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Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Early MRI in optic neuritis: the risk for clinically definite multiple sclerosis
J K Swanton1, K T Fernando, C M Dalton
1Department of Neuroinflammation and NMR Research Unit, UCL Institute of Neurology, London, UK. joswanton@yahoo.com
Abstract:
MRI brain lesions at presentation with optic neuritis (ON) increase the risk for developing clinically definite (CD) multiple sclerosis (MS). More detailed early MRI findings may improve prediction of conversion. The objectives of this study were to investigate the influence of number, location and activity of lesions at presentation, new lesions at early follow-up and non-lesion MRI measures on conversion from optic neuritis (ON) to CDMS. 142/143 ON patients, prospectively recruited into a serial MRI and clinical follow-up study, were followed-up at least once. Cox regression analysis determined independent early MRI predictors of time to CDMS from: (i) baseline lesion number, location and activity measures, (ii) three-month lesion activity measures and (iii) brain atrophy, magnetization transfer ratio and spectroscopy measures. 114/142 (80%) had abnormal baseline brain or cord MRI. 57 (40%) developed CDMS (median of 16 months from clinically isolated syndrome onset). Median follow-up of the non-converters was 62 months. Multivariate analysis of baseline parameters revealed gender, periventricular and gadolinium-enhancing lesions as independent predictors of CDMS. Considering both scans together, gender, baseline periventricular and new T2 lesions at follow-up remained significant (hazard ratios 2.1, 2.4 and 4.9, respectively). No non-conventional measure predicted CDMS. It was concluded that new T2 lesions on an early follow-up scan were the strongest independent predictor of CDMS.
Insights
New T2 lesions on early follow-up MRI scans are the strongest predictor of conversion from optic neuritis (ON) to clinically definite multiple sclerosis (CDMS). This finding aids in predicting MS development in ON patients.
Area of Science:
- Neuroimaging
- Neurology
- Multiple Sclerosis Research
Background:
- MRI brain lesions in optic neuritis (ON) indicate a higher risk for developing clinically definite multiple sclerosis (CDMS).
- Detailed early MRI findings can potentially improve the prediction of conversion to CDMS.
Purpose of the Study:
- To investigate how lesion characteristics (number, location, activity) at presentation, early follow-up MRI findings, and non-lesion MRI measures influence conversion from ON to CDMS.
Main Methods:
- Prospective study of 142 ON patients with serial MRI and clinical follow-up.
- Cox regression analysis used to identify independent early MRI predictors of time to CDMS.
- Evaluated baseline and 3-month MRI measures, including lesion activity, brain atrophy, magnetization transfer ratio, and spectroscopy.
Main Results:
- 80% of patients had abnormal baseline MRI; 40% converted to CDMS within a median of 16 months.
- Baseline predictors included gender, periventricular, and gadolinium-enhancing lesions.
- New T2 lesions on early follow-up MRI were the strongest independent predictor of CDMS (HR 4.9).
Conclusions:
- New T2 lesions identified on early follow-up MRI scans are the most significant independent predictor for CDMS conversion in ON patients.
- Baseline periventricular lesions and gender also independently predict CDMS.
- Non-conventional MRI measures did not predict CDMS in this cohort.
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