[Multiple sclerosis and new imaging methods]

BACKGROUND OF PROBLEM: The recognition of the power of MRI and CT to show the involvement of the central nervous system in multiple sclerosis, as well as in other neuropathological phenomena, stimulate considerably their use in the assessment of diagnosis. Much experience gained during the development and clinical application of imaging on the basis of magnetic resonance (MRI) justify the use of this method also in verification of the diagnosis of multiple sclerosis. The development and clinical application of specific pulse sequences and unconventional techniques as e.g. "magnetisation transfer imaging", and other new methods with greater resolution are used in applied research. Routine clinical examinations of the brain and spinal cord are performed especially by use of "dual echo spin images". Flair sequences are not always more significantly sensitive, however, they can provide surprisingly remarkable facts. SUBJECTIVES: The aim of this study is to support the firm or tentative clinical diagnosis of multiple sclerosis.

131 patients with multiple sclerosis were hospitalized at our clinic and examined by use of computerised tomography (CT) and magnetic resonance (MRI). The results of these examinations confirmed firmly the diagnosis of multiple sclerosis in 98 patients. The tentative diagnosis assessed in 33 patients was not supported by MRI. The findings gained by brain examination were evaluated according to the conditions assessed by Fazekasz and American Multiple Sclerosis Association. Examinations were performed by Signa Contour 0.5 Tesla magnetic resonance on transverse planes, and on sagital planes in T1 VO and T2 VO.

During the initial period (1995-1996), CT examination of the brain was performed in 16 patients with firm diagnosis of multiple sclerosis, out of whom only 24% had the pathological periventricular finding within the white matter. Therefore, a majority of patients were subdued to MRI. In these patients, the characteristic finding of hyperintensive lesions were found within T2 VO. They were situated within periventricular white matter as well as in cerebellum, and in 24 patients they were located within the cervical part of the spinal cord. The patients forming the latter group had severe neurologic findings, and ranged 4-9 of the Kurtzke scale. MRI enabled to assess the diagnosis of multiple sclerosis in all patients. Out of the group of 33 patients, only 2 were subdued to CT of the brain. Their findings did not yield any changes in shape of brain tissue structures. MRI findings in these patients did not verify the diagnosis of multiple sclerosis sufficiently. The neurological findings were not pronounced, achieving the 1-3 degree of Kurtzke scale.

Current techniques of CNS imaging, either by use of computerised tomography of MRI do not enable the assessment of the firm diagnosis of multiple sclerosis to full extent. MRI is capable only of supporting it. (Ref. 7.)