Skip to main content
February 1, 1996

Serial gadolinium-enhanced MRI of the brain and spinal cord in early relapsing-remitting multiple sclerosis

February 1996 issue
46 (2) 373-378


Although serial MRI studies of the brain in relapsing-remitting MS have demonstrated frequent asymptomatic disease activity, less is known about the spinal cord. We carried out monthly gadolinium-enhanced brain and spinal cord MRI scans over 1 year in 10 patients with relapsing-remitting MS. Six of the patients had a total of 11 clinical relapses, eight of which involved the spinal cord. A total of 167 active (enhancing or new nonenhancing) lesions in the brain and 19 in the spinal cord were present. Only one active brain lesion was symptomatic compared with six spinal cord lesions. Overall, one-third of new spinal cord lesions were symptomatic, and three-quarters of clinical spinal cord relapses were associated with a new MRI lesion in a location appropriate to the symptoms. Activity in both the spinal cord and brain was more common around the time of relapse. There was a strong association between the spinal cord and brain MRI activity. We did not detect progressive spinal cord atrophy from measurements of a spinal cord cross-sectional area. We conclude that, in relapsing-remitting MS, imaging of the brain alone will detect 90% of active lesions; spinal cord MRI using current technology will therefore provide only modest gains in treatment trials in which lesion activity is the primary outcome measure. The lack of progressive spinal cord atrophy in these patients, suggesting that significant axonal loss has not occurred, is in keeping with their good recovery after relapse. That brain and spinal cord lesions occur concurrently implies a systemic trigger for disease activity.
NEUROLOGY 1996;46: 373-378.

Get full access to this article

View all available purchase options and get full access to this article.


Isaac C, Li DKB, Genton M, et al. Multiple sclerosis a serial study using MRI in relapsing patients. Neurology 1988;38:1511-1515.
Willoughby EW, Grochowski E, Li DKB, Oger J, Kastrukoff LF, Paty DW. Serial magnetic resonance scanning in patients with multiple sclerosis: a second prospective study in relapsing patients. Ann Neurol 1989;25:43-49.
Truyen L, Gheuhens J, Parizel PM, Van den Vyver FL, Martin JJ. Long term follow-up of MS by standardized, non-contrast-enhanced MRI. J Neurol Sci 1991;106:35-40.
Bastianello JA, Pozzilli C, Bernardi S, et al. Serial study of gadolinium-DTPA MRI enhancement in multiple sclerosis. Neurology 1990;40:591-595.
Harris JO, Frank JA, Patronas NJ, McFarlin DF, McFarland HF. Serial gadolinium-enhanced magnetic resonance imaging scans in patients with early relapsing-remitting multiple sclerosis: implications for clinical trials and natural history. Ann Neurol 1991;29:548-555.
Miller DH, Rudge P, Johnson G, et al. Serial gadolinium enhanced magnetic resonance imaging in multiple sclerosis. Brain 1988;111:927-939.
Thompson AJ, Kermode AG, Wicks D, et al. Major differences in the dynamics of primary and secondary progressive multiple sclerosis. Ann Neurol 1991;29:53-62.
Barkhof F, Scheltens P, Frequin STFM, et al. Relapsing-remitting multiple sclerosis: sequential enhanced MR imaging vs clinical findings in determining disease activity. AJR 1992;159:1041-1047.
Capra R, Marciano N, Vignolo LA, Chiesa A, Gasparotti R. Gadolinium-pentetic acid magnetic resonance imaging in patients with relapsing remitting multiple sclerosis. Arch Neurol 1992;49:687-689.
McFarland HF, Frank JA, Albert PS, et al. Using gadolinium-enhanced magnetic resonance imaging lesions to monitor disease activity in multiple sclerosis. Ann Neurol 1992;32:758-766.
Stone LA, Smith ME, Albert PS, et al. Blood brain barrier disruption as measured by contrast enhanced MRI in patients with mild relapsing remitting multiple sclerosis: relationship to course, gender and age. Neurology 1995;45:1122-1126.
Kappos L, Stadt D, Ratzka M, et al. Magnetic resonance imaging in the evaluation of treatment in multiple sclerosis. Neuroradiology 1988;30:299-302.
Miller DH, Barkhof F, Berry I, Kappos L, Scotti G, Thompson AJ. Magnetic resonance imaging in monitoring the treatment of multiple sclerosis: concerted action guidelines. J Neurol Neurosurg Psychiatry 1991;54:683-688.
Kastrukoff LF, Oger JJF, Hashimoto SA, et al. Systemic lymphoblastoid interferon therapy in chronic progressive multiple sclerosis. I. Clinical and MRI evaluation. Neurology 1990;40:479-486.
Koopmans RA, Li DKB, Zhoa GJ, Redekop WK, Paty DW. MRI assessment of cyclosporine therapy of MS in a multicenter trial [abstract]. Neurology 1992;42(suppl 3):210.
Paty DW, Li DKB, the UBC MS/MRI Study Group, the IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. II. MRI analysis results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology 1993;43:662-667.
Masaryk TJ, Modic MT, Geisenger MA, et al. Cervical myelopathy: a comparison of magnetic resonance and myelography. J Comp Assist Tomogr 1986;10:184-194.
Maravilla KR, Weintreb JC, Suss R, Nunally RL. Magnetic resonance demonstration of multiple sclerosis plaques in the cervical cord. AJR 1985;144:381-385.
Miller DH, McDonald WI, Blumhardt LD, et al. Magnetic resonance imaging in isolated noncompressive spinal cord syndromes. Ann Neurol 1987;22:714-723.
Honig LS, Sheremata WA. Magnetic resonance imaging of spinal cord lesions in multiple sclerosis. J Neurol Neurosurg Psychiatry 1989;52:459-466.
Turano G, Jones SJ, Miller DH, Du Boulay GH, Kakigi R, McDonald WI. Correlation of SEP abnormalities with brain and cervical cord MRI in multiple sclerosis. Brain 1991;114:663-681.
Larsson EM, Holtas S, Nilsson O. Gd-DTPA-enhanced MR in suspected spinal multiple sclerosis. AJNR 1989;10:1071-1076.
Kidd D, Thorpe JW, Thompson AJ, et al. Spinal cord MRI using multi-array coils and fast spin echo. II. Findings in multiple sclerosis. Neurology 1993;43:2632-2637.
Wiebe S, Lee DH, Karlik SJ, et al. Serial cranial and spinal cord magnetic resonance imaging in multiple sclerosis. Ann Neurol 1992;32:643-650.
Kidd D, Thompson AJ, Kendall BE, Miller DH, McDonald WI. A serial MRI study of the brain and spinal cord in progressive multiple sclerosis [abstract]. J Neurol 1994;241(suppl 1):S151.
Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983;13:227-231.
Kurtzke JF. Rating neurological impairment in multiple sclerosis an expanded disability scale. Neurology 1983;33:1444-1452.
Bland JM, Altman DG. Statistic methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307-310.
Miller DH, Barkhof F, Nauta JJP. Gadolinium enhancement increased the sensitivity of MRI in detecting disease activity in multiple sclerosis. Brain 1993;116:1077-1094.
Grossman RI, Gonzales-Scarano F, Atlas SW, Galetta S, Silberberg DH. Multiple sclerosis: gadolinium enhancement in MR imaging. Radiology 1986;161:721-725.
Smith ME, Stone LA, Albert PS, et al. Clinical worsening in multiple sclerosis is associated with increased frequency and area of gadopentetate dimeglumine-enhancing magnetic resonance imaging lesions. Ann Neurol 1993;33:480-489.
Thompson AJ, Miller D, Youl B, et al. Serial gadolinium-enhanced MRI in relapsing/remitting multiple sclerosis of varying disease duration. Neurology 1992;42:60-63.
Matthews PM, Francis G, Antel J, Arnold DL. Proton magnetic resonance spectroscopy for metabolic characterization of plaques in multiple sclerosis. Neurology 1991;41:1251-1226.
Davie CA, Hawkins CP, Barker GJ, et al. Serial proton magnetic resonance spectroscopy in acute multiple sclerosis. Brain 1994;117:49-58.
Dousset V, Grossman RI, Ramer KN, et al. Experimental allergic encephalomyelitis and multiple sclerosis: lesion characterization with magnetization transfer imaging. Radiology 1992;182:483-491.
Gass A, Barker GJ, Kidd D, et al. Correlation of magnetization transfer ratio with clinical disability in multiple sclerosis. Ann Neurol 1994;36:62-67.

