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Cranial magnetic resonance imaging in the evaluation of myelopathy of undetermined etiology

Departments of Neurology (Drs. Miska and McQuillen) and Neuroradiology (Dr. Pojunas), Medical College of Wisconsin, Milwaukee, WI.

The spinal form of MS is a clinical conundrum, the solution of which may yield many answers; to be certain that it is MS and not another disease causing the myelopathy is often diffcult. We evaluated 20 patiente with myelopathy of undetermined etiology (clinical findings limited to the spinal cord) using T₂-weighted cranial magnetic resonance imaging (T₂ MRI) and cranial computerized tomography (CT). Some patients were also studied with flash visual evoked responses (FVER) and spinal fluid analysis for myelin basic protein (MBP) and oligoclonal banding (OCB). Thirteen patients had T₂ MRIs consistent with demyelinating disease (two or more areas of increased signal intensity, of appropriate size, in periventricular/subcortical white matter), while only one CT showed focal lesions. FVER were abnormal in 8 of 15 patients tested; spinal fluid OCB was present in 12 of 16 patients tested, only 1 of whom had elevated MBP. T₂ MRI showed lesions typical of demyelination in the majority of study patients, was much more sensitive than CT, and was well correlated with evidence of demyelination by other tests. Although the specificity of T₂ MRI in MS is unknown, it may be very high in this clinical setting.

Address correspondence and reprint requests to Dr. Miska, Department of Neurology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Mil-waukee, WI 53226.

Received February 24, 1986. Accepted for publication in final form August 19, 1986.

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