From the Guidelines
Yes, initial early Multiple Sclerosis (MS) nerve damage to the spinal cord can occur without being detected by a brain Magnetic Resonance Imaging (MRI) scan.
Key Points
- The diagnosis of MS is based on the detection of lesions within the CNS that demonstrate dissemination in space (DIS) and dissemination in time (DIT) 1.
- Brain MRI features can be normal in patients with Primary Progressive MS (PPMS) and small spinal cord lesions might not be detected despite notable technical improvements 1.
- The presence of asymptomatic spinal cord lesions in patients with brain MRI findings that are suggestive of Radiologically Isolated Syndrome (RIS) heralds an increased risk of short-term progression to either Clinically Isolated Syndrome (CIS) or Primary Progressive MS 1.
- Spinal cord MRI can detect lesions that are not visible on brain MRI, and the addition of spinal cord MRI to brain imaging can be of clinical relevance in certain situations 1.
- High-resolution imaging is required for the detection of spinal cord lesions due to the small cross-sectional area of the spinal cord 1.
- The 2017 revision of the McDonald criteria emphasizes the importance of lesion location and characteristics in the diagnosis of MS, and careful determination of which imaging features and patterns constitute ‘typical’ MS lesions is crucial 1.
- Brain and spinal cord volume measures have no role in the MS diagnostic criteria but are valuable for early evaluation of treatment responses and prediction of disease evolution 1.
From the Research
Spinal Cord Involvement in Multiple Sclerosis
- Multiple Sclerosis (MS) is an inflammatory disorder that affects both the brain and the spinal cord 2, 3, 4, 5, 6.
- Spinal cord abnormalities at disease onset have important implications for diagnosis and prognosis 2, 5.
Detection of Spinal Cord Damage
- MRI studies in MS focus more often on the brain than on the spinal cord, due to technical challenges in imaging the spinal cord 2, 3.
- Conventional MRI may not be sensitive enough to detect spinal cord lesions, especially in the early stages of the disease 4, 5.
- Quantitative MRI measures of cord size and tissue integrity may be more sensitive to axonal loss and other pathological processes in the spinal cord than conventional MRI 2, 4.
Role of Spinal Cord MRI in MS Diagnosis and Monitoring
- Spinal cord MRI findings are important to establish a prompt and accurate diagnosis of MS, and to provide valuable data for monitoring the disease course 3, 6.
- Spinal cord lesions and atrophy are associated with disability progression, and may be useful in predicting disease course and treatment response 4, 5, 6.
- Spinal cord MRI may provide relevant additional information to brain MRI in understanding MS pathophysiology, and in identifying MS patients at higher risk of developing more severe disability 6.