correlative role of contrast-enhanced MR in evaluation of myelopathic changes in patients with progressive and clinically-active multiple sclerosis

ABSTRACT

During a period of time extending from January 2003 to May 2004, 16 patients [12 females and 4 Males] of ages ranging from 17-40 years and suffering from multiple sclerosis of the CNS with superadded myelopathic changes were involved in this study. All patients were initially evaluated on neurologic basis to asses the extent of disability according to a variety of functional assessment scores [EDSS and ambulation test of Kertzke] that was followed by an initial pre/ post contrast MR examination of the brain and cervical/dorsal spinal cord using a 1.5 T MR Units where analysis of the obtained images to get a basis datae as regard the morphologic criteria of any detected focal lesions including their site, shape, sizes in mm [to get the total lesion load of the brain and cord at this basis sitting], counts and postcontrast pattern of enhancement, follow-up clinical and MR exarninations were performed for all patients twice [at 3 and 6 months interval] so that a total of 32 follow-up examinations were done in addition to the initial ones to estimate the changes involving the initially detected lesions [according to the same morphologic basis], to detect any newly developing lesions and to asses the diagnostic value of contrast injection in monitoring of the clinically active lesions. In our study a moderate correlation between lesion load and sensory function and EDSS was noted. A majority [70%] of patients with new clinical manifestations had one or two enhancing lesions. Agreement of MR-findings and clinical examination was noted in almost 60% of the follow up examinations MR showed lesion progression in 44% of patients with clinical deterioration and 35% of those with clinical improvement or stability. We have finally concluded that MR imaging is the most accurate diagnostic procedure in monitoring multiple sclerosis lesions of the brain and/or spinal cord even in submanifest stage and in providing an undoubted evidence of lesions activity on both initial and serial scans. So, the procedure is an essential one that should be done documentarily and complementarily hand by hand with clinical assessments