Differentiation of Multiple Sclerosis from Other Inflammatory Disorders and Cerebrovascular Disease: Value of Spinal MR Imaging
Abstract
Purpose To determine the value of magnetic resonance (MR) imaging in the spinal cord to differentiate multiple sclerosis (MS) from other inflammatory disorders and cerebrovascular diseases (together, other neurologic disease [OND]). Materials and methods The study population included 66 patients with OND and 25 patients with MS, who were matched for age, sex, and symptom duration or severity. Brain MR imaging included gadolinium-enhanced T1-weighted and dual-echo T2-weighted spin-echo sequences to assess the number, size, and appearance of lesions, contrast enhancement, and compatibility with diagnostic criteria for MS. Spinal cord MR imaging included cardiac-triggered gadolinium-enhanced sagittal T1-weighted spin-echo and dual-echo T2-weighted sequences to assess the general appearance (normal, focal lesion, diffuse abnormality) and number or size of focal lesions. Images obtained in MS and OND patients were compared. Specificity, sensitivity, accuracy, and positive and negative predictive values with MR images were calculated. Results Brain images were abnormal in all MS patients and in 65% of OND patients. Abnormal cord images were found in 92% of MS and 6% of OND patients. The combination of brain and spinal cord images increased accuracy of diagnosis compared with use of brain images alone. Conclusion In contrast to MS, cord lesions are very uncommon in OND. This finding can help differentiate these disorders.
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Spinal cord lesions occur in 80-90% of patients with established MS and up to half of patients with CIS, most often in the cervical cord.
“Spinal cord lesions occur in 80-90% of patients with established MS and up to half of patients with CIS, most often in the cervical cord.10,11”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [11]
In older adults, a stringent interpretation of brain MRI criteria for MS is mandatory and spinal cord MRI is helpful since spinal cord lesions do not occur with healthy aging.
“In this situation a stringent interpretation of brain MRI criteria for MS is mandatory and spinal cord MRI is helpful since spinal cord lesions do not occur with healthy aging.11”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [11]
Spinal cord lesions can be very helpful in making a diagnosis of MS (cord lesions do not occur with healthy aging or cerebrovascular disease and provide additional evidence of dissemination in space) and may provide important prognostic information.
“However, spinal cord lesions can be very helpful in making a diagnosis of MS (cord lesions do not occur with healthy aging or cerebrovascular disease 11 and provide additional evidence of dissemination in space 10 ) and may provide important prognostic information.67”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [11]
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- Authors
- Bot, J. C. J., Barkhof, F., à Nijeholt, G. L., van Schaardenburg, D., Voskuyl, A. E., Ader, H. J., Pijnenburg, J. A. L., Polman, C. H., Uitdehaag, B. M. J., Vermeulen, E. G. J., & Castelijns, J. A.
- Affiliations
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Vrije Universiteit Amsterdam (NL)
- Neurology, Inc (US)
- ORCID
- Venue
- Radiology
- Published
- 2002-04
- Volume
- 223
- Issue
- 1
- Pages
- 46-56
- ISSN
- 0033-8419 (ISSN-L)
- 1527-1315
- OpenAlex
- W2092959805
- Cited by
- 168
- References
- 57
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 1 · 2023: 2 · 2022: 5 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 7 · 2017: 5 · 2016: 11 · 2015: 11 · 2014: 10 · 2013: 8 · 2012: 13
- FWCI
- 3.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Radiology (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- multiple sclerosis, spinal cord lesions, differential diagnosis, cerebrovascular disease, gadolinium-enhanced MRI, brain MRI, diagnostic accuracy, spinal cord MRI
- MeSH terms
- Adult, Cerebrovascular Disorders, Diagnosis, Differential, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Myelitis, Sensitivity and Specificity
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