Multiple Sclerosis (MS) of the Spinal Cord

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Multiple Sclerosis (MS) of the Spinal Cord
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From Applied Radiology

Posted 11/16/2006

Brendan P. Coleman, MD


Summary and Diagnosis
Summary

A 27-year-old woman presented to the hospital with right-sided weakness. A magnetic resonance imaging (MRI) study was obtained.
Diagnosis

Multiple sclerosis (MS) of the spinal cord.
Imaging Findings

The MRI of the cervical spine showed fairly well-defined areas of increased signal on T2-weighted imaging in the upper cervical spine. T1-weighted imaging (not shown) did not show corresponding areas of decreased signal intensity. There was no enhancement with gadolinium administration (not shown) that would indicate active lesions. There was no associated cord edema or swelling, which may sometimes be seen early in the disease process.
Figure 1. (click image to zoom)




Figure 2. (click image to zoom)




Discussion

Multiple sclerosis is a demyelinating disease of the brain and spinal cord. Most patients with MS have spinal cord lesions that can be seen with MRI, which is helpful in diagnosis because of the rarity of spinal cord findings in other neurological disease processes.

In as many as 90% of MS patients, the spinal cord is involved.[1] It is estimated that approximately 35% of MS patients exhibit spinal symptoms only. The cervical spinal cord is twice as likely to be involved as the lower levels. The diagnosis of MS is made clinically according to specific criteria, requiring neurologic symptoms that involve multiple areas of the nervous system or neurologic episodes at different times, or both.

Multipule sclerosis of the spinal cord may exhibit one or several of multiple imaging findings. Often, there is ≥1 foci of increased signal on T2-weighted images with or without corresponding decreased signal in the spinal cord on T1-weighted images.

At an early stage of the disease, images may show cord edema and swelling. Later in the disease, imaging may reveal cord atrophy. Active lesions show enhancement after contrast administration. Multiple sclerosis may present with a single large lesion that mimicks a neoplasm.[2]
Conclusion

The diagnosis of MS is made clinically; however, the identification of spinal cord lesions with MRI may be helpful in equivocal cases.