Menoyo, Michael Barnett, Marc Girard, Maria Trojano, Pierre Grammond, Pierre Duquette, Patrizia Sola, Raed Alroughani, Raymond Hupperts, Steve VucicTomas Kalincik, Vincent Van pesch, Jeannette Lechner-Scott

Research output: Contribution to journalArticlepeer-review


Background: The current best practice suggests yearly magnetic resonance imaging (MRI) to monitor treatment response in multiple sclerosis (MS) patients. Objective: To evaluate the current practice of clinicians changing MS treatment based on subclinical new MRI lesions alone. Methods: Using MSBase, an international MS patient registry with MRI data, we analysed the probability of treatment change among patients with clinically silent new MRI lesions. Results: A total of 8311 MRI brain scans of 4232 patients were identified. Around 26.9% (336/1247) MRIs with one new T2 lesion were followed by disease-modifying therapy (DMT) change, increasing to 50.2% (129/257) with six new T2 lesions. DMT change was twice as likely with new T1 contrast enhancing compared to new T2 lesions odds ratio (OR): 2.43, 95% confidence interval (CI): 2.00–2.96 vs OR: 1.26 (95% CI: 1.22–1.29). DMT change with new MRI lesions occurred most frequently with ‘injectable’ DMTs. The probability of switching therapy was greater only after high-efficacy therapies became available in 2007 (after, OR: 1.43, 95% CI: 1.28–1.59 vs before, OR: 0.98, 95% CI: 0.520–1.88). Conclusion: MS clinicians rely increasingly on MRI alone in their treatment decisions, utilizing low thresholds (1 new T2 lesion) for optimizing MS therapy. This signals a shift towards no evidence of disease activity (NEDA)-3 since high-efficacy therapies became available.

Original languageEnglish
Pages (from-to)1569-1577
Number of pages9
JournalMultiple Sclerosis Journal
Issue number12
Publication statusPublished - Oct 1 2018


  • Disease-modifying therapy
  • magnetic resonance imaging
  • subclinical lesions

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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