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Spinal cord abnormalities in recently diagnosed MS patients: added value of spinal MRI examination.

Abstract

OBJECTIVE

The most recent diagnostic criteria for multiple sclerosis (MS) ascertain that findings from spinal cord MRI can be used to demonstrate dissemination in space. Because little is known about the prevalence and characteristics of cord lesions early in the disease, the authors studied the prevalence of spinal cord abnormalities in patients with early-stage MS and assessed their impact on diagnostic classification.

METHODS

The brains and spinal cords of 104 recently diagnosed patients with MS were examined. Median interval between first symptom and diagnosis was 18.4 months. The brain MRI protocol included before and after gadolinium axial T1-weighted conventional spin-echo sequences and dual-echo spin-echo images. For spinal cord MRI, sagittal cardiac-triggered dual-echo T2-weighted and sagittal T1-weighted spin-echo images were included. Clinical assessment for each patient included age, sex, clinical signs for spinal cord involvement, and Expanded Disability Status Scale.

RESULTS

Abnormal cord MRIs were found in 83% of patients, usually with only focal lesions. Diffuse cord abnormalities were found in 13% of patients, although in isolation they were found in only three patients. Focal cord lesions were often multiple (median number, 3.0), small (median, 0.8 vertebral segments), and primarily (56.4%) situated in the cervical spinal cord. In 68 of 104 patients (65.4%), two or more focal lesions were visible on spinal cord images. The criteria for dissemination in space, as defined in the McDonald criteria for the brain, were met in only 66.3% of the patients. This percentage increased to 84.6% when spinal cord MRI abnormalities were also included.

CONCLUSION

Spinal cord abnormalities are prevalent in patients with early-stage MS, have distinct morphologic characteristics, and help to determine dissemination in space at time of diagnosis.

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  • Authors+Show Affiliations

    ,

    MR Center for MS Research, Departments of Radiology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands. J.Bot@VUMC.nl

    , , , , , ,

    Source

    Neurology 62:2 2004 Jan 27 pg 226-33

    MeSH

    Adult
    Brain
    Contrast Media
    Female
    Gadolinium
    Humans
    Magnetic Resonance Imaging
    Male
    Middle Aged
    Multiple Sclerosis
    Organ Specificity
    Spinal Cord

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    14745058

    Citation

    Bot, J C J., et al. "Spinal Cord Abnormalities in Recently Diagnosed MS Patients: Added Value of Spinal MRI Examination." Neurology, vol. 62, no. 2, 2004, pp. 226-33.
    Bot JC, Barkhof F, Polman CH, et al. Spinal cord abnormalities in recently diagnosed MS patients: added value of spinal MRI examination. Neurology. 2004;62(2):226-33.
    Bot, J. C., Barkhof, F., Polman, C. H., Lycklama à Nijeholt, G. J., de Groot, V., Bergers, E., ... Castelijns, J. A. (2004). Spinal cord abnormalities in recently diagnosed MS patients: added value of spinal MRI examination. Neurology, 62(2), pp. 226-33.
    Bot JC, et al. Spinal Cord Abnormalities in Recently Diagnosed MS Patients: Added Value of Spinal MRI Examination. Neurology. 2004 Jan 27;62(2):226-33. PubMed PMID: 14745058.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Spinal cord abnormalities in recently diagnosed MS patients: added value of spinal MRI examination. AU - Bot,J C J, AU - Barkhof,F, AU - Polman,C H, AU - Lycklama à Nijeholt,G J, AU - de Groot,V, AU - Bergers,E, AU - Ader,H J, AU - Castelijns,J A, PY - 2004/1/28/pubmed PY - 2005/1/15/medline PY - 2004/1/28/entrez SP - 226 EP - 33 JF - Neurology JO - Neurology VL - 62 IS - 2 N2 - OBJECTIVE: The most recent diagnostic criteria for multiple sclerosis (MS) ascertain that findings from spinal cord MRI can be used to demonstrate dissemination in space. Because little is known about the prevalence and characteristics of cord lesions early in the disease, the authors studied the prevalence of spinal cord abnormalities in patients with early-stage MS and assessed their impact on diagnostic classification. METHODS: The brains and spinal cords of 104 recently diagnosed patients with MS were examined. Median interval between first symptom and diagnosis was 18.4 months. The brain MRI protocol included before and after gadolinium axial T1-weighted conventional spin-echo sequences and dual-echo spin-echo images. For spinal cord MRI, sagittal cardiac-triggered dual-echo T2-weighted and sagittal T1-weighted spin-echo images were included. Clinical assessment for each patient included age, sex, clinical signs for spinal cord involvement, and Expanded Disability Status Scale. RESULTS: Abnormal cord MRIs were found in 83% of patients, usually with only focal lesions. Diffuse cord abnormalities were found in 13% of patients, although in isolation they were found in only three patients. Focal cord lesions were often multiple (median number, 3.0), small (median, 0.8 vertebral segments), and primarily (56.4%) situated in the cervical spinal cord. In 68 of 104 patients (65.4%), two or more focal lesions were visible on spinal cord images. The criteria for dissemination in space, as defined in the McDonald criteria for the brain, were met in only 66.3% of the patients. This percentage increased to 84.6% when spinal cord MRI abnormalities were also included. CONCLUSION: Spinal cord abnormalities are prevalent in patients with early-stage MS, have distinct morphologic characteristics, and help to determine dissemination in space at time of diagnosis. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/14745058/full_citation L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=14745058 DB - PRIME DP - Unbound Medicine ER -