Magnetic resonance imaging of spinal cord lesions in multiple sclerosis.

Abstract OBJECTIVE Neurosurgeons are frequently asked to evaluate patients for spinal cord biopsies when preoperative magnetic resonance imaging studies demonstrate nonspecific features. These lesions often appear unresectable, but surgeons must decide whether a biopsy is warranted. To determine the best approach to these cases, we evaluated the clinicopathological findings for patients with unknown spinal cord lesions who underwent spinal cord biopsies. METHODS Thirty-eight consecutive patients who underwent spinal cord biopsies at the Mayo Clinic (Rochester, MN) between August 1988 and July 1998 were studied. A detailed review of the case histories, radiological results, surgical notes, histological findings, and outcomes was performed. RESULTS Spinal cord biopsies were performed for 21 male and 17 female patients (mean age, 42.1 yr) with progressive neurological deficits related to spinal cord lesions. All patients underwent preoperative magnetic resonance imaging evaluations. High T2-weighted signal intensity and spinal cord expansion were identified in 92 and 87% of cases, respectively. After gadolinium infusion, the majority (94%) of the inflammatory lesions demonstrated patchy and often peripherally situated enhancement. This neuroradiological pattern was less common for neoplasms (50%) and benign lesions (40%). The most common pathological findings were inflammatory changes of demyelination or sarcoidosis, which together accounted for 13 cases (34%). Nonspecific changes or benign lesions were observed in 10 cases (26%). Neoplasms were identified in eight cases (21%). One case of tuberculosis and one of schistosomiasis were found. Overall, 47% of the preoperative diagnoses made by the attending surgeon were correct. For 26% of the patients, specific treatment was based on the biopsy results. The average follow-up period was 12 months (standard deviation, 14 mo; range, 0–50 mo). CONCLUSION Preoperative laboratory and imaging studies are often diagnostically inconclusive in cases of spinal cord lesions with nonspecific features. Biopsies should be considered for patients with progressive symptomatic lesions.

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Serial cranial and spinal cord magnetic resonance imaging in multiple sclerosis

Annals of Neurology ◽

10.1002/ana.410320507 ◽

1992 ◽

Vol 32 (5) ◽

pp. 643-650 ◽

Cited By ~ 51

Author(s):

S. Wiebe ◽

D. H. Lee ◽

S. J. Karlik ◽

M. Hopkins ◽

M. K. Vandervoort ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Spinal Cord ◽

Magnetic Resonance ◽

Resonance Imaging

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How to use spinal cord magnetic resonance imaging in the McDonald diagnostic criteria for multiple sclerosis

Annals of Neurology ◽

10.1002/ana.20412 ◽

2005 ◽

Vol 57 (4) ◽

pp. 606-607 ◽

Cited By ~ 11

Author(s):

Tijmen Korteweg ◽

Frederik Barkhof ◽

Bernard M. J. Uitdehaag ◽

Chris H. Polman

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Spinal Cord ◽

Magnetic Resonance ◽

Diagnostic Criteria ◽

Resonance Imaging

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Incorrect Reference Citation in: HLA-DRB1*1501 and Spinal Cord Magnetic Resonance Imaging Lesions in Multiple Sclerosis

Archives of Neurology ◽

10.1001/archneurol.2010.56 ◽

2010 ◽

Vol 67 (4) ◽

pp. 514

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Spinal Cord ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Reference Citation

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Magnetic resonance imaging correlates of physical disability in relapse onset multiple sclerosis of long disease duration

Multiple Sclerosis Journal ◽

10.1177/1352458513492245 ◽

2013 ◽

Vol 20 (1) ◽

pp. 72-80 ◽

Cited By ~ 66

Author(s):

H Kearney ◽

MA Rocca ◽

P Valsasina ◽

L Balk ◽

J Sastre-Garriga ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Spinal Cord ◽

Magnetic Resonance ◽

Physical Disability ◽

Disease Duration ◽

Resonance Imaging ◽

Lesion Load ◽

Brain And Spinal Cord

Background: Understanding long-term disability in multiple sclerosis (MS) is a key goal of research; it is relevant to how we monitor and treat the disease. Objectives: The Magnetic Imaging in MS (MAGNIMS) collaborative group sought to determine the relationship of brain lesion load, and brain and spinal cord atrophy, with physical disability in patients with long-established MS. Methods: Patients had a magnetic resonance imaging (MRI) scan of their brain and spinal cord, from which we determined brain grey (GMF) and white matter (WMF) fractional volumes, upper cervical spinal cord cross-sectional area (UCCA) and brain T2-lesion volume (T2LV). We assessed patient disability using the Expanded Disability Status Scale (EDSS). We analysed associations between EDSS and MRI measures, using two regression models (dividing cohort by EDSS into two and four sub-groups). Results: In the binary model, UCCA ( p < 0.01) and T2LV ( p = 0.02) were independently associated with the requirement of a walking aid. In the four-category model UCCA ( p < 0.01), T2LV ( p = 0.02) and GMF ( p = 0.04) were independently associated with disability. Conclusions: Long-term physical disability was independently linked with atrophy of the spinal cord and brain T2 lesion load, and less consistently, with brain grey matter atrophy. Combinations of spinal cord and brain MRI measures may be required to capture clinically-relevant information in people with MS of long disease duration.

