1. Jalal Jalal Shokouhi-MD General secretary of Iranian society of Radiology www.medimage.ir jalaljalalshokouhi@hotmail.com www.medimage.ir jalaljalalshokouhi@hotmail.com

2. Age is the same as brain MS (18-50,95% in 30-40) Female>Male Commonly involved 97% of known cases (50% in C-cord). Shape is focal, confluent or entire cord length. 30%-40% of plaques could be asymptomatic. All level could be involved (50% in C-cord). 2

3. 3

4. 4

5. 5

6. 6

7. 7

8. Lateral and Posterior aspects of the cord adjacent pia. Plaque signal is the same as brain. Mild cord expansion due to swelling and edema. Acute phase shows enhancement by GD (T1,Flair or T1 STIR) 8

9. 9

10. 10

11.  Diffuse lessions are primary, secondary progressive  Focal plaques are relapsing-remitting subtype  Cord atrophy (18%) chronic M.S. Primary lesions Axonal degeneration from distal disease 11

12. 12

13. 13

14. 14

15. 15

16. 1) Routine in M.S. signs 2) Early diagnosis 3) Rule out clinical mimics 4) To predict prognosis(short and long term) 5) To monitor treatment 6) To monitor treatment complications Conventional MRI is for: 16

17.  MRI detection (86%)  Intermediate to T2 weighted (PDW, T2)  T1 correlated better with microscopic (PDW & T2 are not)  T1 Cellular infiltration and edema  T1 finding correlation with clinic is important  T2 shows watery changes  Fast STIR, fast spine T2  T2*, Fat Sat. images  MT: magnetization transfer measurements specially in brain diffuse M.S.  Post processing of MR images 17

18. 18

19. 19

20. 20

21. non-uniform intensity in all images specially by surface coils in C-cord imaging (A bias) Post processing of MR images(TR, TE,Tissue) 1)Uniformity correction 2)Registration for image analysis 3)Image segmentation (sets of pixels) 4)Measurement of lesion volumes 5)Atrophy diagnosis 6)Magnetization transfer (assessing proton of macromolecules) “MTR” (Cell membrane and myelin) Exchanging magnetization between mobile protons and fix ones in macromolecules 21

22. 7) Least-squares fitting and relaxometry or calculated MTR is a quantitative assessment of tissue damage (T1,T2,T2*=R1,R2,R2*) 8) Diffusion tensor imaging (DTI), tractography(EPI)(Echo- planar imaging) DW images (DTI is a 3D DW) 9) Perfusion (abnormal CBF cerebral blood flow in M.S.) 10) 3D anatomo-functional composite image as data handling 22

23. 23

24. 24

25. 25

26. 26

27. 27

28. Thank you for your attention 28