Someone has made a comment about the poor impact of treatments on progression and I made comment about trials and you only find lesions if you look for them. MRI can spot lesions if they are big enough but with MRI they seldom look in the spinal cord. Lesions in the spinal cord are more likely to impact disability progression as this measures loss of lower limb function. But how many studies actually look for spinal cord lesions. In this analysis they looked at 228 studies with MRI and surprise surprise only 3 reported outcomes. That means 99% of trials cannot really comment on Progression independent of relapses (New lesions can really be clinical or subclinical relapses). This is yet another reason why this outcome can be fundementally flawed. Spinal cord MRI is seldom done because it is hard to do because the spinal cord moves during the scan due to breathing
Toubasi AA, Lakhani DA, Moore J, Schilling K, Bagnato F. Spinal cord imaging in multiple sclerosis: A vital component we can no longer overlook. Mult Scler. 2026 Apr 21:13524585261438770.
Purpose: We conducted a systematic review to examine the use of spinal cord (SC) magnetic resonance imaging (MRI) in clinical trials for multiple sclerosis (MS) and discussed the significant challenges that impede its widespread implementation.
Major findings: We identified 291 phase II and phase III clinical trials. Of these, 228 (78.4%) included at least one MRI outcome. Eight clinical trials (2.7%) were planned to include at least one SC MRI outcome, but only three (1.0%) reported related methodologies or results. The MRI metrics considered in these studies included cervical SC cross-sectional area (1.0%) and SC T2-lesion number (0.3%).
Conclusion: A very small proportion of clinical trials have used SC MRI metrics as outcome measures. Given the substantial impact of SC disease on disability, it is essential to standardize SC imaging, post-processing, and analytical methods across centres to enhance the effectiveness and applicability of SC MRI in future clinical trials.
Source: multiple-sclerosis-research.org