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Spinal Cord in Multiple Sclerosis: MR Imaging Features and Differential Diagnosis
Alex Rovira, Cristina Auger
Seminars in Ultrasound, CT and MRI, Available online 6 May 2016
Multiple sclerosis (MS) is a progressive inflammatory, demyelinating, and neurodegenerative autoimmune disease of the central nervous system (CNS) characterized pathologically by perivascular infiltrates of mononuclear inflammatory cells, demyelination, axonal loss, and gliosis with formation of focal and diffuse abnormalities. The optic nerves, brainstem, spinal cord, and cerebellar and periventricular white matter regions are most commonly affected, although cortical and subcortical gray matter damage is also prominent. MS leads to chronic progressive disability in most individuals with this condition.
MS affects more than 2.5 million people worldwide. The onset usually occurs between the age of 20 and 40 years, and women are affected 3-fold more often than men. MS is the leading cause of nontraumatic disability in young adults at the peak of their productive life, involved in building their career, social status, and family. As a consequence, it is associated with a tremendous loss of health-related quality of life, work productivity, and employment, not only of the patients but also of their caregivers.
The high sensitivity of magnetic resonance imaging (MRI) in depicting brain and spinal cord demyelinating plaques has made this technique the most important paraclinical tool in current use for diagnosing MS, understanding the natural history of the disease, and monitoring and predicting the efficacy of disease-modifying treatments. Spinal cord MRI is not performed as commonly as brain MRI in MS, mainly because of certain technical difficulties and the increase in total acquisition time, but the spinal cord findings can be of value for establishing an early and accurate diagnosis of the disease, imparting prognostic information, and in some cases, providing valuable data for monitoring treatment response.