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This retrospective, observational MRI study compared spinal cord critical demyelinating lesions anatomically associated with progressive motor impairment with any additional “noncritical” spinal cord demyelinating lesions. MRI characteristics that favored critical spinal cord demyelinating lesions included moderate-to-severe, focal, lesion-associated spinal cord atrophy; lateral column axial location; central region; ventral column; and larger lesion size. In particular, the presence of focal, lesion-associated atrophy, lateral column axial location, and larger lesion size may be associated with the development of progressive motor impairment in MS.

Fifteen healthy controls, 22 patients with left asymptomatic ICS, and 33 patients with right asymptomatic ICS underwent fMRI, Mini-Mental State Examination, Digit Span Test, and Verbal Learning Tests. Patients with asymptomatic ICS had significant impairment in delayed recall of verbal memory. Patients with left and right asymptomatic ICS showed different patterns of FC alterations in both anterior and posterior circulation territories.