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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.
Multiple Sclerosis (Houndmills, Basingstoke, England)
|April 25, 2000
Summary
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.