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Cervical MRI Rating Scale: Innovative Approach to Differentiate between Demyelinating and Disc Lesions

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Abstract

Purpose

The difficult differentiation between multiple sclerosis (MS) lesions and cervical spondylotic myelopathy (CSM) in the cervical spine is well known. The magnetic resonance imaging (MRI) appearance of both lesions is similar, and clinical parameters are usually used for diagnosis. The objective was to establish a reliable radiologic paradigm for diagnosis of demyelinating lesions in the cervical spine.

Methods

The MRI studies of 33 patients with MS (42 lesions) and 55 patients with CSM (60 lesions) were obtained. Lesions were evaluated for vertebral level, lesion location and size in the sagittal and axial planes, cord thickness, well-defined or ill-defined borders, presence of edema and enhancement with gadolinium. Significant differences were used to create a paradigm, which was used for the evaluation of a different group of 32 MRIs with 42 concomitant MS and CSM lesions.

Results

Significant differences were seen in the level, location within the cord in both planes, lesion size, cord thickness and lesion border. The MS lesions were well-defined lesions found in C1–3, posterior in the sagittal plane, central in the axial plane, with a normal or increased cord thickness. Good agreement was seen in the validation stage.

Conclusion

The new CSM-MS lesion score allows accurate diagnosis of demyelinating lesions in the cervical spine vs. CSM lesions.

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References

  1. Chong AL, Chandra RV, Chuah KC, Roberts EL, Stuckey SL. Proton Density MRI Increases Detection of Cervical Spinal Cord Multiple Sclerosis Lesions Compared with T2-Weighted Fast Spin-Echo. AJNR Am J Neuroradiol. 2016;37:180-4.

    Article  CAS  PubMed  Google Scholar 

  2. Dula AN, Pawate S, Dortch RD, Barry RL, George-Durrett KM, Lyttle BD, Dethrage LM, Gore JC, Smith SA. Magnetic resonance imaging of the cervical spinal cord in multiple sclerosis at 7T. Mult Scler. 2016;22:320–8.

    Article  CAS  Google Scholar 

  3. Hittmair K, Mallek R, Prayer D, Schindler EG, Kollegger H. Spinal cord lesions in patients with multiple sclerosis: comparison of MR pulse sequences. AJNR Am J Neuroradiol. 1996;17:1555–65.

    CAS  PubMed  Google Scholar 

  4. Ronthal M. On the coincidence of cervical spondylosis and multiple sclerosis. Clin Neurol Neurosurg. 2006;108:275–7.

    Article  Google Scholar 

  5. Bashir K, Hadley MN, Whitaker JN. Surgery for spinal cord compression in multiple sclerosis. Curr Opin Neurol. 2001;14:765–9.

    Article  CAS  Google Scholar 

  6. Bashir K, Cai CY, Moore TA 2nd, Whitaker JN, Hadley MN. Surgery for cervical spinal cord compression in patients with multiple sclerosis. Neurosurgery. 2000;47:637–42; discussion 642–3.

    CAS  PubMed  Google Scholar 

  7. Tan LA, Kasliwal MK, Muth CC, Stefoski D, Traynelis VC. Is cervical decompression beneficial in patients with coexistent cervical stenosis and multiple sclerosis? J Clin Neurosci. 2014;21:2189–93.

    Article  Google Scholar 

  8. Lubelski D, Alvin MD, Silverstein M, Senol N, Abdullah KG, Benzel EC, Mroz TE. Quality of life outcomes following surgery for patients with coexistent cervical stenosis and multiple sclerosis. Eur Spine J. 2014;23:1699–704.

    Article  Google Scholar 

  9. Lubelski D, Abdullah KG, Alvin MD, Wang TY, Nowacki AS, Steinmetz MP, Ransohoff RM, Benzel EC, Mroz TE.Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis: a cohort-controlled analysis. Spine J. 2014;14:331–7.

    Article  Google Scholar 

  10. Harrop JS, Naroji S, Maltenfort M, Anderson DG, Albert T, Ratliff JK, Ponnappan RK, Rihn JA, Smith HE, Hilibrand A, Sharan AD, Vaccaro A. Cervical myelopathy: a clinical and radiographic evaluation and correlation to cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2010;35:620–4.

    Article  Google Scholar 

  11. Kim HJ, Tetreault LA, Massicotte EM, Arnold PM, Skelly AC, Brodt ED, Riew KD. Differential diagnosis for cervical spondylotic myelopathy: literature review. Spine (Phila Pa 1976). 2013;38(22 Suppl 1):S78–88.

    Article  Google Scholar 

  12. Brain R, Wilkinson M. The association of cervical spondylosis and disseminated sclerosis. Brain. 1957;80:456–78.

    Article  CAS  Google Scholar 

  13. Lebl DR, Bono CM. Update on the diagnosis and management of cervical spondylotic myelopathy. J Am Acad Orthop Surg. 2015;23:648–60.

    Article  Google Scholar 

  14. Fehlings MG, Tetreault LA, Wilson JR, Skelly AC. Cervical spondylotic myelopathy: current state of the art and future directions. Spine (Phila Pa 1976). 2013;38(22 Suppl 1):S1–8.

    Article  Google Scholar 

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Acknowledgements

The authors thank Ms. Yael Nissan for figure preparation.

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Authors and Affiliations

  1. Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel

    Uri Givon & Anat Achiron

  2. Imaging Division, Sheba Medical Center, Tel Hashomer, Israel

    Chen Hoffman

  3. Orthopedic Division, Sheba Medical Center, Tel Hashomer, Israel

    Alon Friedlander

  4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Uri Givon, Chen Hoffman, Alon Friedlander & Anat Achiron

Authors
  1. Uri Givon
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  2. Chen Hoffman
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  3. Alon Friedlander
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  4. Anat Achiron
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Corresponding author

Correspondence to Uri Givon.

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Conflict of interest

U. Givon, C. Hoffman, A. Friedlander and A. Achiron declare that they have no competing interests.

Additional information

U. Givon and C. Hoffman contributed equally to the research.

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Givon, U., Hoffman, C., Friedlander, A. et al. Cervical MRI Rating Scale: Innovative Approach to Differentiate between Demyelinating and Disc Lesions. Clin Neuroradiol 29, 639–644 (2019). https://doi.org/10.1007/s00062-018-0721-1

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  • DOI: https://doi.org/10.1007/s00062-018-0721-1

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