Citation: Alrehaili, A.A.; Faizo, N.L.; Alsulimani, B.M.; Alsulimani, R.K.; Aldwaila, D.A.; Alqarni, N.J.; Faizo, N.L. Exploring Spinal Cord Changes in Multiple Sclerosis Patients Using MRI. NeuroSci 2024, 5, 87–97. https:// doi.org/10.3390/neurosci5010006 Academic Editor: Fabrizio Michetti Received: 6 February 2024 Revised: 4 March 2024 Accepted: 5 March 2024 Published: 12 March 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). Article Exploring Spinal Cord Changes in Multiple Sclerosis Patients Using MRI Amani A. Alrehaili 1, * , Nahla L. Faizo 2 , Batool M. Alsulimani 2 , Raghad K. Alsulimani 2 , Dana A. Aldwaila 2 , Nada J. Alqarni 2 and Nisreen Lutfi Faizo 3 1 Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia 2 Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia; nfaizo@tu.edu.sa (N.L.F.); s44002952@students.tu.edu.sa (B.M.A.); s44002047@students.tu.edu.sa (R.K.A.); s44009573@students.tu.edu.sa (D.A.A.); s44000371@students.tu.edu.sa (N.J.A.) 3 Department of Clinical Anatomy, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia; nlfaizo@kau.edu.sa * Correspondence: arhili@tu.edu.sa Abstract: Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system (CNS). The diagnosis of MS is based on clinical signs and symptoms as well as findings in magnetic resonance imaging (MRI) sequences by demonstrating the spatial and temporal dispersion of white matter lesions, which are thought to be typical of MS in distribution, shape, extent, and signal abnormalities. Spinal cord MRI can identify asymptomatic lesions and rule out malignancies or spinal stenosis in patients for whom brain imaging is not helpful in making an MS diagnosis. This study examines the MRI features of Saudi Arabian patients clinically proven to have MS with typical lesions exclusively evident in the spinal cord. This retrospective cross-sectional study was carried out in 151 patients who are confirmed cases of MS based on clinical findings and MRI results. Patients’ MRI data were reviewed from the picture archiving and communication system (PACS). The study revealed that MS incidence was higher in females than males and that the number of people diagnosed with MS increased in middle age. Cervical cord plaques and cervical cord curve straightening were the most frequent changes (67% and 56%, respectively), indicating that MRI can complement and even replace clinical data in MS diagnosis, leading to earlier, more precise diagnoses and speedier starts to treatment. Keywords: central nervous system; magnetic resonance imaging; multiple sclerosis; spinal cord 1. Introduction Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) characterized by chronic inflammation, demyelination, gliosis, and neuronal loss. MS lesions occur at different times and in different CNS locations. For this reason, MS lesions are sometimes said to be “scattered in time and space” [1]. The definite etiology of MS is still not completely understood; however, different factors are thought to contribute to the disease occurrence. Environmental factors such as smoking and low vitamin D have shown significant association with MS [2]. In addition, people with genetic susceptibility are frequently affected, especially those with major histocompatibility complex (MHC) class II phenotype, human leukocyte antigen (HLA)-DR2, and HLA-DR4 [3]. Furthermore, MS can be brought on by diseases such as childhood chicken pox caused by viruses that have portions that resemble the myelin sheath and other viral infections that affect the immune system. Therefore, MS is thought to be caused by complex interactions between environmental variables and genetic vulnerability. NeuroSci 2024, 5, 87–97. https://doi.org/10.3390/neurosci5010006 https://www.mdpi.com/journal/neurosci