Spinal cord magnetic resonance imaging in suspected multiple sclerosis

We examined the value of spinal cord magnetic resonance imaging (MRI) in th e diagnostic work-up of multiple sclerosis (MS). Forty patients suspected o f having MS were examined within nibs after the start of symptoms. Disabili ty assessed, and symptoms were categorized as either brain or spinal cord. Work-up further included fluid analysis and standard proton-density, T2-, a nd T1-weighted gadolinium-enhanced brain and spinal cord MRL. Patients were categorized as either clinically definite MS (II = 13), laboratory-support ed definite MS (II = 14), or clinically probable MS (n = 4); four patients had clinically probable MS, and in nine MS was suspected. Spinal cord abnor malities were found in 35 of 40 patients (87.5 %), consisting of focal lesi ons in 31, only diffuse abnormalities in two,and both in two. Asymptomatic spinal cord lesions occurred in six patients. All patients with diffuse spi nal cord abnormality had clear spinal cord. symptoms and a primary progress ive disease course. In clinically definite MS, the inclusion of spinal imag ing increased the sensitivity of MRI to 100 %. Seven patients without a def inite 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 atyp ical brain abnormalities suggesting ischemic/vascular disease. No spinal co rd abnormalities were found, and during follow-up MS was ruled out. Spinal cord abnormalities are common in suspected MS, and may occur asymptomatic. Although diagnostic classification is seldom, spinal cord imaging increases diagnostic sensitivity of MRI in patients with suspected MS. In addition, patients with primary progressive MS may atypical lesions may be improved. ly be earlier diagnosed. Finally, differentiation with atypical lesions may be improved.