Spinal Cord Imaging Techniques in Multiple Sclerosis

Spinal cord involvement in multiple sclerosis (MS) is a key determinant of long-term disability, driving motor, sensory and autonomic dysfunction. Conventional magnetic resonance imaging (MRI) sequences, including T1-weighted, T2-weighted and short tau inversion recovery (STIR), remain the clinical mainstay for lesion detection. However, standard protocols often lack sensitivity for small or longitudinal changes. Recent advances encompass high-field systems, quantitative mapping and automated image analysis. Quantitative magnetisation transfer, diffusion tensor imaging and myelin water fraction techniques afford microstructural insights into demyelination, axonal injury and remyelination. Automated segmentation pipelines now permit reliable measurement of cross-sectional area and grey versus white matter compartments, enabling robust atrophy assessments. Synthetic image generation, derived from multiparametric maps, shortens scan times while preserving morphometric accuracy. Ultra-high-field MRI and novel post-processing algorithms further improve lesion conspicuity, volumetric precision and topographical mapping of inflammatory activity. These developments facilitate enhanced monitoring of disease progression, refined risk stratification and more sensitive outcome measures for clinical trials, underscoring the global significance of spinal cord imaging as both a diagnostic and prognostic tool in MS care.

Research from Nature Portfolio

A foundational report introduced a fully automated framework for simultaneous segmentation of cervical grey and white matter. By integrating two atlas-based fusion algorithms, the method achieved segmentation accuracy equivalent to expert raters, with cross-sectional area measures at the C2/C3 level showing high agreement. Grey matter delineation reached a Dice similarity coefficient above 0.82 in both healthy controls and early MS, demonstrating the feasibility of large-scale, observer-independent studies of spinal cord atrophy. This approach has laid the groundwork for fully automated pipelines in multicentre trials and routine clinical practice.

Spinal Cord Imaging Techniques in Multiple Sclerosis publication trend

The graph below shows the total number of articles in spinal cord imaging techniques in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Demyelination: Loss of the myelin sheath insulating nerve fibres, leading to impaired signal conduction.

Cross-sectional area (CSA): The planar area of the spinal cord at a given vertebral level, used to quantify atrophy.

Magnetisation Prepared Rapid Acquisition Gradient Echo (MPRAGE): A T1-weighted MRI sequence commonly employed for high-resolution anatomical imaging.

Multiparametric mapping (MPM): A quantitative MRI approach that generates maps of proton density and relaxation rates for tissue characterisation.

Synthetic T1-weighted MRI: An image reconstructed from quantitative maps to mimic conventional T1 contrast while reducing scan time.

Segmentation: The computational delineation of anatomical structures (e.g. grey and white matter) within MRI data.

Spinal cord atrophy: Reduction in cord volume or CSA over time, indicative of neuroaxonal loss.

References

1. The prevalence and topography of spinal cord demyelination in multiple sclerosis: a retrospective study. Acta Neuropathologica (2024).
2. Reliability of spinal cord measures based on synthetic T1-weighted MRI derived from multiparametric mapping (MPM). NeuroImage (2023).
3. The added value of spinal cord lesions to disability accrual in multiple sclerosis. Journal of Neurology (2023).
4. Fully automated grey and white matter spinal cord segmentation. Scientific Reports (2016).