Spinal cord MRI in multiple sclerosis—diagnostic, prognostic and clinical value
Abstract
Multiple sclerosis (MS) is an inflammatory disorder of the CNS that affects both the brain and the spinal cord. MRI studies in MS focus more often on the brain than on the spinal cord, owing to the technical challenges in imaging this smaller, mobile structure. However, spinal cord abnormalities at disease onset have important implications for diagnosis and prognosis. Furthermore, later in the disease course, in progressive MS, myelopathy becomes the primary characteristic of the clinical presentation, and extensive spinal cord pathology--including atrophy, diffuse abnormalities and numerous focal lesions--is common. Recent spinal cord imaging studies have employed increasingly sophisticated techniques to improve detection and quantification of spinal cord lesions, and to elucidate their relationship with physical disability. Quantitative MRI measures of cord size and tissue integrity could be more sensitive to the axonal loss and other pathological processes in the spinal cord than is conventional MRI, putting quantitative MRI in a key role to elucidate the association between disability and spinal cord abnormalities seen in people with MS. In this Review, we summarize the most recent MS spinal cord imaging studies and discuss the new insights they have provided into the mechanisms of neurological impairment. Finally, we suggest directions for further and future research.
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Conventional MRI of the multiple sclerosis spinal cord has low specificity for underlying pathological processes, and radiological changes fail to consistently correlate with measures of disability.
“Conventional magnetic resonance imaging (MRI) of the multiple sclerosis spinal cord is limited by low specificity regarding the underlying pathological processes”
From Neurite dispersion: a new marker of multiple sclerosis spinal cord pathology? (2017) · cites this paper as [12]
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Tactile-associated recruitment of the cervical cord is altered in patients with multiple sclerosis
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Approaches to Normalization of Spinal Cord Volume: Application to Multiple Sclerosis
Healy, B. C., Arora, A., Hayden, D. L., Ceccarelli, A., Tauhid, S., Neema, M., & Bakshi, R. (2011) · Journal of Neuroimaging · doi:10.1111/j.1552-6569.2011.00629.x · Cited by 63 · see citing works
Atrophy and structural variability of the upper cervical cord in early multiple sclerosis
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Evidence for enhanced functional activity of cervical cord in relapsing multiple sclerosis
Agosta, F., Valsasina, P., Rocca, M. A., Caputo, D., Sala, S., Judica, E., Stroman, P. W., & Filippi, M. (2008) · Magnetic Resonance in Medicine · doi:10.1002/mrm.21595 · Cited by 62 · see citing works
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Self-citationComparison of MRI sequences for evaluation of multiple sclerosis of the cervical spinal cord at 3T
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Magnetization-transfer histogram analysis of the cervical cord in patients with multiple sclerosis.
Bozzali, M., Rocca, M. A., Iannucci, G., Pereira, C., Comi, G. P., & Filippi, M. (1999) · PubMed Central · Cited by 53 · see citing works
Casting light on multiple sclerosis heterogeneity: the role of HLA-DRB1 on spinal cord pathology
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Self-citationAssessing Neuronal MetabolismIn Vivoby Modeling Imaging Measures
Ciccarelli, O., Toosy, A., Stefano, N. D., Wheeler‐Kingshott, C. A. M. G., Miller, D. H., & Thompson, A. J. (2010) · Journal of Neuroscience · doi:10.1523/jneurosci.3330-10.2010 · Cited by 50 · see citing works
Self-citationRocca, M. A., Valsasina, P., Damjanovic, D., Horsfield, M. A., Mesaroš, Š., Stošić-Opinćal, T., Drulovic, J. S., & Filippi, M. (2012) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2012-303821 · Cited by 50 · see citing works
Low Myo‐inositol indicating astrocytic damage in a case series of neuromyelitis optica
