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Differentiation of Multiple Sclerosis from Other Inflammatory Disorders and Cerebrovascular Disease: Value of Spinal MR Imaging¹

¹ From the Department of Radiology, MR Center for MS Research (J.C.J.B., F.B., G.L.N., J.A.C.), Rheumatology (D.v.S., A.E.V.), Biostatistics and Epidemiology (H.J.A.), Neurology (J.A.L.P., C.H.P., B.M.J.U.), and Vascular Surgery (E.G.J.V.), Vrije Universiteit (VU) Medical Centre, PO Box 7057, 1007 MB Amsterdam, the Netherlands. Received April 2, 2001; revision requested May 7; final revision received September 26; accepted October 9. Supported by Dutch MS society grant 97-307 from Sichting Vrienden MS Research. Address correspondence to J.C.J.B. (e-mail: J.Bot@VUMC.nl).

PURPOSE: To determine the value of magnetic resonance (MR) imaging in the spinal cord to differentiate multiple sclerosis (MS) from other inflammatory disorders and cerebrovascular diseases (together, other neurologic disease [OND]).

MATERIALS AND METHODS: The study population included 66 patients with OND and 25 patients with MS, who were matched for age, sex, and symptom duration or severity. Brain MR imaging included gadolinium–enhanced T1-weighted and dual-echo T2-weighted spin-echo sequences to assess the number, size, and appearance of lesions, contrast enhancement, and compatibility with diagnostic criteria for MS. Spinal cord MR imaging included cardiac-triggered gadolinium-enhanced sagittal T1-weighted spin-echo and dual-echo T2-weighted sequences to assess the general appearance (normal, focal lesion, diffuse abnormality) and number or size of focal lesions. Images obtained in MS and OND patients were compared. Specificity, sensitivity, accuracy, and positive and negative predictive values with MR images were calculated.

RESULTS: Brain images were abnormal in all MS patients and in 65% of OND patients. Abnormal cord images were found in 92% of MS and 6% of OND patients. The combination of brain and spinal cord images increased accuracy of diagnosis compared with use of brain images alone.

CONCLUSION: In contrast to MS, cord lesions are very uncommon in OND. This finding can help differentiate these disorders.

© RSNA, 2002

Index terms: Brain, MR, 10.1214 • Connective tissue, diseases, 10.61, 30.61 • Lupus erythematosus, 10.612, 30.612 • Nervous system, diseases, 10.871 • Sarcoidosis, 10.22, 30.22 • Sclerosis, multiple, 10.871, 30.871 • Sjögren syndrome, 10.695, 30.695 • Spinal cord, MR, 31.1214, 32.1214

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