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Multisequence MRI in clinically isolated syndromes and the early development of MS
P A Brex1, J I O'Riordan, K A Miszkiel
1NMR Research Unit, Institute of Neurology, The National Hospital, London, UK.
Objective:
To apply multisequence MRI techniques to patients with clinically isolated syndromes, to document the pattern and frequency of abnormalities at baseline and early follow-up, and to determine their predictive values for the early development of clinical MS.
Background:
Disseminated lesions on T2-weighted brain MRI confer an increased risk of progression to clinically definite MS. Newer MRI techniques increase detection of lesions in both brain and spinal cord, and clarify further their pathology. The predictive value of such techniques for the development of clinical MS needs to be defined.
Methods:
Brain and spinal MRI were performed on 60 patients after their first demyelinating event. A total of 50 patients were followed for 1 year, and 49 underwent repeat brain MRI 3 months after the initial scan.
Results:
At baseline, 73% of patients had lesions on T2-weighted fast spin-echo (FSE) brain images and 42% had asymptomatic spinal cord lesions. Fast fluid-attenuated inversion-recovery brain did not improve detection of brain lesions. Repeat brain MRI demonstrated new FSE lesions in 43% of patients. After 1 year, 26% of patients developed MS. The MRI features that provided the best combination of sensitivity and specificity for the development of MS were the presence of new FSE lesions at follow-up and enhancing lesions at baseline. The frequency of developing clinical MS was higher for those with both brain and spinal cord lesions at baseline (48%) than brain lesions alone (18%).
Conclusions:
The combination of baseline MRI abnormalities and new lesions at follow-up, indicating dissemination in space and time, was associated with a high sensitivity and specificity for the early development of clinical MS. These data suggest a potential role for new diagnostic criteria for MS based on early MRI activity. Such criteria may be useful in selecting patients for therapeutic trials at this early clinical stage.
Insights
Multisequence MRI can predict early Multiple Sclerosis (MS) development. New lesions on follow-up MRI and baseline enhancing lesions are key indicators for MS progression in clinically isolated syndromes.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Disseminated T2-weighted brain MRI lesions increase the risk of developing clinically definite Multiple Sclerosis (MS).
- Advanced MRI techniques enhance lesion detection in the brain and spinal cord, offering clearer pathological insights.
- The predictive value of these advanced MRI techniques for early MS development requires definition.
Purpose of the Study:
- To utilize multisequence MRI to identify patterns and frequencies of abnormalities in patients with clinically isolated syndromes.
- To assess the predictive value of these MRI findings for the early onset of clinical MS.
- To evaluate the role of MRI in diagnosing MS at an early stage.
Main Methods:
- Brain and spinal MRI scans were performed on 60 patients post-first demyelinating event.
- Fifty patients were followed for one year, with 49 undergoing repeat brain MRI at three months.
- T2-weighted fast spin-echo (FSE) and fast fluid-attenuated inversion-recovery (FLAIR) brain MRI sequences were employed.
Main Results:
- Baseline T2-weighted FSE brain MRI revealed lesions in 73% of patients; 42% had asymptomatic spinal cord lesions.
- Repeat brain MRI showed new FSE lesions in 43% of patients within three months.
- After one year, 26% of patients developed MS. The strongest predictors for MS development were new FSE lesions at follow-up and baseline enhancing lesions. Patients with both brain and spinal cord lesions at baseline had a higher MS development rate (48%) compared to those with brain lesions alone (18%).
Conclusions:
- The combination of baseline MRI abnormalities and new lesions on follow-up MRI, indicating dissemination in space and time, demonstrated high sensitivity and specificity for predicting early clinical MS.
- These findings suggest that early MRI activity could be incorporated into new diagnostic criteria for MS.
- Such MRI-based criteria may aid in selecting appropriate patients for therapeutic trials during the early clinical phase of MS.