Ciccarelli, O., Thomas, D. L., Vita, E. D., Wheeler‐Kingshott, C. A. M. G., Kachramanoglou, C., Kapoor, R., Leary, S. M., Matthews, L., Palace, J. A., Chard, D., et al. (2013) · Annals of Neurology · doi:10.1002/ana.23909 · Cited by 48 · see citing works
Self-citationRegional Cervical Cord Atrophy and Disability in Multiple Sclerosis: A Voxel-based Analysis
Valsasina, P., Rocca, M. A., Horsfield, M. A., Absinta, M., Messina, R., Caputo, D., Comi, G., & Filippi, M. (2012) · Radiology · doi:10.1148/radiol.12120813 · Cited by 48 · see citing works
In vivo imaging of spinal cord atrophy in neuroinflammatory diseases
Liu, W. W., Nair, G., Vuolo, L., Bakshi, A., Massoud, R., Reich, D. S., & Jacobson, S. (2014) · Annals of Neurology · doi:10.1002/ana.24213 · Cited by 47 · see citing works
Benedetti, B., Rocca, M. A., Rovaris, M., Caputo, D., Zaffaroni, M., Capra, R., Bertolotto, A., Martinelli, V., Comi, G., & Filippi, M. (2009) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2009.173120 · Cited by 45 · see citing works
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Liptak, Z., Berger, A. M., Sampat, M. P., Charil, A., Felsovalyi, O., Healy, B. C., Hildenbrand, P. G., Khoury, S. J., Weiner, H. L., Bakshi, R., et al. (2008) · American Journal of Neuroradiology · doi:10.3174/ajnr.a1162 · Cited by 43 · see citing works
Cervical cord functional MRI changes in relapse-onset MS patients
Valsasina, P., Agosta, F., Absinta, M., Sala, S., Caputo, D., & Filippi, M. (2009) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2009.187526 · Cited by 43 · see citing works
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Spinal Cord Normalization in Multiple Sclerosis
Oh, J., Seigo, M. A., Saidha, S., Sotirchos, E. S., Zackowski, K., Chen, M., Prince, J. L., Diener‐West, M., Calabresi, P. A., & Reich, D. S. (2014) · Journal of Neuroimaging · doi:10.1111/jon.12097 · Cited by 41 · see citing works
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Abnormal cervical cord function contributes to fatigue in multiple sclerosis
Rocca, M. A., Absinta, M., Valsasina, P., Copetti, M., Caputo, D., Comı, G., & Filippi, M. (2012) · Multiple Sclerosis Journal · doi:10.1177/1352458512440516 · Cited by 35 · see citing works
Liu, Z., Yaldizli, Ö., Pardini, M., Sethi, V., KEARNEY, H. F., Muhlert, N., Wheeler‐Kingshott, C. A. M. G., Miller, D. H., & Chard, D. (2014) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2014.11.004 · Cited by 34 · see citing works
Self-citationAcute transverse myelitis with normal brain MRI
Perumal, J., Zabad, R., Caon, C., MacKenzie, M., Tselis, A. C., Bao, F., Latif, Z., Zak, I., Lisak, R. P., & Khan, O. (2007) · Journal of Neurology · doi:10.1007/s00415-007-0686-5 · Cited by 33 · see citing works
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A pilot MRI study of white and grey matter involvement by multiple sclerosis spinal cord lesions
KEARNEY, H. F., Miszkiel, K., Yiannakas, M. C., Ciccarelli, O., & Miller, D. (2012) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2012.09.005 · Cited by 31 · see citing works
Self-citationVoxel-based cervical spinal cord mapping of diffusion abnormalities in MS-related myelitis
Toosy, A., Kou, N., Altmann, D. R., Wheeler‐Kingshott, C. A. M. G., Thompson, A. J., & Ciccarelli, O. (2014) · Neurology · doi:10.1212/wnl.0000000000000857 · Cited by 30 · see citing works
Self-citation1H-Magnetic Resonance Spectroscopy in diffuse and focal cervical cord lesions in Multiple Sclerosis
Bellenberg, B., Busch, M., Trampe, N., Gold, R., Chan, A., & Lukas, C. (2013) · European Radiology · doi:10.1007/s00330-013-2942-7 · Cited by 30 · see citing works
Cervical cord FMRI abnormalities differ between the progressive forms of multiple sclerosis
Valsasina, P., Rocca, M. A., Absinta, M., Agosta, F., Caputo, D., Comı, G., & Filippi, M. (2011) · Human Brain Mapping · doi:10.1002/hbm.21346 · Cited by 29 · see citing works
Short-term evolution of spinal cord damage in multiple sclerosis: a diffusion tensor MRI study
Théaudin, M., Saliou, G., Ducot, B., Deiva, K., Denier, C., Adams, D., & Ducreux, D. (2012) · Neuroradiology · doi:10.1007/s00234-012-1057-1 · Cited by 29 · see citing works