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Breakthrough Disease While on Multiple Sclerosis Immunomodulatory Therapy

10.1093/med/9780197583425.003.0017 ◽

2021 ◽

pp. 55-56

Author(s):

Jonathan L. Carter

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Spinal Cord ◽

White Matter ◽

Magnetic Resonance ◽

Disease Activity ◽

Brain Magnetic Resonance Imaging ◽

White Matter Lesions ◽

Dimethyl Fumarate ◽

Resonance Imaging

A 36-year-old woman with a history of relapsing-remitting multiple sclerosis was evaluated for new multiple sclerosis symptoms accompanied by new, enhancing, white matter lesions on brain magnetic resonance imaging. Her multiple sclerosis presented with L’hermitte sign when she was 24 years old. She had onset of bilateral lower extremity and left upper extremity tingling at age 26 years. Magnetic resonance imaging and cerebrospinal fluid examination at the time were supportive of the diagnosis of multiple sclerosis, and disease-modifying therapy was recommended by her neurologist. She initiated therapy with dimethyl fumarate at age 30 years after several further relapses. Surveillance magnetic resonance imaging showed new gadolinium-enhancing lesions on brain magnetic resonance imaging on each of 3 consecutive yearly scans. Urine culture and sensitivity tests were performed to rule out occult urinary tract infection; results of this testing were negative. magnetic resonance imaging of the brain concurrently showed new enhancing white matter lesions. The patient was diagnosed with clinical and radiographic breakthrough disease activity while receiving therapy for multiple sclerosis. The patient was treated with 5 days of intravenous methylprednisolone for her relapse. After discussion with the patient, it was decided to transition therapy from dimethyl fumarate to ocrelizumab infusions for her breakthrough disease activity. This decision was further supported by the patient’s concerns that she might be entering an early progressive phase of the disease. In patients with spinal-predominant multiple sclerosis, or with symptoms potentially indicating new spinal cord involvement, it may be necessary to include spinal cord imaging to assess for new disease activity.

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Magnetic resonance imaging of the cervical spinal cord in multiple sclerosis at 7T

Multiple Sclerosis Journal ◽

10.1177/1352458515591070 ◽

2015 ◽

Vol 22 (3) ◽

pp. 320-328 ◽

Cited By ~ 31

Author(s):

Adrienne N Dula ◽

Siddharama Pawate ◽

Richard D Dortch ◽

Robert L Barry ◽

Kristen M George-Durrett ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Spinal Cord ◽

White Matter ◽

Magnetic Resonance ◽

High Resolution ◽

Healthy Volunteers ◽

Cervical Spinal Cord ◽

Resonance Imaging ◽

Lower Field

Background: The clinical course of multiple sclerosis (MS) is mainly attributable to cervical and upper thoracic spinal cord dysfunction. High-resolution, 7T anatomical imaging of the cervical spinal cord is presented. Image contrast between gray/white matter and lesions surpasses conventional, clinical T1- and T2-weighted sequences at lower field strengths. Objective: To study the spinal cord of healthy controls and patients with MS using magnetic resonance imaging at 7T. Methods: Axial (C2–C5) T1- and T2*-weighted and sagittal T2*-/spin-density-weighted images were acquired at 7T in 13 healthy volunteers (age 22–40 years), and 15 clinically diagnosed MS patients (age 19–53 years, Extended Disability Status Scale, (EDSS) 0–3) in addition to clinical 3T scans. In healthy volunteers, a high-resolution multi-echo gradient echo scan was obtained over the same geometry at 3T. Evaluation included signal and contrast to noise ratios and lesion counts for healthy and patient volunteers, respectively. Results/conclusion: High-resolution images at 7T exceeded resolutions reported at lower field strengths. Gray and white matter were sharply demarcated and MS lesions were more readily visualized at 7T compared to clinical acquisitions, with lesions apparent at both fields. Nerve roots were clearly visualized. White matter lesion counts averaged 4.7 vs 3.1 (52% increase) per patient at 7T vs 3T, respectively ( p=0.05).

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