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Published on: April 14, 2014
Early MRI in optic neuritis: the risk for disability
J K Swanton1, K T Fernando, C M Dalton
1NMR Unit, Institute of Neurology, Queen Square, London WC1N 3BG, UK. j.swanton@ion.ucl.ac.uk
Background:
MRI findings influence the risk of patients with optic neuritis (ON) developing clinically definite (CD) multiple sclerosis (MS) but their influence on future disability is less clear.
Objective:
To investigate in patients with ON the influence of lesion number, location and activity, and non-lesion MRI measures obtained on early scans on disability.
Methods:
A total of 106 of 143 prospectively recruited patients with ON had reached a scheduled 5-year follow-up, of whom 100 were evaluated clinically. Lesion number, location, and activity measures were analyzed at baseline (within 3 months of onset) and lesion activity measures were studied at 3-month follow-up. Brain atrophy, magnetization transfer ratio, and spectroscopy measures were also analyzed. Ordinal logistic regression assessed the association between early MRI findings and subsequent disability.
Results:
At median 6 years follow-up, 48% had converted to CDMS and 52% remained with clinically isolated syndrome (median Expanded Disability Status Scale 2 and 1). In the final models, both the presence and the number of spinal cord lesions at baseline (odds ratios [OR] 3.30, 1.94) and new T2 lesions at follow-up (OR 7.12, 2.06) were significant independent predictors of higher disability. Disability was also predicted by the presence at baseline of gadolinium-enhancing lesions (OR 2.78) and number of infratentorial lesions (OR 1.82). Only spinal cord lesions predicted disability in patients converting to CDMS.
Conclusion:
Spinal cord, infratentorial, and gadolinium lesions within 3 months of optic neuritis onset and new T2 lesions after 3 months predicted disability after 6 years; only spinal cord lesions were predictive of disability in those developing clinically definite multiple sclerosis.
Insights
Early MRI scans showing spinal cord lesions, infratentorial lesions, or gadolinium-enhancing lesions in optic neuritis patients predict future disability. New T2 lesions also predict disability, with spinal cord lesions being key for those developing multiple sclerosis.
Area of Science:
- Neuroimaging
- Neurology
- Clinical Research
Background:
- Multiple Sclerosis (MS) risk is influenced by MRI findings in Optic Neuritis (ON) patients.
- The impact of these MRI findings on long-term disability is less understood.
Purpose of the Study:
- To determine how early MRI lesion characteristics and non-lesion measures in ON patients predict future disability.
- To analyze the influence of lesion number, location, and activity on disability progression.
Main Methods:
- 106 ON patients were followed for 5 years, with 100 clinically evaluated.
- Baseline MRI (within 3 months) and 3-month follow-up MRI analyzed lesion data.
- Brain atrophy, magnetization transfer ratio, and spectroscopy were also assessed.
Main Results:
- At 6 years, 48% converted to clinically definite MS (CDMS).
- Spinal cord lesions (baseline) and new T2 lesions (follow-up) independently predicted higher disability.
- Gadolinium-enhancing lesions and infratentorial lesion number also predicted disability.
Conclusions:
- Early MRI findings (spinal cord, infratentorial, gadolinium lesions) and new T2 lesions predict 6-year disability after ON.
- Spinal cord lesions were the sole predictor of disability in patients who developed CDMS.
