Spinal cord imaging in multiple sclerosis: A vital component we can no longer overlook

Purpose: We conducted a systematic review to examine the use of spinal cord (SC) magnetic resonance imaging (MRI) in clinical trials for multiple sclerosis (MS) and discussed the significant challenges that impede its widespread implementation. Major findings: We identified 291 phase II and phase III clinical trials. Of these, 228 (78.4%) included at least one MRI outcome. Eight clinical trials (2.7%) were planned to include at least one SC MRI outcome, but only three (1.0%) reported related methodologies or results. The MRI metrics considered in these studies included cervical SC cross-sectional area (1.0%) and SC T 2 -lesion number (0.3%). Conclusion: A very small proportion of clinical trials have used SC MRI metrics as outcome measures. Given the substantial impact of SC disease on disability, it is essential to standardize SC imaging, post-processing, and analytical methods across centres to enhance the effectiveness and applicability of SC MRI in future clinical trials.