Hickman, S. J., Coulon, O., Parker, G. J. M., Barker, G. J., Stevenson, V. L., Chard, D., Arridge, S., Thompson, A. J., & Miller, D. H. (2003) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.10354 · Cited by 24 · see citing works
Self-citationSolanky, B., Abdel‐Aziz, K., Yiannakas, M. C., Berry, A., Ciccarelli, O., & Wheeler‐Kingshott, C. A. M. G. (2012) · NMR in Biomedicine · doi:10.1002/nbm.2867 · Cited by 19 · see citing works
Self-citationCharil, A., Caputo, D., Cavarretta, R., Sormani, M. P., Ferrante, P., & Filippi, M. (2006) · Multiple Sclerosis Journal · doi:10.1177/1352458506070714 · Cited by 19 · see citing works
Age Related Changes in Metabolite Concentrations in the Normal Spinal Cord
Abdel‐Aziz, K., Solanky, B., Yiannakas, M. C., Altmann, D. R., Wheeler‐Kingshott, C. A. M. G., Thompson, A. J., & Ciccarelli, O. (2014) · PLoS ONE · doi:10.1371/journal.pone.0105774 · Cited by 17 · see citing works
Self-citationSpinal cord MRI should always be performed in clinically isolated syndrome patients: No
Rovira, À., & Tintoré, M. (2014) · Multiple Sclerosis Journal · doi:10.1177/1352458514543812 · Cited by 6 · see citing works
Spinal cord MRI should always be performed in clinically isolated syndrome patients: Yes
Barkhof, F. (2014) · Multiple Sclerosis Journal · doi:10.1177/1352458514546518 · Cited by 6 · see citing works
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Pathophysiological and cognitive mechanisms of fatigue in multiple sclerosis
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Epidemiology and treatment of multiple sclerosis in elderly populations
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Self-citationNeurite dispersion: a new marker of multiple sclerosis spinal cord pathology?
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“However, the pathological substrate of radiological changes are relatively nonspecific and fail to consistently correlate with measures of disability.(12) New quantitative MRI methods that assess functionally relevant microstructure noninvasively and relate to changes at the microscopic level are urgently needed.”
Backgroundon behalf of the MAGNIMS study group, Sastre‐Garriga, J., Pareto, D., Battaglini, M., Rocca, M. A., Ciccarelli, O., Enzinger, C., Wuerfel, J. T., Sormani, M. P., Barkhof, F., et al. (2020) · Nature Reviews Neurology · doi:10.1038/s41582-020-0314-x · Cited by 278 · see citing works
Self-citationSpinal cord involvement in multiple sclerosis and neuromyelitis optica spectrum disorders
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Self-citationMagnetic Resonance Imaging in Multiple SclerosisPreprint
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The topographical model of multiple sclerosis
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Self-citationA Review of the Segmental Diameter of the Healthy Human Spinal Cord
Frostell, A., Hakim, R., Thelin, E. P., Mattsson, P., & Svensson, M. A. (2016) · Frontiers in Neurology · doi:10.3389/fneur.2016.00238 · Cited by 126 · see citing works
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Arrambide, G., Rovira, À., Sastre‐Garriga, J., Tur, C., Castilló, J., Río, J., Vidal‐Jordana, Á., Galán, I., Rodrı́guez‐Acevedo, B., Midaglia, L. S., et al. (2017) · Multiple Sclerosis Journal · doi:10.1177/1352458517697830 · Cited by 120 · see citing works
Singh, S., Dallenga, T., Winkler, A., Roemer, S., Maruschak, B., Siebert, H., Brück, W., & Stadelmann, C. (2017) · Journal of Neuroinflammation · doi:10.1186/s12974-017-0831-8 · Cited by 118 · see citing works
Spatial distribution of multiple sclerosis lesions in the cervical spinal cord
Eden, D., Gros, C., Badji, A., Dupont, S. M., Leener, B. D., Maranzano, J., Zhuoquiong, R., Liu, Y., Granberg, T., Ouellette, R., et al. (2019) · Brain · doi:10.1093/brain/awy352 · Cited by 117 · see citing works
Self-citationAdvances in spinal cord imaging in multiple sclerosis
Moccia, M., Ruggieri, S., Ianniello, A., Toosy, A., Pozzilli, C., & Ciccarelli, O. (2019) · Therapeutic Advances in Neurological Disorders · doi:10.1177/1756286419840593 · Cited by 102 · see citing works
Self-citationAxonal loss in the multiple sclerosis spinal cord revisited
