The contribution of additional sequences to diagnose in the evaluation of MS patients with cervical cord lesions

OBJECTIVE: Multiple sclerosis (MS) is a neurodegenerative disease with progressive myelopathy which is characterized by multifactorial, multiple, inflammatory demyelinating plaques in the central nervous system (CNS). Pathogenesis of MS is unknown. Spinal cord involvement is observed in 55- 75% of MS patients. Cervical spinal cord involvement is observed in 67% of patients with spinal cord involvement. In the evaluation of spinal cord lesions, routine magnetic resonance imaging (MRI) protocol is used for sagittal T2W, axial T2W, sagittal TIRM, sagittal T1W, and in some patients with contrast-enhanced fat-suppressed T1W sequences. In some patients, due to technical reasons, CSF movement within the spinal canal and artifacts due to environmental vascular structures, sequences taken in the routine protocol may be inadequate. In such cases, in addition to routine sequences, sagittal PSIR, sagittal PD + T2W, axial TIRM sequences may be added. The aim of this study was to determine the superiorities and shortcomings of the additional sequences in detection of cervical MS plaques and to determine their contribution to the diagnosis. MATERIALS AND METHODS: Between 01.06.2016 and 26.09.2018, sagittal PSIR, sagittal PD + T2W, axial TIRM sequences taken in addition to the routine sequences used in the diagnosis of cervical MS were retrospectively investigated. Totally 48 patients and 111 lesions were evaluated. Sagittal images were compared with sagittal TIRM sequence and axial images were compared with axial T2W sequence. The visibility, localization, number, size, border sharpness, intensity and intensity ratio of each lesions were evaluated. RESULTS: According to the results of statistical analysis, the sequences with the highest visibility were sagittal PSIR, sagittal TIRM and axial TIRM sequences. There were invisible lesions in the PD + T2W sequence and in the axial T2W sequence. In the evaluation of the lesion size, the lesions were larger in the sagittal and axial TIRM sequences than in the other sequences. Border sharpness was highest in the axial TIRM sequence and lowest in the PD + T2W sequence. In terms of density ratios, it was determined that the most significant contrast difference was observed in the sagittal PSIR sequence. CONCLUSIONS: Based on these results, very successful results can be achieved with sagittal TIRM and axial TIRM sequences in visibility, border sharpness and size measurement. To our opinion, in the evaluation of cervical MS, the sagittal and axial TIRM sequences should be added to the images. We also found that the sagittal PSIR sequence with intensity ratios and visibility results were very good. For this reason, we think that it will contribute to the diagnosis especially in detecting lesions that are difficult to distinguish from the surrounding tissues.