MRI of a Patient with Multiple Sclerosis Lesions in the Cervical and Thoracic Spine (blue circle)
Magnetic resonance imaging (MRI) was first used to visualize multiple sclerosis (MS) in the upper cervical spine in the late 1980s. Spinal MS is often associated with concomitant brain lesions; however, as many as 20% of patients with spinal lesions do not have intracranial plaques. Contrary to the white and gray matter in the brain, white and gray matter can both be affected in the spine. No strong correlation has been established between the extent of the plaques and the degree of clinical disability. Spinal cord atrophy is most relevant to progressive forms of MS (primary progressive and secondary progressive), in which it closely links to physical disability.
MRI is currently considered to be the most sensitive diagnostic imaging modality for revealing demyelinating plaques, as recommended by the Consortium of Multiple Sclerosis Centers. No specific field strength is recommended. MRI shows abnormalities in 95% of patients with clinically definitive MS.
The spinal cord MR imaging protocol for MS should include sagittal T1-w and T2-w acquisitions, STIR or phase-sensitive inversion recovery, axial T2-w imaging through suspicious lesions, and, in some cases, postcontrast gadolinium-enhanced T1-w imaging.