Multiple sclerosis (cervical spinal cord)

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Clinical History: 
A 28 year old woman

Diagnosis:
Multiple sclerosis (cervical spinal cord)

MR Technique: 
Sagittal 2D FSE STIR and post-contrast T1-weighted images of the cervical cord are presented. Sequence specific parameters were TR/TE/TI = 4000/31/160 and 608/8.5, with scan times of 4:13 and 3:13. The slice thickness was 3 mm, which is important for visualization of spinal cord lesions (that the thickness not be greater). For the sagittal FLAIR exam, this was performed using 2D technique with TR/TE/TI = 9000/121/2500, a slice thickness of 4 mm and a scan time of 3:36. The exams were performed at 1.5 T on a Siemens Avanto MR system.

Imaging Findings:
At the C6-7 level, there is a large lesion posteriorly within the cord, best seen on the T2-weighted scan (on which it is hyperintense), with subtle abnormal contrast enhancement. This lesion was interval and not seen on the previous exam (performed three years prior, image not illustrated). Multiple additional small cord lesions were seen on the current exam (but not illustrated for the purposes of this case presentation), all hyperintense on T2 weighted images, with many demonstrating abnormal contrast enhancement. Little residual was seen regarding several previously identified cord lesions. In multiple sclerosis (MS), by definition lesions are separated in space and time. Observations on the presented cervical spine MR exam, when combined with the previous exam, confirm this diagnosis. Due predominantly to receiver coil design and intrinsic anatomy, brain lesions in MS are easiest to identify, followed by those in the cervical cord (with the poorest imaged area being the thoracic spine). Thus a complete exam for MS includes a brain, cervical spine, and thoracic spine MR (the latter to include the conus), both prior to and following IV contrast administration (performed to identify lesion activity). If a cord lesion is identified that is suspicious for MS, and a brain MR has not been performed, then the brain MR exam should be performed. In this instance, a single sagittal FLAIR image from the brain MR performed at the same time as the cervical spine identifies multiple hyperintense periventricular lesions, with several callosal lesions also identified (with a flat ependymal border) – all characteristic for MS.