Petrova, N., Carassiti, D., Altmann, D. R., Baker, D., & Schmierer, K. (2017) · Brain Pathology · doi:10.1111/bpa.12516 · Cited by 96 · see citing works
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Association of HLA Genetic Risk Burden With Disease Phenotypes in Multiple Sclerosis
Isobe, N., Keshavan, A., Gourraud, P., Zhu, A. H., Datta, E., Schlaeger, R., Caillier, S. J., Santaniello, A., Lizée, A., Himmelstein, D. S., et al. (2016) · JAMA Neurology · doi:10.1001/jamaneurol.2016.0980 · Cited by 89 · see citing works
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Mathur, D., Lafuente, E. M., Ureña‐Peralta, J. R., Sorribes, L., Hernández, A., Casanova, B., López‐Rodas, G., Ferrer, F. C., & Burgal, M. (2017) · Brain Sciences · doi:10.3390/brainsci8010001 · Cited by 65 · see citing works
Amide proton transfer CEST of the cervical spinal cord in multiple sclerosis patients at 3T
By, S., Barry, R. L., Smith, A. K., Lyttle, B. D., Box, B. A., Bagnato, F. R., Pawate, S., & Smith, S. A. (2017) · Magnetic Resonance in Medicine · doi:10.1002/mrm.26736 · Cited by 64 · see citing works
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Self-citationHigh serum neurofilament light chain normalizes after hematopoietic stem cell transplantation for MS
Thebault, S., Tessier, D. R., Lee, H., Bowman, M., Bar‐Or, A., Arnold, D. L., Atkins, H. L., Tabard‐Cossa, V., & Freedman, M. S. (2019) · Neurology Neuroimmunology & Neuroinflammation · doi:10.1212/nxi.0000000000000598 · Cited by 62 · see citing works
Late-Onset MS: Disease Course and Safety-Efficacy of DMTS
Buscarinu, M. C., Reniè, R., Morena, E., Romano, C., Bellucci, G., Marrone, A., Bigi, R., Salvetti, M., & Ristori, G. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.829331 · Cited by 60 · see citing works
Guidelines for the conduct of clinical trials in spinal cord injury: Neuroimaging biomarkers
Seif, M., Wheeler‐Kingshott, C. A. M. G., Cohen‐Adad, J., Flanders, A. E., & Freund, P. (2019) · Spinal Cord · doi:10.1038/s41393-019-0309-x · Cited by 60 · see citing works
Clinically relevant cranio-caudal patterns of cervical cord atrophy evolution in MS
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Self-citationMultiple sclerosis lesions affect intrinsic functional connectivity of the spinal cord
Conrad, B. N., Barry, R. L., Rogers, B. P., Maki, S., Mishra, A., Thukral, S., Sriram, S., Bhatia, A., Pawate, S., Gore, J. C., et al. (2018) · Brain · doi:10.1093/brain/awy083 · Cited by 58 · see citing works
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Preferential spinal cord volume loss in primary progressive multiple sclerosis
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Neuroimaging features in inflammatory myelopathies: A review
Cacciaguerra, L., Sechi, E., Rocca, M. A., Filippi, M., Pittock, S. J., & Flanagan, E. P. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.993645 · Cited by 52 · see citing works
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- Authors
- Kearney, H., Miller, D. H., & Ciccarelli, O.
- Affiliations
- National Hospital for Neurology and Neurosurgery (GB)
- Corresponding author
- Kearney, Hugh
- Venue
- Nature Reviews Neurology
- Published
- 2015-05-26
- Volume
- 11
- Issue
- 6
- Pages
- 327-338
- ISSN
- 1759-4758 (ISSN-L)
- 1759-4766
- OpenAlex
- W1577466874
- Cited by
- 235
- References
- 132
- Citations by year
- 2026: 13 · 2025: 19 · 2024: 30 · 2023: 20 · 2022: 19 · 2021: 21 · 2020: 18 · 2019: 31 · 2018: 22 · 2017: 19 · 2016: 21 · 2015: 2
- FWCI
- 3.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Neurology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Queen Mary University of London
- National Institute for Health and Care Research (NF-SI-0508-10058)
- Multiple Sclerosis Society
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Keywords
- multiple sclerosis, spinal cord MRI, spinal cord lesions, quantitative MRI, disability, myelopathy, spinal cord atrophy, axonal loss, progressive multiple sclerosis
- MeSH terms
- Humans, Magnetic Resonance Imaging, Multiple Sclerosis, Neuromyelitis Optica, Prognosis, Spinal Cord, Disease Progression, Gray Matter
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