When spinal cord lesions are seen on the MRI image, is it possible to say for sure that these lesions are due to MS? Or is it just an indication of demyelination? More specifically, are spinal cord lesions due to MS different from those due to Ankylosing spondylitis or lupus?
I know that the diagnosis of MS is not based solely on MRI images, but I was just curious about this particular matter.
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
The simplest answer to your question is no: when a spinal cord lesion is seen on MRI, there is no definitive way to exclude MS. A spinal cord lesion could be various things, one of which is, as you mention, demyelination. However, other possibilities include infection, autoimmune inflammation (latter two are called myelitis), even tumor. However, certain features of the imaging as a whole could suggest a particular cause. For example, enhancement (if it lights up with contrast) suggests an "active" lesion, due to permeability of the barrier between the central nervous system and blood, as occurs with MS flares, certain infections, inflammation, etc. More importantly, it is the time course of the symptoms and imaging features combined that help determine what a lesion in the spine is, in addition to the physical examination. Of great importance is also the appearance of the brain on MRI (if there is just a solitary spine lesion without brain lesions, MS would not be diagnosed unless there are specific historical clinical events), and results of other tests such as CSF analysis.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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