Importance of Cervical Magnetic Resonance Imaging in the Diagnosis, Treatment, and Monitoring of Hispanic Puerto Rican Multiple Sclerosis Patients

Background: Some Health Insurances in Puerto Rico (PR) limit the number of magnetic resonance imaging (MRI) procedures that can be done in Hispanic Puerto Rican Multiple Sclerosis (MS) patients or suspected MS patients. This limitation has its repercussions, not only in diagnosis, but also in prognostic information, disease course (in certain cases) and Disease Modifying Therapy (DMT) selection. In terms of DMT monitoring, MRIs are mandatory in patients treated with natalizumab, fingolimod, dimethyl fumarate, on at least an annual basis, and every 3 to 6 months in patients, at a high risk of PML, who are being treated with natalizumab. Additionally, a cervical spinal cord MRI performed concurrently with a brain MRI could have prognostic value in the evaluation of clinically isolated syndrome (CIS) MS patients and would reduce the number of patients requiring a subsequent MRI appointment. Another very important factor to point out is that spinal cord lesion load and severity of cord atrophy are believed to be more relevant to disability than white matter lesions in the brain (in different phenotypes of MS).

Objectives: Describe and illustrate the importance of including a Spinal Cord MRI with a Brain MRI when evaluating and following disease progression in Puerto Rican Hispanic MS Patients. Also, demonstrate the benefits of a full neuro MRI evaluation for Puerto Rican Hispanic MS Patients when monitoring and choosing the appropriate DMT for a patient.

Methods: A cross-sectional study was conducted in which data was obtained from Hispanic Puerto Rican MS patients treated at the San Juan MS Center.

Results: A total of 738 Puerto Rican MS patients with an average age of 46 years old participated in the study. The population consisted of 159 males and 579 females. Of these participants, 734 had MRI reports present at their last office visit to the San Juan MS Center, and 731 patients had Brain lesions in Brain MRI reports. In terms of lesions present in MRI reports, 392 had lesion/s present in both Brain and Cervical MRI reports, 204 had lesion/s present in Brain MRI report only, 81 did not have Cervical MRIs done but had lesion/s reported in Brain MRI and 54 had spinal lesion/s that were not cervical.

Conclusions: The spinal cord is a frequently affected region of the nervous system that may be overlooked when diagnosing multiple sclerosis. Spinal cord MRIs are an integral part of the diagnostic process of MS, as it can help differentiate MS from other demyelination pathologies. Thus, it is necessary to incorporate Spinal cord MRIs in the clinical diagnosis of MS as it can help guide diagnosis, progression, and treatment with the various DMTs available to the patient for best quality of care. It is therefore necessary for health insurances to better understand the necessities experienced by the MS population to further expand the quality of care.