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Aim/objective This study aims at emphasizing the role of MRI spectroscopy in diagnosis and follow up of post therapeutic response of different stages of the disease of multiple sclerosis. Background Multiple Sclerosis (MS) is a chronic inflammatory, and degenerative autoimmune disorder of the central nervous system (CNS) that is characterized by unpredictable clinical relapses, remissions and by progression of disability over time. There is a need to understand the mechanisms of neurodegeneration in progressive multiple sclerosis. Meanwhile secondary progressive multiple sclerosis develops after an initial relapsing remitting multiple sclerosis course. MRS has the unique ability to characterize the chemical pathology of brain, as well as regions of the brain that are not associated with evident structural abnormalities on conventional MRI. So, it can help to better define the natural history of the disease process and, it can help in monitoring metabolic responses to therapy. Patients and Methods: This study, included 40 patients who presented with clinically diagnosed multiple sclerosis followed by conventional and post contrast MRI and referred for further assessment by MR spectroscopy study. Patients with contraindications to MRI (e.g. cardiac prosthesis, metallic implants and sever claustrophobia) were excluded. Results : The age of included patients ranged from 18 to 45 years with a mean age of 34.67±8.23 years. 60% of the patients were females and 40% of them were males, the sensitivity, specificity and positive predictive value of H-MRS in the diagnosis of MS were 94.4%, 76.2%, 71.5% respectively compared to 87.3%, 69.2%, and 65.8% in case of c-MRI.Conclusion Adding MR spectroscopy to conventional MRI increases

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