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Diagnostic brain MRI findings in primary progressive multiple sclerosis
M Kremenchutzky1, D Lee, G P Rice
1Department of Clinical Neurological Sciences, London Health Sciences Centre-UC, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
Abstract:
The clinical course of multiple sclerosis can be classified as relapsing from onset (relapsing-remitting), or progressive from onset (primary progressive - PPMS). These clinical phenotypes have been based on historical and clinical observations. It has been reported that PPMS patients tend to have quantitatively less MRI activity and disease burden. We evaluated the sensitivity and diagnostic value of conventional brain MRI scan in 143 PPMS patients. Brain MRIs were blindly evaluated to determine if they satisfied Paty and/or Fazekas diagnostic criteria. Patients were divided into those with typical, atypical or normal scans. They satisfied brain MRI criteria in 92% cases. Findings included: 131 typical, four atypical, and eight normal scans. All 12 non-typical scans' subjects had spinal onset; spinal MRI scans were positive in four of seven cases. Sex, age of onset, site and number of symptoms involved at onset among those groups were not significantly different but accumulation of disability had a tendency to be slower in these few individuals with normal or atypical head MRI's. Although there may be quantitative differences in lesion activity/burden, MRI scanning in PPMS unexpectedly has diagnostic sensitivity very similar to that seen in RRMS. A normal brain MRI is unusual in PPMS patients.
Insights
Primary progressive multiple sclerosis (PPMS) diagnosis via MRI is highly sensitive, even with atypical or normal brain scans. This finding is similar to relapsing-remitting MS, challenging previous assumptions about disease burden.
Area of Science:
- Neurology
- Radiology
Background:
- Multiple sclerosis (MS) clinical courses are categorized as relapsing-remitting (RRMS) or primary progressive (PPMS).
- PPMS is historically associated with lower MRI-detected disease activity and burden compared to RRMS.
Purpose of the Study:
- To evaluate the diagnostic sensitivity and value of conventional brain MRI in primary progressive multiple sclerosis.
- To compare MRI findings in PPMS with established diagnostic criteria and assess correlations with clinical presentation.
Main Methods:
- Brain MRIs from 143 PPMS patients were blindly assessed against Paty and/or Fazekas criteria.
- Patients were categorized into typical, atypical, or normal brain MRI groups.
- Clinical data including onset, disability accumulation, and spinal MRI findings were analyzed.
Main Results:
- Brain MRI criteria were met in 92% of PPMS patients (131 typical, 4 atypical, 8 normal).
- Atypical or normal brain MRIs were more common in patients with spinal onset.
- Disability accumulation showed a trend towards being slower in patients with atypical or normal brain MRIs.
- MRI sensitivity in PPMS was unexpectedly similar to that observed in RRMS.
Conclusions:
- Conventional brain MRI demonstrates high diagnostic sensitivity in primary progressive multiple sclerosis.
- A normal brain MRI is uncommon in PPMS patients, but atypical findings can occur, particularly with spinal onset.
- The diagnostic utility of brain MRI in PPMS is comparable to RRMS, despite potential quantitative differences in lesion burden.