The Assessment Of Spinal Cord For Patients With Multiple Sclerosis Using Magnetic Resonance Imaging: A Systematic Review

Abstract

Background:  Magnetic resonance imaging of the spinal cord is important in multiple sclerosis diagnosis and management, providing information on detection of lesions, progression of the disease and clinical disability. This systematic review   aimed to assess the MRI diagnostic performance in identification of spinal cord lesions in patients with MS.

Methodology: The current systematic was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Cochrane Library, and Google Scholar databases were accessed. Based on a rigorous screening process, studies that met the inclusion criteria were selected for data extraction and assessed for potential risk of bias. We reviewed studies examining CSA measurement techniques, particularly using magnetic resonance imaging (MRI), and their ability to track spinal cord atrophy in MS. Key outcome measures included reproducibility and reliability, image quality (signal-to-noise ratio and contrast-to-noise ratio), and comparative CSA analysis between MS patients at different disease stages and healthy controls.

Results: A 98 studies were identified from the database search. After screening, 7 studies met the inclusion criteria and were included in the systematic review. CSA measurements are reproducible and reliable when high-quality imaging protocols, such as Active Surface Model (ASM) combined with Phase-Sensitive Inversion Recovery (PSIR), are used. High-field MRI (3T) improves image quality, significantly enhancing lesion detection and CSA measurement accuracy. CSA reductions were most pronounced in secondary progressive MS (SPMS) and primary progressive MS (PPMS) patients, with strong correlations to clinical disability measures (EDSS). CSA was consistently smaller in MS patients compared to healthy controls, particularly in progressive MS forms, highlighting its potential as a biomarker for disease progression.

Conclusion: CSA is a valuable and reliable biomarker for spinal cord atrophy in MS, particularly in progressive forms of the disease. The use of high-field MRI and multi-parametric imaging techniques can enhance CSA measurement accuracy and improve disease monitoring.