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Updated: Jul 19, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Baseline MRI predicts future attacks and disability in clinically isolated syndromes
1Unit of Clinical Neuroimmunology (Department of Neurology), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain. mtintore@vhebron.net
Objective:
To determine the relation between baseline MRI and both conversion to multiple sclerosis (MS) and development of disability in a cohort of patients with clinically isolated syndromes (CIS).
Methods:
From 1995 to 1998, 175 consecutive patients with CIS underwent brain MRI within 3 months of their first attack and again 12 months and 5 years later. We studied the number and location of lesions at baseline and development of new T2 lesions. We also analyzed conversion to MS and development of disability (Expanded Disability Status Scale [EDSS] > or = 3.0).
Results:
We included 156 patients with CIS followed for a median of 7 years. Compared to the reference group with 0 Barkhof criteria at baseline MRI, patients with one or two Barkhof criteria showed an adjusted hazard ratio (HR) of 6.1 (2.2 to 16.6) and patients with three to four Barkhof criteria of 17.0 (6.7 to 43) for conversion to MS and differentiated patients with low, medium, and high conversion risk. EDSS at year 5 correlated with baseline number of Barkhof criteria (r = 0.46, p < 0.0001). When categorizing by number of baseline lesions, similar results were seen. Patients with a baseline MRI with three to four Barkhof criteria had an adjusted HR of 3.9 (1.1 to 13.6) for reaching EDSS > or = 3.0. Only 10% of the latter had disability at year 5, but 40% reached this at 8 years.
Conclusions:
Baseline MRI determines the risk for converting to clinically definite multiple sclerosis and correlates with disability at 5 years. The proportion of patients developing disability is low during the first 5 years but rapidly increases shortly after.
Insights
Baseline MRI scans accurately predict conversion to multiple sclerosis (MS) and future disability in patients with clinically isolated syndromes (CIS). Early MRI findings identify high-risk individuals, guiding prognosis and management strategies.
Area of Science:
- Neurology
- Radiology
- Clinical Medicine
Background:
- Clinically isolated syndromes (CIS) represent the initial presentation of potential multiple sclerosis (MS).
- Predicting conversion to MS and subsequent disability is crucial for patient management.
- Baseline magnetic resonance imaging (MRI) may offer prognostic insights.
Purpose of the Study:
- To investigate the relationship between baseline MRI characteristics and the risk of conversion to MS.
- To assess the correlation between baseline MRI findings and the development of disability in CIS patients.
- To evaluate the predictive value of MRI for long-term outcomes in CIS.
Main Methods:
- A cohort of 175 patients with CIS underwent serial brain MRIs at baseline, 12 months, and 5 years.
- Baseline MRI analysis included lesion number, location, and fulfillment of Barkhof criteria.
- Conversion to MS and disability (Expanded Disability Status Scale [EDSS] ≥ 3.0) were monitored over a median follow-up of 7 years.
Main Results:
- Patients with three to four Barkhof criteria on baseline MRI had a significantly higher risk of MS conversion (HR 17.0) compared to those with none.
- The number of baseline lesions correlated with EDSS scores at 5 years (r = 0.46, p < 0.0001).
- Baseline MRI with three to four Barkhof criteria predicted a higher risk of reaching EDSS ≥ 3.0 (HR 3.9), with disability increasing notably after 5 years.
Conclusions:
- Baseline MRI is a powerful tool for determining MS conversion risk and predicting disability at 5 years in CIS patients.
- The presence of specific MRI lesion patterns at baseline stratifies patients into low, medium, and high-risk categories.
- While disability accumulation is slow in the initial 5 years, it accelerates thereafter, emphasizing the prognostic importance of early MRI findings.