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Predictive value of lesions for relapses in relapsing-remitting multiple sclerosis

J A Koziol1, S Wagner, D F Sobel

  • 1Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA.

AJNR. American Journal of Neuroradiology
|February 7, 2001
PubMed
Abstract

Insights

Magnetic resonance imaging (MRI) markers like enhancing lesions do not reliably predict multiple sclerosis relapses. The absence of these MRI markers suggests a more favorable clinical course for patients with relapsing-remitting multiple sclerosis.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Relapsing-remitting multiple sclerosis (RRMS) is characterized by unpredictable exacerbations.
  • Contrast-enhanced T1-weighted MR images showing enhancing lesions have been suggested as predictors of impending RRMS exacerbations.

Purpose of the Study:

  • To evaluate the predictive accuracy of enhancing lesions, new enhancing lesions, and new hypointense lesions ("black holes") for RRMS exacerbations.
  • To assess these MRI markers in a cohort of 50 RRMS patients over a 6-month timeframe.

Main Methods:

  • Monthly MRI scans and clinical examinations were conducted for 50 RRMS patients over 12 months.
  • The study analyzed the operating characteristics of enhancing lesions, new enhancing lesions, and new black holes as predictors of clinical relapse.

Main Results:

  • The positive predictive values (PV+) for exacerbations from enhancing lesions, new enhancing lesions, or new black holes did not exceed 0.25.
  • The best predictor for new enhancing lesions was their occurrence in the prior 3 months (PV+: 0.79).
  • New black holes were best predicted by their occurrence in the prior 2 months (PV+: 0.54).

Conclusions:

  • No single MRI marker reliably predicted impending relapses in RRMS with high precision.
  • The absence of observed MRI markers correlated with a more favorable clinical course, indicating fewer relapses.

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