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The following is a summary of “Limited added value of systematic spinal cord MRI vs brain MRI alone to classify patients with MS as active or inactive during follow-up,” published in the April 2025 issue of Journal of Neurology by Hong et al. 

The role of spinal cord (SC) MRI in tracking multiple sclerosis (MS) activity after diagnosis is unclear. Its added value over brain MRI alone is still debated. 

Researchers conducted a retrospective study to compare disease activity detection using brain MRI alone versus combined brain and spinal cord MRI.  

They analyzed 221 intervals from 68 patients in the EMISEP cohort over 5 years. Each interval included brain MRI (3D FLAIR, axial T2, axial PD) and SC MRI (sagittal T2, PSIR, axial T2*w, 3D T1) at 2 time points to detect new lesions and classify intervals as symptomatic or asymptomatic. 

The results showed SC MRI activity without clinical relapse or brain MRI activity was rare (4/221 intervals, 2%). New SC lesions were linked to baseline brain lesion count (OR = 1.002 [1.000; 1.0004], P = 0.015) and new brain lesions (OR = 1.170 [1.041; 1.314], P = 0.009), but not baseline SC lesions (P = 0.6). 

Investigators supported current guidelines recommending routine monitoring with brain MRI alone, even in patients with high SC lesion load. 

Source: link.springer.com/article/10.1007/s00415-025-13068-2