Imaging of the spine in multiple sclerosis.

The spinal cord is a common site of involvement in multiple sclerosis (MS), and a major cause of the disability suffered by MS patients. High quality MR imaging of the spinal cord is therefore important for diagnosis and research. Imaging of the spine, however, presents many technical difficulties because of the small size of the spinal cord and the potential for artifacts. This article discusses technical difficulties such as pulse sequences, the use of newer imaging techniques, and the application of spinal MR imaging in clinical settings. Major studies are underway involving spinal cord imaging, and clinical trials of disease-modifying agents are beginning to include spinal cord imaging, especially measurements of atrophy, as part of their protocols. In clinical practice, spinal cord imaging is essential for ruling out other causes of myelopathies, particularly spinal cord compression, and can help in the diagnosis of MS when brain imaging is normal, or in older individuals in whom findings in the brain are less specific.