Multiple Sclerosis (MS) of the Spine

View Key Images

Diagnosis Definition

Multiple sclerosis (MS) is the most common demyelinating process involving the central nervous system; the diagnosis is made from a combination of clinical, imaging, and laboratory findings
Patients with MS can present with motor, sensory, visual, and/or autonomic pathway symptoms
Spinal MS is often associated with brain lesions; however, 20% of patients with spinal lesions do not have intracranial plaques
Spinal cord atrophy is related to progressive MS and physical disability

Imaging Findings

The 2017 revised McDonald criteria confirmed that MRI is the most useful paraclinical test to aid the diagnosis of MS, and can be used to establish dissemination of lesions in space and time
Spinal MS lesions often occur in the cervical region and less frequently in the lower thoracic spinal cord (T7–12)
Depending on their age, MS plaques appear normal or slightly hypointense on T1-weighted images and hyperintense on T2; the spinal cord may be enlarged when the disease is active and is atrophied when chronic
Spinal plaques may appear as nodules, rings, or arcs on enhanced MRI and are generally less than 2 vertebral bodies in length, although involvement can be diffuse
Enhancement, seen as high signal on T1, indicates active disease

Pearls

Spinal cord lesions are more likely than brain lesions to be symptomatic and leave residual neurological impairment, due to poor compensatory capacity of the spinal cord; despite this, 58% of new spinal cord lesions are asymptomatic
The differential diagnosis includes primary or metastatic spinal cord neoplasm (cysts and hemorrhage common), acute disseminated encephalomyelitis (non-relapsing and history of viral infection), sarcoidosis (pial involvement common), transverse myelitis (usually involving a longer segment), infarct (usually a single lesion in an older patient with vascular disease), vasculitis, radiation myelitis (l-3 years latency period), and arteriovenous fistula (associated with serpiginous flow void)

References

Valsasina P, Aboulwafa M, Preziosa P, et al. Cervical cord T1-weighted hypointense lesions at MR imaging in multiple sclerosis: relationship to cord atrophy and disability. Radiology 2018; 288: 234–244
Tartaglino LM, Friedman DP, Flanders AE, Lublin FD, Knobler RL, Liem. Multiple sclerosis in the spinal cord: MR appearance and correlation with clinical parameters. Radiology 1995; 195(3):725-732
Traboulsee A, Simon JH, Stone L, Fisher E, Jones DE, et al. Revised Recommendations of the Consortium of MS Centers Task Force for a Standardized MRI Protocol and Clinical Guidelines for the Diagnosis and Follow-Up of Multiple Sclerosis. AJNR Am J Neuroradiol 2016; 37(3):394-401

Case-based learning.
Perfected.

Try MRI Online Premium for free.

Mastery Series video courses

High-yield cases

Expert case reviews

CME & SA-CME credits

Learn from world renowned radiologists anytime,
actice on real, high-yield cases with MRI Online Premium.

Learn from world renowned
radiologistsanytime, anywhere and practice on real, high-yield cases with MRI Online Premium.