Spinal Cord MRI In Suspected Multiple Sclerosis

Lycklama, Nijeholt GJ, Uitdehaag BM, Bergers E, Castelijns JA, Polman CH, Barkhof F
Eur Radiol 2000;10(2):368-76
Dutch MS-MRI Center, Vrije Universiteit Hospital, Dept of Radiology, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
PMID# 10663771; UI# 20130925

We examined the value of Spinal Cord Magnetic Resonance Imaging (MRI) in the diagnostic work-up of Multiple Sclerosis (MS). Forty patients suspected of having MS were examined within 24 months after the start of symptoms.

Disability was assessed, and symptoms were categorized as either Brain or Spinal Cord. Work-up further included CerebroSpinal Fluid analysis and standard Proton-Density, T2-, and T1-weighted Gadolinium-enhanced Brain and Spinal Cord MRI.

Patients were categorized as either Clinically Definite MS (n = 13), Laboratory-Supported Definite MS (n = 14), or Clinically Probable MS (n = 4); four patients had Clinically Probable MS, and in nine MS was suspected.

Spinal Cord abnormalities were found in 35 of 40 patients (87.5 %), consisting of focal Lesions in 31, only diffuse abnormalities in two, and both in two. Asymptomatic Spinal Cord lesions occurred in six patients.

All patients with diffuse Spinal Cord abnormality had clear Spinal Cord symptoms and a Primary/Progressive disease course. In Clinically Definite MS, the inclusion of Spinal Imaging increased the sensitivity of MRI to 100 %.

Seven patients without a definite diagnosis had Clinically Isolated Syndromes involving the Spinal Cord. Brain MRI was inconclusive, while all had Focal Spinal Cord lesions which explained symptoms and ruled out other causes.

Two other patients had atypical Brain abnormalities suggesting Ischemic/Vascular Disease. No Spinal Cord abnormalities were found, and during follow-up MS was ruled out.

Spinal Cord abnormalities are common in suspected MS, and may occur asymptomatic (Clinically Silent MS lesions). Although diagnostic classification is seldom changed, Spinal Cord Imaging increases diagnostic sensitivity of MRI in patients with suspected MS.

In addition, patients with Primary/Progressive MS may possibly be earlier diagnosed. Finally, differentiation with atypical lesions may be improved.

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