Vanishing MS T2-bright lesions before puberty: a distinct MRI phenotype?

Area of Science:

• Neurology
• Pediatric Neurology
• Radiology

Background:

• Multiple sclerosis (MS) onset before puberty may present uniquely.
• Pediatric MS patients might not meet adult MRI diagnostic criteria.
• The distinctiveness of initial MRI findings in prepubertal MS is not well understood.

Purpose of the Study:

• To investigate if the initial MRI presentation differs between prepubertal and later-onset pediatric multiple sclerosis.
• To compare lesion characteristics and resolution in early-onset pediatric MS (EOPMS) versus later-onset pediatric MS (LOPMS).

Main Methods:

• A UCSF MS database was queried for pediatric MS patients (onset ≤18 years) with brain MRI within 3 months of symptom onset.
• Compared lesion counts (overall, well-defined, ovoid, large, confluent, gadolinium-enhancing) between EOPMS (<11 years) and LOPMS (≥11 years).
• Assessed lesion resolution on the next available MRI scan.

Main Results:

• Thirteen EOPMS and 18 LOPMS patients were identified.
• EOPMS patients had fewer well-defined ovoid T2-bright lesions (p=0.004) and more confluent lesions (31% vs 0%, p=0.02) on initial MRI compared to LOPMS.
• Ninety-two percent of EOPMS patients showed lesion reduction on the second scan versus 29% of LOPMS patients (p=0.002).

Conclusions:

• Prepubertal MS exhibits a distinct MRI phenotype compared to later-onset pediatric MS.
• These MRI differences may indicate distinct underlying biological processes in EOPMS.
• Current MRI criteria for MS diagnosis may require revision for the prepubertal age group to ensure timely diagnosis.