NEW YORK (Reuters Health) Jun 04 - Dutch investigators have confirmed that diffuse spinal cord changes detected by magnetic resonance imaging (MRI) are associated with genuine pathology in patients with multiple sclerosis (MS).
In the May issue of the Annals of Neurology, Dr. Elisabeth Bergers, of Vrije Universiteit in Amsterdam, and colleagues note that correlations between clinical features and focal spinal cord lesions "have shown promising results." For a full understanding of diffuse abnormalities, they write, postmortem confirmation is required.
In the current study, they compared post-mortem in situ proton density/T2-weighted MRIs with targeted high-resolution in vitro axial MRI and histopathology of spinal cords from seven subjects with MS. The disease had been diagnosed 14 to 42 years prior to death. The researchers point out that in situ MRI is not confounded by flow and movement artifacts that are present in images from living subjects.
In situ scans revealed one subject with a spinal cord that was normal except for a single lesion in the medulla oblongata. Two had multiple focal lesions but not diffuse signal changes; one had only diffuse abnormalities, and three had combined focal and diffuse abnormalities.
Diffuse abnormalities seen on in situ MRI were associated with increased signal intensity on the axial high-resolution MRI and with histopathological demyelination. Dr. Bergers and her associates attribute the diffuse abnormalities to primary presentation in the spinal cord rather than being secondary to brain lesions.
However, "in situ sagittal MRI underestimates the number and extensiveness of spinal cord lesions and underlying focal components of diffuse abnormalities," investigators found.
They conclude that in vivo MRI lacks a sufficient signal-to-noise ratio or contrast resolution (or both) to correctly document these spinal cord abnormalities.
Ann Neurol 2002;51:652-656.
© 2002 Reuters Ltd