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Multiple sclerosis (MS) patients often present with lesions in spinal cord magnetic resonance (MR) volumes. However, accurately detecting these lesions is challenging and prone to inter-and intra-rater variability. Deep learning-based methods have the potential to aid clinicians in detecting and segmenting MS lesions, but can also be affected by rater variability. This study assesses the inter-and intra-rater variability in manual segmentation of spinal cord lesions, and evaluates raters and a state-of-the-art nnU-Net model against a ground truth (GT) segmentation of a senior expert. Four experts segmented twelve spinal cord MR volumes from six patients twice, at a time distance of two weeks. Considerable inter-and intra-rater variability were observed, with the total number of detected lesions ranging from 28 to 60, depending on the rater. Moreover, the segmented volumes of individual lesions varied substantially …