MULTIPLE-SCLEROSIS OF THE SPINAL-CORD - DIAGNOSIS AND FOLLOW-UP WITH CONTRAST-ENHANCED MR AND CORRELATION WITH CLINICAL ACTIVITY

PURPOSE: Although MR findings in multiple sclerosis (MS) are well know n, the relationship between MR-detected lesions and clinical activity has not been studied in the spinal cord. The purpose of this study was to determine whether serial MR imaging provides evidence of disease a ctivity unsuspected on clinical examination and to determine whether i t is useful in monitoring patients with MS primarily affecting the spi nal cord. METHODS: twenty-five consecutive patients with MS and with s igns and symptoms of myelopathy underwent a full neurologic examinatio n and contrast-enhanced MR imaging of the spinal cord at intervals of 0, 2, 6, and 12 months. Disability was rated according to Kurtzke's fu nctional systems and the expanded disability status scale (EDSS), Clin ical status of myelopathy (improved, deteriorated, or stable) was also assessed. Hyperintense lesions were counted on T2-weighted images and a weighted lesion load was calculated for each patient. The number of enhancing lesions was also determined. RESULTS: We found a moderate c orrelation between lesion load and sensory function and EDSS. Seventy percent of patients with new clinical manifestations of myelopathy had one or more enhancing lesions, Agreement between MR findings and clin ical examination in evincing disease activity was found in 60% of foll ow-up examinations. MR images showed lesion progression in seven (44%) of 16 occurrences of clinical deterioration and in 21 (35%) of 60 occ urrences of clinical improvement or stability. CONCLUSION: Serial MR i maging provides evidence of disease activity unsuspected on clinical e xamination and could be useful in monitoring patients with MS primaril y affecting the spinal cord.