Cervical MRI Rating Scale: Innovative Approach to Differentiate between Demyelinating and Disc Lesions

Purpose: The difficult differentiation between multiple sclerosis (MS) lesions and cervical spondylotic myelopathy (CSM) in the cervical spine is well known. The magnetic resonance imaging (MRI) appearance of both lesions is similar, and clinical parameters are usually used for diagnosis. The objective was to establish a reliable radiologic paradigm for diagnosis of demyelinating lesions in the cervical spine. Methods: The MRI studies of 33 patients with MS (42 lesions) and 55 patients with CSM (60 lesions) were obtained. Lesions were evaluated for vertebral level, lesion location and size in the sagittal and axial planes, cord thickness, well-defined or ill-defined borders, presence of edema and enhancement with gadolinium. Significant differences were used to create a paradigm, which was used for the evaluation of a different group of 32 MRIs with 42 concomitant MS and CSM lesions. Results: Significant differences were seen in the level, location within the cord in both planes, lesion size, cord thickness and lesion border. The MS lesions were well-defined lesions found in C1–3, posterior in the sagittal plane, central in the axial plane, with a normal or increased cord thickness. Good agreement was seen in the validation stage. Conclusion: The new CSM-MS lesion score allows accurate diagnosis of demyelinating lesions in the cervical spine vs. CSM lesions.