Spinal Cord Imaging in Clinically Isolated Syndrome

Spinal cord imaging is typically routine in demyelinating syndromes when symptoms and signs indicate spinal cord disease. However, spinal cord imaging is less frequently included for clinically isolated syndromes (CIS) of the cerebrum, optic nerve, or brainstem and cerebellum. To determine the impact of cord imaging on diagnosis of multiple sclerosis (MS), investigators recruited 121 patients with monofocal CIS (63 referable to the spinal cord, 58 with nonspinal presentations), at least 24 months of follow-up, and both brain and spinal cord magnetic resonance imaging (MRI) at baseline. Spine imaging included sagittal T2-weighted and proton-density sequences of the entire cord. At baseline, 82 patients (67.8%) had focal lesions in the spinal cord; 31 of these patients had a nonspinal CIS. Mean follow-up was 5 years (range, 2–10 years).

At initial presentation, 36 patients fulfilled 2010 McDonald criteria for MS (JW Neurol Jan 25 2011). Six additional patients with nonspinal presentations would meet McDonald criteria if spinal cord imaging were included. The odds ratio for conversion from CIS to clinically definite MS (CDMS) was 3.53 for patients with versus those without baseline spinal cord lesions, and the time to conversion was significantly shorter for those with spinal cord lesions. In the nonspinal presentation subgroup, the odds ratio for CDMS conversion was 6.48 with versus without spinal cord lesions.