Michigan Journal of Medicine

Introduction

Magnetic resonance imaging (MRI) is commonly used to diagnosis and monitor long-term multiple sclerosis (MS) disease progression.¹ MS is not defined by a single pathognomonic symptom; however, urologic dysfunction is a hallmark features of the disease.^2,3 Despite the emphasis placed on MRI for diagnosis and disease monitoring, there is not a well described method for correlating MRI lesions with bothersome urologic symptoms or treatment. We investigated whether lesion type and location were associated with any specific urologic intervention.

Methods

We retrospectively reviewed records of MS patients with bothersome urinary symptoms who had been evaluated by a neuro-urologist between 2010 and 2017. Patients with concomitant CNS MRI were included. MRIs were categorized by CNS lesion location and presence of T1 and T2 findings.⁴ Abstracted data included patient demographics, MS duration, MS type, MRI data, and attempted or maintained urological management strategies. Interventions examined include medication (selective beta-3 adrenergic agonists and anticholinergic medication), catheterization, botulinum toxin injection series, and urinary diversion surgery.

Results

37 MS patients met inclusion criteria. Cohort had mean age of 60.2 years, mean time with MS was 12.7 years, and 84% had urologic intervention. The most common intervention was medication (70%) and the majority of patients were on multi-treatment therapy (MTT, 51%). Neither cortical nor cerebellar lesions were associated with any specific urologic interventions. T1 and T2 brainstem lesions were associated with surgery (p=0.007, 0.006). T1 and T2 spinal cord lesions were associated with MTT (p=0.032, 0.007). T2 thoracic cord lesions were associated with medication and Botox (p=0.024, 0.017).

Figure 1. Summary of associations lesion type, lesion location, and specific urologic interventions. Significance set at p-value<0.05, p-values determined via logistic regression. Multivariable regression accounts for lesion type (T1 or T2), lesion location, and specified urologic outcomes. N-values represent total number of lesions and percentages are relative to number of patients who presented with a given lesion type.

Conclusion

This study highlights the relationship between MRI lesions and specific urologic interventions in MS patients. It is the first report to examine relationship between MRI and specific outcomes rather than symptoms or urodynamic findings. Within this cohort, spinal cord and brainstem lesions were associated with symptoms bothersome enough to progress to urologic intervention, specifically MTT, medication, and Botox. These findings contribute to the growing research supporting the integral role of spinal cord lesions in development of MS urologic dysfunction and offer the potential to predict and target urologic interventions based on MRI lesion type and location.

References

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3. Nazari, F., Shaygannejad, V., Mohammadi Sichani, M. et al. The prevalence of lower urinary tract symptoms based on individual and clinical parameters in patients with multiple sclerosis. BMC Neurol 20, 24 (2020). https://doi.org/10.1186/s12883-019-1582-1

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