Information & Authors


Published In

Volume 46Number 2February 1996
Pages: 373-378

Publication History

Published online: February 1, 1996
Published in print: February 1996


Request permissions for this article.


Affiliations & Disclosures

From the NMR Research Unit, Institute of Neurology, Queen Square, London, England.
The work of the NMR Research Group is made possible by a generous grant from the Multiple Sclerosis Society of Great Britain and Northern Ireland. JT is funded by the Medical Research Council. The spinal multi-array coil was kindly provided by GE Medical Systems.
Received November 22, 1994. Accepted in final form June 15, 1995.
Address correspondence to Dr Miller, NMR Research Unit, Institute of Neurology, Queen Square, London WCIN 3BG, England.

Metrics & Citations



Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis, Neurology, 53, 3, (448-448), (2023)./doi/10.1212/WNL.53.3.448
  2. Spinal cord atrophy and disability in MS, Neurology, 51, 1, (234-238), (2023)./doi/10.1212/WNL.51.1.234
  3. Asymptomatic myelitis in neuromyelitis optica and autoimmune aquaporin-4 channelopathy, Neurology Clinical Practice, 5, 2, (175-177), (2023)./doi/10.1212/CPJ.0000000000000104
  4. CSF nitric oxide metabolites are associated with activity and progression of multiple sclerosis, Neurology, 63, 8, (1439-1445), (2023)./doi/10.1212/01.WNL.0000142043.32578.5D
  5. The added value of spinal cord lesions to disability accrual in multiple sclerosis, Journal of Neurology, (2023).
  6. How patients with multiple sclerosis acquire disability, Brain, 145, 9, (3147-3161), (2022).
  7. NFL during acute spinal cord lesions in MS: a hurdle for the detection of inflammatory activity, Journal of Neurology, 269, 7, (3495-3500), (2022).
  8. Recurrence and Prognostic Value of Asymptomatic Spinal Cord Lesions in Multiple Sclerosis, Journal of Clinical Medicine, 10, 3, (463), (2021).
  9. Differentiation between Spinal Intramedullary Astrocytoma and Spinal Multiple Sclerosis Using Clinical and Radiologic Factors, The Nerve, 7, 2, (83-88), (2021).
  10. Diagnostic value of gadolinium contrast administration for spinal cord magnetic resonance imaging in multiple sclerosis patients and correlative markers of lesion enhancement, Multiple Sclerosis Journal - Experimental, Translational and Clinical, 7, 4, (205521732110479), (2021).
  11. See more

View Options

Get Access

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

Purchase this article to get full access to it.

Purchase Access, $39 for 24hr of access

View options

Full Text

View Full Text

Full Text HTML

View Full Text HTML







Share article link