Abstract
Spinal cord imaging in multiple sclerosis (MS) plays a significant role in diagnosing and tracking disease progression. The spinal cord is one of four key areas of the central nervous system where documenting the dissemination in space in the McDonald criteria for diagnosing MS. Spinal cord lesion load and the severity of cord atrophy are believed to be more relevant to disability than white matter lesions in the brain in different phenotypes of MS. Axonal loss contributes to spinal cord atrophy in MS and its degree correlates with disease severity and prognosis. Therefore, measures of axonal loss are often reliable biomarkers for monitoring disease progression. With recent technical advances, more and more qualitative and quantitative MRI techniques have been investigated in an attempt to provide objective and reliable diagnostic and monitoring biomarkers in MS. In this article, we discuss the role of spinal cord imaging in the diagnosis and prognosis of MS and, additionally, we review various techniques that may improve our understanding of the disease.
Highlights
Multiple sclerosis (MS) is a chronic, inflammatory, autoimmune, neurodegenerative disease characterized by a wide range of symptoms
Their study categorized a large cohort of MS patients into four subgroups by low- and high-lesion loads counted on conventional magnetic resonance imaging (MRI) combined with low- and high-disability levels assessed by expanded disability status scale (EDSS) scores
They found that the MTR values measured over the whole cord cross-sectional images at the C3−4 level were significantly lower in the low-lesion high-disability subgroup than those in low-lesion low-disability subjects, while there was no significant difference in the two subgroups with high-lesion loads [50]
Summary
Multiple sclerosis (MS) is a chronic, inflammatory, autoimmune, neurodegenerative disease characterized by a wide range of symptoms. The cross-sectional area (CSA) of the SC typically ranges from 67 to 101 mm at the cervical level in adulthood [4,5,6] These dimensions and the anatomical configuration of the SC make magnetic resonance imaging (MRI) one of the most suitable techniques to image the SC in vivo and it has been widely used for decades in clinical and research settings. MRI metrics have been used over the past two decades in both routine practice and research in diagnosing MS and its progression, there are still several major challenges related to sensitivity, specificity, reproducibility and reliability These technical challenges include: image artifacts caused by respiratory and cardiac motion; swallowing and CSF pulsations; fatty tissue influence; susceptibility artifacts at air/tissue interfaces when a gradient echo-based sequence is used; mobility of the SC; insufficient signal-to-noise ratio (SNR); imaging resolution; and the lack of normative data. We identified more articles from the references of the articles we reviewed
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