Magnetic resonance imaging in isolated noncompressive spinal cord syndromes

Abstract

The frequency with which patients presenting with acute or chronic noncompressive cord syndromes subsequently develop multiple sclerosis is uncertain. Magnetic resonance imaging (MRI) was performed on 121 patients with such syndromes to determine the frequency of asymptomatic brain lesions and to assess the sensitivity of MRI in detecting the local cord lesion. MRI findings were compared with those from visual, brainstem, and somatosensory evoked potentials (VEPs, BAEPs, SEPs), and cerebrospinal fluid electrophoresis. Lesions were seen in the appropriate cord region in 47 of 73 patients (64%) with a cervical syndrome, and in 7 of 25 patients (28%) with a thoracic or lumbar syndrome. MRI demonstrated more cervical lesions than did SEPs, but fewer thoracic or lumbar lesions. Cord swelling was seen in 6 patients and atrophy in 10. Of those with acute syndromes, abnormalities were seen with brain MRI in 18 of 32 patients (56%), with VEPs in 2 of 30 patients (7%), and with BAEPs in 2 of 24 patients (8%). In patients with chronic syndromes, abnormalities were seen with brain MRI in 73 of 89 patients (82%), with VEPs in 22 of 80 patients (28%), and with BAEPs in 12 of 62 patients (19%). Brain MRI was thus more sensitive than evoked potentials were in establishing multiplicity of lesions. However, in acute syndromes, it was not possible to diagnose multiple sclerosis from a single abnormal brain scan in chronic syndromes, a diagnosis of clinically probable multiple sclerosis could be made from one scan, provided there was no better explanation for the abnormalities: the added presence of oligoclonal bands allows a diagnosis of laboratory-supported, definite multiple sclerosis as was the case in 28 patients in this series.

Early prognosis of multiple sclerosis

“…Using the 2005 diagnostic criteria for MS , 10% to 15% of CIS patients will convert to definite MS based on MRI changes alone without having any clinical episodes for up to two decades (Chard et al, 2011). Nevertheless, T2 abnormalities are present in 50-70% of patients at the CIS stage (Miller et al, 1987;Beck et al, 1993a;Sastre-Garriga et al, 2003). In addition, the typical MRI findings correspond to the known histopathology of the disease.…”

The utility of MRI in suspected MS [RETIRED]

“…[3][4][5] Thus, approximately 50 to 80% of individuals who present with a clinically isolated syndrome (CIS) already have lesions on MRI, consistent with prior (occult) disease activity. [6][7][8][9][10][11][12][13] Two randomized, controlled trials of interferon beta (IFN␤) have recently demonstrated a treatment benefit in patients with a CIS and MRI abnormalities suggestive of MS. 14,15 All existing diagnostic criteria for RRMS, including those of Schumacher et al 16 and Poser et al 17 as well as a recent consensus statement, 18 require two or more distinct events separated in time (generally by more than a month) in addition to involvement of at least two distinct areas of the CNS (the so-called criteria of dissemination in time and space). Importantly, also, all of the existing diagnostic schemes require the exclusion of alternative diagnoses by appropriate laboratory and radiographic studies prior to the application of the diagnostic algorithm.…”

Inflammation and the brain

“…The lesions responsible for spinal or optic nerve demyelination can also be imaged in vivo (Miller et al, 1987(Miller et al, ,1988. Correlations between magnetic resonance images, the evolution of symptoms, and clinical neurophysiology show that the deficits, at least in optic neuritis, are associated with altered blood-brain barrier permeability and conduction block, without demyelination or axonal degeneration necessarily having occurred (Youl et al, 1991).…”