title: Spinal-cord MRI in multiple sclerosis.
abstract: The potential of MRI of the spinal cord as a diagnostic tool in MS has recently gained much interest. Dual echo spin echo MRI is most sensitive for the detection of spinal-cord abnormalities, which range from multiple focal lesions to confluent areas of high signal intensity. In some patients, commonly those with primary progressive disease, diffuse areas of slightly increased signal intensity are found. Disappointingly, the relation between MRI findings and clinical disability is weak. Studies relating MRI findings with histopathology have revealed substantial axonal loss in the spinal cords of patients with MS, whether focal lesions are present of not. Further, diffuse cord atrophy is found in advanced MS, which may reflect axonal loss. In the diagnostic setting, spinal-cord imaging is valuable. First, asymptomatic spinal-cord lesions are very rare in disorders other than MS. For example, in a patient with equivocal brain findings such as an elderly patient with vascular-ischaemic lesions, a normal spinal-cord examination can help rule out MS. Second, presence of asymptomatic spinal lesions may help confirm a diagnosis of MS when few or no brain lesions are present.
authors.affiliation: MS-MRI Centre, VU Medical Centre, Department of Radiology, Amsterdam, Netherlands. g.lycklama@vumc.nl
authors.forename: Geert
authors.initials: G
authors.lastname: Lycklama
authors.forename: Alan
authors.initials: A
authors.lastname: Thompson
authors.forename: Massimo
authors.initials: M
authors.lastname: Filippi
authors.forename: David
authors.initials: D
authors.lastname: Miller
authors.forename: Chris
authors.initials: C
authors.lastname: Polman
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009103:Multiple Sclerosis / Q000145:classification / Q000000981:diagnostic imaging*; D011856:Radiographic Image Enhancement; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology*